涓€涓叏鏂伴澏鐐癸細浼氭垚涓烘暟浜块珮琛€鑴備汉缇ょ殑鏂板笇鏈涘悧锛
更新时间:2022-12-08
12.7 鐭ヨ瘑鍒嗗瓙 The Intellectual 鈥滄櫤璇嗗墠娌垮鑰呪€濄€佹繁鍦虫咕瀹為獙瀹よ祫娣辩爺绌跺憳鐜嬬珛閾?/p> 缂栬€呮寜 鏈湡鎴戜滑璁ㄨ楂樿鑴傛不鐤楅鍩熺殑涓€涓叏鏂伴澏鐐光€斺€擜SGR1锛屽畠鍙兘浼氫负杩囧幓鍥涘崄骞存寔缁ぇ绾㈠ぇ绱殑闄嶈鑴傞鍩熷甫鏉ユ柊鐨勬満浼氥€?/p> 鎾版枃 | 鐜嬬珛閾?/strong> 聽鈼徛?聽 聽 聽 聽 聽 聽 聽銆€鈼徛?聽 聽 聽 聽 聽 聽 聽銆€鈼?/strong> 璇昏€呬滑鑲畾瀵光€滈珮琛€鑴傗€濆苟涓嶉檶鐢熴€傚父瑙勭殑浣撴鎶ュ憡閲屾湁涓嶅皯椤圭洰鍜岄珮琛€鑴傜浉鍏筹紝渚嬪鎬昏儐鍥洪唶銆佷綆瀵嗗害鑴傝泲鐧斤紙鎵€璋撯€滃潖鑳嗗浐閱団€濓級銆侀珮瀵嗗害鑴傝泲鐧斤紙鎵€璋撯€滃ソ鑳嗗浐閱団€濓級銆佷互鍙婄敇娌逛笁閰瓑绛夈€傞珮琛€鑴傛槸瀵圭幇浠d汉缇や骇鐢熼噸澶у仴搴峰▉鑳佺殑鎸囨爣锛屽緢澶氱柧鐥咃紝鐗瑰埆鏄績鑲屾濉炪€佽剳鍗掍腑绛夊績鑴戣绠$柧鐥咃紝鍜岃剛鑲倽銆佽倽纭寲绛変唬璋㈢柧鐥咃紝閮藉拰杩囬珮鐨勮鑴傛寚鏍囧瘑鍒囩浉鍏炽€?/p> 鐩墠鍏ㄤ笘鐣屾湁瓒呰繃2浜夸汉闇€瑕佹棩甯告湇鐢ㄤ粬姹€绛夐檷琛€鑴傝嵂鐗╂潵鎺у埗琛€鑴傦紝鍦ㄥ彂杈惧浗瀹剁殑涓€佸勾浜虹兢浣撲腑浣跨敤闄嶈剛鑽墿鐨勬瘮渚嬫洿楂橈紙浠ョ編鍥戒负渚嬶紝45宀佷互涓婁汉缇ゆ湁25%闇€瑕佹棩甯镐娇鐢ㄩ檷鑴傝嵂鐗┞燵1]锛夈€傚彲鎯宠€岀煡锛屼即闅忕潃鍏ㄧ悆鐨勭粡娴庣ぞ浼氬彂灞曞拰鑰侀緞鍖栵紝鍑虹幇琛€鑴傚紓甯搞€侀渶瑕佸尰鐤楀共棰勭殑浜虹兢鍙細瓒婃潵瓒婂銆?/p> 楂樿鑴傘€佺壒鍒槸楂樿儐鍥洪唶锛屽苟涓嶄粎浠呮槸涓畝鍗曠殑楗涔犳儻闂銆備互鑳嗗浐閱囦负渚嬶紝浜轰綋涓殑鑳嗗浐閱囧彧鏈夊ぇ绾?0%鏉ヨ嚜椋熺墿鎽勫叆锛堟瘮濡傝泲榛勫氨鏄瘜鍚儐鍥洪唶鐨勯鐗╋級锛屽叾浣?0%鍒欐潵鑷倽鑴忚嚜韬殑鍚堟垚[2]銆傝繖鏄洜涓鸿儐鍥洪唶鏈韩鏄浜轰綋鏋佸叾閲嶈鐨勭敓鐗╁垎瀛愶紝姣忎竴涓汉浣撶粏鑳炵殑缁嗚優鑶滈兘闇€瑕佺浉褰撴瘮渚嬬殑鑳嗗浐閱囧垎瀛愶紝浠ュ鍔犲叾闊ф€у拰娴佸姩鎬э紱涔熸湁澶ч噺鍥洪唶绫荤殑婵€绱犳槸鐢ㄨ儐鍥洪唶鍒堕€犵殑锛屼緥濡傝偩涓婅吅鐨川婵€绱犮€佸悇绉嶆€ф縺绱犵瓑銆傚洜姝わ紝瀵逛簬鍑虹幇楂樿鑴傞棶棰樼殑浜烘潵璇达紝闄や簡闇€瑕佹敞鎰忛ギ椋熶腑鐨勮儐鍥洪唶鍚噺锛屽線寰€涔熼渶瑕佽嵂鐗╁奖鍝嶄綋鍐呯殑鑳嗗浐閱囦唬璋紙渚嬪闄嶄綆鍏跺悎鎴愬拰鍚告敹锛屼績杩涘叾鍒嗚В鍜屾帓鍑猴級锛屾墠鑳借捣鍒板ソ鐨勯檷鑴傛晥鏋溿€?/p> 闄嶈剛鑽殑閫昏緫 鐩墠鍖昏嵂甯傚満涓婁富瑕佷娇鐢ㄧ殑闄嶈剛鑽墿涔熷ぇ浣撳彲浠ユ寜杩欎釜閫昏緫杩涜鍖哄垎銆?/p> 棣栧綋鍏跺啿鐨勫氨鏄粬姹€绫昏嵂鐗╋紝杩欐槸杩囧幓鍥涘崄骞存椂闂撮噷浣跨敤鏈€涓哄箍娉涚殑闄嶈剛鑽墿銆備粬姹€绫昏嵂鐗╀富瑕侀€氳繃鎶戝埗鑳嗗浐閱囧悎鎴愰€斿緞涓婄殑鍏抽敭閰垛€斺€擧MG-CoA杩樺師閰舵潵璧锋晥銆傝繖绫昏嵂鐗╀腑璇炵敓杩囨浘缁忕殑鈥滆嵂鐜嬧€濓細1992骞翠笂甯傘€佸巻鍙查攢鍞瓒呰繃1000浜跨編鍏冪殑绔嬫櫘濡ャ€?/p> 闄嶈剛鑽鍩熷彟涓€涓柊鍏撮澏鐐规槸PCSK9銆傝嚜2015骞磋捣锛屽凡缁忔湁閽堝PCSK9铔嬬櫧鐨勪袱涓崟鍏嬮殕鎶椾綋鑽墿锛圗volocumab鍜孉lirocumab锛夊拰涓€涓皬鏍搁吀鑽墿(Inclisiran)涓婂競閿€鍞紝瀹冧滑鐨勪綔鐢ㄦ満鍒舵槸淇冭繘鑲濊剰浠庤娑蹭腑鍥炴敹澶氫綑鐨勮儐鍥洪唶銆?/p> 闄や笂杩颁袱澶х被鑽墿涔嬪锛屼緷鎶橀害甯冪瓑闃绘椋熺墿涓殑鑳嗗浐閱囪鑲犻亾鍚告敹鐨勮嵂鐗┿€佽儐姹侀吀铻悎鍓傜瓑淇冭繘鑲濊剰鍒╃敤鑳嗗浐閱囧埗閫犺儐閰搞€佷粠鑰岄檷浣庤儐鍥洪唶鍚噺鐨勮嵂鐗╋紝涔熼兘鏈夊悇鑷殑鐢ㄦ涔嬪湴[3]銆?/p> 鑰孉SGR1杩欎釜闄嶈鑴傜殑鏂伴澏鐐癸紝鍏朵綔鐢ㄦ満鐞嗕笌涓婅堪鐨勯檷琛€鑴傝嵂鐗╁畬鍏ㄤ笉鍚岋紝瀹冩槸閫氳繃淇冭繘鑳嗗浐閱囩殑鎺掓硠鏉ヨ捣鍒伴檷琛€鑴傛晥鏋滅殑銆?/strong> 涓轰簡鏇村ソ鍦拌鏄嶢SGR1鐨勪綔鐢紝鎴戜滑鍏堢矖鐣ユ弿杩颁竴涓嬩汉浣撳唴鑳嗗浐閱囩殑浠h阿璺緞銆?/p> 鑲濊剰鏄儐鍥洪唶浠h阿鐨勬牳蹇冨櫒瀹橈紝鑲濊剰鑷韩鍒堕€犵殑鎴栬€呴鐗╂潵婧愮殑鑳嗗浐閱囧垎瀛愶紝浼氬拰鐢樻补涓夐叝涓€璧峰湪鑲濊剰缁嗚優涓鐗瑰畾鐨勮泲鐧借川鍒嗗瓙鍖呰9锛屽舰鎴愮洿寰勫嚑鍗佺撼绫崇殑寰矑锛岄€氳繃琛€娑茶繍杈撹繘鍏ュ叏韬悇涓櫒瀹橈紝灏嗚儐鍥洪唶鍜岀敇娌逛笁閰緵缁欐墍鏈夌粏鑳炰娇鐢紝杩欏氨鏄墍璋撶殑鈥滃潖鑳嗗浐閱団€?浣庡瘑搴﹁剛铔嬬櫧銆傝€屽叏韬繃鍓╃殑鑳嗗浐閱囷紝鍒欓€氳繃绫讳技鐨勫寘瑁瑰拰閫掗€佹柟寮忛€氳繃琛€娑擦洖鏀跺埌鑲濊剰涓紝杩欏氨鏄墍璋撶殑鈥滃ソ鑳嗗浐閱団€?楂樺瘑搴﹁剛铔嬬櫧銆傝€岃倽鑴忎腑杩囧墿鐨勮儐鍥洪唶涔熸湁鍑犱釜鍘诲锛屽畠浠涔堣鐢ㄤ簬鍒堕€犲浐閱囩被婵€绱犳垨鑰呰儐姹佺殑涓昏鎴愬垎涔嬩竴鈥斺€旇儐閰革紝瑕佷箞鍒欎細琚垎娉屽埌鑳嗗泭涓紝骞朵即闅忚儐姹佽繘鍏ユ秷鍖栫郴缁熻鎺掓硠鍑轰汉浣撱€傝€屽鏋滀笂杩颁富瑕佷唬璋㈢幆鑺傚け琛★紝鑲濊剰涓埗閫犲拰杈撳嚭鐨勮儐鍥洪唶瓒呰繃浜嗕汉浣撻渶瑕侊紝鍒欏氨浼氬嚭鐜伴珮琛€鑴傘€佽剛鑲倽绛夌棁鐘躲€傦紙褰撶劧锛岃繖閲岄渶瑕佸啀娆″己璋冿紝杩欎粎浠呮槸瀵硅儐鍥洪唶浠h阿涓€涓瀬绔矖绯欏拰杩囧害绠€鍖栫殑闃愯堪銆傦級 鍥犳锛屽鏋滆兘澶熶績杩涜儐鍥洪唶閫氳繃鑳嗘眮澶栨帓锛屼篃搴旇鑳藉璧峰埌涓嶉敊鐨勯檷琛€鑴傛晥鏋溿€傝繖涓不鐤楅珮琛€鑴傜殑鏂瑰紡锛屾湁鐐圭被浼间簬鍒楀噣绫昏嵂鐗╃殑闄嶈绯栨晥鏋溿€傝繖绫昏嵂鐗╃殑浣滅敤鏈哄埗鏄姂鍒惰偩鑴忎腑涓€涓悕涓洪挔-钁¤悇绯栧崗鍚岃浆杩愯泲鐧?鐨勮泲鐧借川锛岄樆姝㈣偩鑴忎粠琛€娑蹭腑鍥炴敹钁¤悇绯栧垎瀛愶紝浠庤€岃澶ч噺钁¤悇绯栧垎瀛愰殢灏挎恫鎺掑嚭浣撳銆傝繖涓綔鐢ㄦ満鍒跺苟涓嶆秹鍙婁汉浣撲腑澶嶆潅鐨勮憽钀勭硸浠h阿璺緞锛屽嵈鑳界珛绔胯褰卞湴闄嶄綆琛€绯栨按骞筹紝娌荤枟2鍨嬬硸灏跨梾锛屼篃鑳藉緢濂藉湴棰勯槻绯栧翱鐥呭紩璧风殑蹇冭绠″苟鍙戠棁銆傚洜姝わ紝杩欑被鑽墿鐩墠鍦ㄥ悇鍥界殑绯栧翱鐥呮不鐤楁寚鍗椾腑鍦颁綅鎸佺画涓婂崌[4]銆?/p> ASGR1鐨勯檷鑴傛満鐞?/strong> 鎴戜滑璇村洖ASGR1杩欎釜闈剁偣銆侫SGR1鐨勫叏绉版槸Asialoglycoprotein Receptor 1锛屽嵆鑴卞斁娑查吀绯栬泲鐧藉彈浣?銆傞【鍚嶆€濅箟锛岃繖鏄粏鑳炶〃闈㈢殑涓€绫诲彈浣撳垎瀛愶紝涓撻棬缁撳悎鍜屾劅鐭ヤ竴绫荤壒娈婄殑绯栧熀鍖栦慨楗扮殑铔嬬櫧璐ㄣ€侫SGR1鍙湪鑲濊剰缁嗚優涓〃杈撅紝鍏跺叿浣撶殑浣滅敤鏈哄埗闀挎湡鏈煡銆備絾宸茬粡鏈変笉灏戦澏鍚戣倽缁嗚優鐨勮嵂鐗╁湪閫氳繃ASGR1鍙椾綋杩涜鍚告敹锛屼緥濡侫lnylam鍏徃寮€鍙戠殑灏忔牳閰歌嵂鐗╋紝灏辨槸閫氳繃娣诲姞鐗规畩鐨勭硸鍩哄寲鍒嗗瓙锛屼粠鑰屼娇鍏惰兘澶熻鑲濊剰缁嗚優琛ㄩ潰鐨凙SGR鎵€璇嗗埆锛屾彁楂樺叾琚倽缁嗚優鍚告敹鐨勮兘鍔沎5]銆?/p> 鍦?016骞达紝涓€椤瑰湪鍐板矝銆佷腹楹﹀拰鑽峰叞浜虹兢涓繘琛岀殑鐮旂┒棣栨鍙戠幇锛孉SGR1鍩哄洜鐨勬煇浜涚綍瑙佸ぉ鐒跺彉寮傦紝鑳藉闄嶄綆鍏跺熀鍥犳椿鎬э紝鍚屾椂鑳藉鏄捐憲闄嶄綆浜虹兢鐨勮鑴傛按骞筹紙鐗瑰埆鏄綆瀵嗗害鑴傝泲鐧斤級鍜屽績琛€绠$柧鐥呴闄┿€傝€屼笖鎼哄甫杩欎簺鍩哄洜缂洪櫡鐨勪汉骞舵病鏈夊嚭鐜颁换浣曞叾浠栨柟闈㈢殑鍋ュ悍闂銆傝繖鏄汉浠涓€娆℃剰璇嗗埌ASGR1鍙兘鎴愪负鍏ㄦ柊鐨勯檷鑴傝嵂鐗╁紑鍙戦澏鐐筟6]銆?/p> 浣咥SGR1鍏蜂綋鏄浣曞拰琛€鑴傝皟鑺備骇鐢熷叧绯荤殑鍛紵 2022骞?鏈堬紝姝︽眽澶у瀹嬩繚浜疄楠屽鐨勪竴椤圭爺绌舵繁鍏ョ爺绌朵簡杩欎釜闂聽[7]銆備粬浠鍏堝彂鐜帮紝鍜屼汉绫荤被浼硷紝ASGR1鍩哄洜鏁查櫎鐨勫皬榧犱腑锛堣鏁查櫎ASGR1鍩哄洜鐨勫皬榧犱腑锛夛紝鍚勯」琛€鑴傛寚鏍囨湁鏄庢樉鐨勪笅闄嶏紝鑲濊剰涓殑鑴傝偑鍫嗙Н涔熸湁鏄捐憲鍑忚交銆傚悓鏃讹紝杩欎簺灏忛紶鐨勮儐姹佸垎娉屾椿鍔ㄥぇ澶у寮猴紝鑳嗘眮涓殑鑳嗗浐閱囧惈閲忎篃鏈夎倝鐪煎彲瑙佺殑鎻愬崌銆傝繖浜涚粨鏋滅洿鎺ユ寚鍚戜簡涓€涓彲鑳芥€э細ASGR1鍩哄洜鍔熻兘鐨勪笅闄嶏紝淇冭繘浜嗚儐鍥洪唶閫氳繃鑳嗘眮鎺掑嚭浣撳锛屼粠鑰岄檷浣庝簡琛€鑴傘€?/p> 鍦ㄥ叿浣撴満鍒跺眰闈紝瀹嬩繚浜疄楠屽鐨勭爺绌跺彂鐜帮紝鍦ㄨ倽鑴忕粏鑳炵殑姝e父娲诲姩涓紝ASGR1浼氭寔缁湴杩涜鎵€璋撳唴鍚炶繃绋嬶細鍦ㄧ粨鍚堜簡鐗瑰畾鐨勭硸鍩哄寲鍒嗗瓙涔嬪悗锛孉SGR1鍙椾綋鎵€鍦ㄧ殑缁嗚優鑶滀細鍙戠敓鍚戝唴鍑归櫡鍜屾柇瑁傦紝褰㈡垚鍖呰9鐫€ASGR1鍒嗗瓙鐨勫皬娑叉淮杩涘叆缁嗚優鍐呴儴銆傝繖浜涘皬娑叉淮鍜岀粏鑳炲唴閮ㄧ殑搴熺墿澶勭悊宸ュ巶婧堕叾浣撹瀺鍚堬紝ASGR1铔嬬櫧鍦ㄦ琚垎瑙f垚涓哄崟涓皑鍩洪吀銆傛帴鐫€锛岃繖浜涜緭鍏ョ殑钀ュ吇鐗╄川鍙互淇冭繘缁嗚優鍐呰剛鑲殑鍚堟垚銆侀樆姝㈣儐鍥洪唶鍒嗗瓙鐨勫鎺掋€傞壌浜庣粏鑳炵殑鎸佺画鐢熼暱绻佹畺闇€瑕佹寔缁笉鏂殑鑴傜被鍒嗗瓙渚涘簲锛屼笂杩拌繃绋嬪彲浠ョ矖鐣ョ殑鐞嗚В涓猴細缁嗚優鎰熷彈鍒版寔缁殑钀ュ吇杈撳叆锛堟潵鑷狝SGR1鍒嗚В鐨勬皑鍩洪吀锛夛紝浠庤€屽惎鍔ㄥ叾鐢熼暱鍜岀箒娈栬繃绋嬶紙鍑嗗鍏呰冻鐨勮剛鑲紝鍖呮嫭鑳嗗浐閱囷級銆?/p> 鑰屽鏋滅牬鍧忔帀ASGR1鐨勫姛鑳斤紝涓婅堪杩囩▼鍒欎細琚浉搴斿湴閫嗚浆锛屽叾涓氨鍖呮嫭鑳嗗浐閱囩殑鍚戝杈撻€佷細琚ぇ澶у寮猴紝灏忛紶鐨勮鑴傛按骞冲洜姝よ兘澶熷緱鍒版樉钁楃殑鏀瑰杽銆?/strong> 鐮旂┒鑰呬滑浣跨敤浜嗕赴瀵岀殑鐮旂┒鎵嬫锛屽寘鎷娇鐢ㄨ嵂鐗╁拰閬椾紶瀛︽搷浣滄縺娲诲拰鎶戝埗涓婅堪杩囩▼涓殑鍚勪釜鍏抽敭鍒嗗瓙锛屽湪鍩瑰吇缁嗚優鍜屽皬榧犳ā鍨嬩腑鍙嶅璇佹槑浜嗕笂杩拌繃绋嬬殑鍙潬鎬с€?/p> 鍊煎緱涓€鎻愮殑鏄紝鐮旂┒鑰呬滑杩樹笓闂ㄧ瓫閫変簡涓€绉嶈兘澶熼珮鏁堢粨鍚圓SGR1铔嬬櫧鐨勫崟鍏嬮殕鎶椾綋鍒嗗瓙锛岃瘉鏄庝簡娉ㄥ皠杩欑鎶椾綋鍚屾牱鍙互鏄捐憲闄嶄綆灏忛紶鐨勮鑴傚拰鑲濊剰鑴傝偑鍫嗙Н锛屾彁楂樿儐鍥洪唶閫氳繃鑳嗘眮鎺掓硠鐨勮兘鍔涳紝涔熻兘澶熷府鍔╄繖浜涘皬榧犳姷鎶楅珮鑴傝偑椋熺墿甯︽潵鐨勯珮琛€鑴傞闄┿€?/p> 鑰屼笖锛岄壌浜嶢SGR1闈剁偣鐨勯檷琛€鑴傛満鍒跺拰浠栨眬绫讳互鍙婁緷鎶橀害甯冪殑鏈哄埗瀹屽叏涓嶅悓锛氬墠鑰呮槸閫氳繃淇冭繘澶氫綑鐨勮儐鍥洪唶澶栨帓锛岃€屽悗鑰呭垯鏄€氳繃鎶戝埗鑳嗗浐閱囧悎鎴愬拰鍚告敹锛屽洜姝ょ悊璁轰笂杩欎簺鑽墿濡傛灉鑱斿悎浣跨敤锛屽皢鑳藉璧峰埌鏇存樉钁楃殑闄嶈鑴傛晥鏋溿€傜爺绌惰€呬滑涔熷湪灏忛紶妯″瀷涓獙璇佷簡杩欎釜鐚滄祴銆?/p> 铏界劧杩欎簺鐮旂┒鐩墠鍙槸鍦ㄥ皬榧犱綋鍐呭畬鎴愶紝浣嗙粨鍚圓SGR1鍩哄洜鍙樺紓鍦ㄤ汉浣撲腑鐨勯檷鑴傛晥鏋滃拰鍋ュ悍鏀剁泭锛岀‘瀹炶瘉鏄庝簡ASGR1鏄竴涓湁宸ㄥぇ浠峰€肩殑闄嶈剛鑽叏鏂伴澏鐐广€?/p> 闄嶈剛鑽墿寮€鍙戠涓嶅紑缃曡閬椾紶鐥呯爺绌?/strong> 濡傛灉鎴戜滑鏆傛椂鎶涘紑ASGR1鐮旂┒鐨勭粏鑺傦紝瀵规瘮瀹冨拰鍏朵粬涓ゅぇ绫婚檷鑴傝嵂鐗╋紙浠栨眬绫诲拰PCSK9绫伙級鐨勫紓鍚岋紝浼氱湅鍒颁竴涓潪甯告湁鍚彂鎬х殑鍏辨€с€備笁鑰呴兘鍏锋湁鍦ㄥぇ浼楀競鍦轰笂娌荤枟楂樿鑴傘€侀闃擦績鑴戣绠¢闄╃殑娼滃姏锛屼絾瀹冧滑涓夎€呯殑鍙戠幇鍜屾垚鑽紝閮界涓嶅紑瀵圭綍瑙侀仐浼犵柧鐥呯殑鐮旂┒銆?/p> 鍏堣浠栨眬绫昏嵂鐗┿€傝繖绫昏嵂鐗╀腑鐨勭涓€涓€斺€旂編浼愪粬姹€锛屾槸鏃ユ湰绉戝瀹惰繙钘ょ珷鍦?970骞翠唬浠庝竴鏍潚闇夎弻鐨勫垎娉岀墿涓彁鍙栫殑锛屽畠鑳藉鏈夋晥鎶戝埗鑳嗗浐閱囧悎鎴愰€斿緞涓殑闄愰€熼叾锛孒MG-CoA杩樺師閰剁殑娲绘€э紝鍥犳鍙兘鐢ㄤ簬闄嶈鑴傛不鐤椼€?/p> 浣嗗鏋滅爺绌朵粎浠呭仠鐣欏湪杩欎竴姝ワ紝鎴戜滑鏄棤娉曞湪鍚庢潵鐨勫巻鍙蹭笂鐪嬪埌澶ф斁寮傚僵鐨勪粬姹€绫昏嵂鐗╃殑銆傚湪鐪熷疄鐨勫巻鍙蹭腑锛岀編浼愪粬姹€骞舵病鏈夎杩滆棨绔犵殑涓滃銆佹棩鏈嵂浼佺涓€涓夊叡涓ヨ們瀵瑰緟锛屽畠鍏跺疄浠庢湭鐪熸杩涘叆澶ц妯′复搴婂簲鐢ㄣ€傞櫎浜嗗洜涓哄姩鐗╁疄楠屼腑鐪嬪埌鐨勪竴浜涗护浜鸿糠鎯戠殑鐜拌薄涔嬪锛屼汉浠綋鏃惰繕鏈変竴涓牴娣辫拏鍥虹殑鎷呭咖锛氳儐鍥洪唶鏄汉浣撴渶閲嶈鐨勭敓鐗╁ぇ鍒嗗瓙涔嬩竴锛岀矖鏆寸牬鍧忓叾鍚堟垚閫斿緞鏄惁浼氬甫鏉ヤ弗閲嶇殑鍋ュ悍椋庨櫓锛焄8]銆?/p> 鍦ㄤ粬姹€绫昏嵂鐗╃湡姝h繘鍏ュぇ瑙勬ā涓村簥搴旂敤涔嬪墠锛岄拡瀵逛竴绉嶇綍瑙侀仐浼犵梾鈥斺€斿鏃忔€ч珮鑳嗗浐閱囪鐥囩殑鐮旂┒璧峰埌浜嗛噸瑕佺殑鎺ㄥ姩浣滅敤銆傚湪1970-80骞翠唬锛岀編鍥藉痉鍏嬭惃鏂ぇ瀛﹁タ鍗楃爺绌朵腑蹇冪殑涓や綅绉戝瀹讹紝Joseph Goldstein鍜孧ichael Brown娣卞叆鐮旂┒浜嗚繖绉嶇柧鐥呯殑鏈虹悊銆傚鏃忔€ч珮鑳嗗浐閱囪鐥囩殑鎮h€呭線寰€鍦ㄥ辜骞存椂鏈熷氨鍑虹幇浜嗕弗閲嶇殑楂樿鑴傞棶棰橈紝鑰屼笖寰€寰€鍜岄ギ椋熶範鎯棤鍏炽€俒9] Goldstein鍜孊rown鎰忚瘑鍒拌繖绫绘偅鑰呰韩浣撶粏鑳炵殑鑳嗗浐閱囧悎鎴愰€斿緞鎸佺画淇濇寔楂樺害娲昏穬鐘舵€侊紝骞朵互姝や负鍩虹锛屽彂鐜颁簡浜轰綋涓儐鍥洪唶鍚堟垚娲诲姩鐨勯噸瑕佽皟鑺傛墜娈典箣涓€鈥斺€斾綆瀵嗗害鑴傝泲鐧藉強鍏跺彈浣撱€?/p> 鍒氬垰鎴戜滑鎻愬埌锛岃倽鑴忔寔缁笉鏂湴鍚戣娑蹭腑閲婃斁浣庡瘑搴﹁剛铔嬬櫧锛屽皢鑳嗗浐閱囪繍閫佸埌韬綋鍚勫銆傝繖浜涜杞戒簡涓板瘜鑳嗗浐閱囩殑寰瀷棰楃矑鍦ㄦ帴瑙︿汉浣撶粏鑳炲悗锛屽彲浠ュ拰缁嗚優琛ㄩ潰鐨勪綆瀵嗗害鑴傝泲鐧藉彈浣撶粨鍚堬紝閫氳繃鍐呭悶杩囩▼杩涘叆缁嗚優鍐呴儴锛岄噴鏀惧嚭鍐呴儴鐨勮儐鍥洪唶渚涚粏鑳炰娇鐢ㄣ€傛樉鐒讹紝褰撴潵鑷倽鑴忕殑浣庡瘑搴﹁剛铔嬬櫧杈冧负鍏呰锛岀粏鑳炲唴閮ㄥ氨涓嶉渶瑕佸啀杩涗竴姝ュ悎鎴愭洿澶氱殑鑳嗗浐閱囷紝鑳嗗浐閱囧悎鎴愭椿鍔ㄥ氨浼氳鎶戝埗銆傜浉鍙嶏紝濡傛灉缁嗚優鍐呰儐鍥洪唶鍚堟垚涓嶈冻锛屽氨闇€瑕佹洿澶氬湴渚濊禆澶栭儴鑳嗗浐閱囦緵搴斻€傝繖鏃跺€欑粏鑳炲氨浼氬埗閫犳洿澶氱殑浣庡瘑搴﹁剛铔嬬櫧鍙椾綋锛岀敤浜庝粠琛€娑蹭腑鎶撳彇鏇村鐨勪綆瀵嗗害鑴傝泲鐧姐€?strong>绠€鑰岃█涔嬶紝澶栭儴鏉ョ殑澶氫簡锛屽唴閮ㄥ氨鍙互灏戝悎鎴愪竴浜涳紝鍐呴儴鍚堟垚涓嶅浜嗭紝灏辫浠庡閮ㄥ鏉ヤ竴鐐广€傝繖鏄竴涓畝鍗曚笖瀹炵敤鐨勮礋鍙嶉璋冭妭杩囩▼銆?/strong> 鑰屽湪瀹舵棌鎬ч珮鑳嗗浐閱囪鐥囨偅鑰呬綋鍐咃紝缁嗚優鎰熺煡澶栭儴鑳嗗浐閱囪緭鍏ョ殑鑳藉姏琚牬鍧忎簡锛屼箣鍚庣爺绌惰€呬滑杩涗竴姝ュ彂鐜拌繖浜涙偅鑰呬綋鍐呮伆鎭版槸浣庡瘑搴﹁剛铔嬬櫧鍙椾綋鍩哄洜鍑虹幇浜嗙己闄仿燵10]锛屽洜姝や笉绠¤娑蹭腑杩愭潵浜嗗灏戣儐鍥洪唶锛岀粏鑳炲唴閮ㄩ兘浠嶇劧鍦ㄦ寔缁敓浜ц儐鍥洪唶锛岃繖褰撶劧閫犳垚浜嗚儐鍥洪唶鐨勮繃鍓╁拰澶ч噺鍫嗙Н銆?/p> 鍦ㄨ繖浜涚爺绌剁殑鍩虹涓婏紝杩滆棨鍜孏oldstein/Brown瀹為獙瀹ゅ悎浣滐紝璇佹槑浜嗙編浼愪粬姹€鐨勫弻閲嶄綔鐢ㄦ満鍒堵燵11]銆傚畠棣栧厛鎶戝埗浜嗙粏鑳炲唴鑳嗗浐閱囩殑鍚堟垚锛屽噺灏戜簡浜轰綋涓儐鍥洪唶鐨勬€婚噺锛涜€岀揣鎺ョ潃锛岀粏鑳炲唴鑳嗗浐閱囨按骞崇殑闄嶄綆锛屽弽杩囨潵鎻愰珮浜嗙粏鑳炲埄鐢ㄤ綆瀵嗗害鑴傝泲鐧藉彈浣撳惛鏀跺閮ㄨ儐鍥洪唶鐨勮兘鍔涳紝灏嗚娑蹭腑鐨勮繃鍓╄儐鍥洪唶杩涗竴姝ラ檷浣庝簡銆傝繖鎵嶅畬鏁磋癄閲婁簡浠栨眬绫昏嵂鐗╃殑闄嶈鑴傚姛鑳姐€?/p> 1987骞达紝缇庡浗榛樻矙涓滃叕鍙哥殑娲涗紣浠栨眬姝e紡鑾锋壒涓婂競鐢ㄤ簬楂樿鑴傛不鐤椼€傚湪姝や箣鍚庯紝瓒呰繃10涓粬姹€绫昏嵂鐗╅檰缁笂甯傞攢鍞紝涓夊崄澶氬勾閲屾嫰鏁戠殑鐢熷懡闅句互璁℃暟銆傝€屽湪杩欎簺鑰€鐪兼垚灏辫儗鍚庯紝閽堝缃曡閬椾紶鐥呯殑鐮旂┒璧峰埌浜嗛毦浠ユ浛浠g殑鍏抽敭浣滅敤銆?/p> 鏃犵嫭鏈夊伓锛孭CSK9绫昏嵂鐗╃殑寮€鍙戜篃鍚屾牱绂讳笉寮€缃曡閬椾紶鐤剧梾鐨勭爺绌躲€?/strong> 2003骞达紝灏卞湪浜轰滑宸茬粡榛樿楂樿鑴傚競鍦哄凡缁忚浠栨眬绫昏嵂鐗╁交搴曠粺娌荤殑鏃跺€欙紝娉曞浗绉戝瀹禖atherine Boileau鍦ㄨ嵎鍏颁竴涓ぇ瀹舵棌涓彂鐜颁簡鎸佺画涓や釜涓栫邯鐨勫鏃忔€ч珮琛€鑴傞棶棰橈紝骞朵笖鎵惧埌浜嗚繖涓鏃忎腑鎼哄甫鐨凱CSK9澧炲己鍨嬪熀鍥犲彉寮俒12]銆傛鍚庝笉涔咃紝缇庡浗瑗垮崡鍖诲涓績鐨凧onathan Cohen鍜孒elen Hobbs鍙堝湪鍙︿竴涓嫭绔嬬殑浜虹兢鐮旂┒涓彂鐜帮紝鐮村潖PCSK9鍩哄洜鍔熻兘鐨勫彉寮傝兘澶熸樉钁楅檷浣庤鑴傦紝涓斾笉浼氬甫鏉ュ仴搴烽闄┞燵13]銆?/p> 鍦ㄨ繖浜涚爺绌剁殑鍩虹涓婏紝浜轰滑杩涗竴姝ョ爺绌跺苟鐞嗚В浜哖CSK9铔嬬櫧鐨勪綔鐢紙涓昏鏄檷浣庣粏鑳炶〃闈㈢殑浣庡瘑搴﹁剛铔嬬櫧鍙椾綋姘村钩锛屼粠鑰岄樆姝㈢粏鑳炲惛鏀惰娑蹭腑鐨勮儐鍥洪唶锛夈€傚娆鹃拡瀵筆CSK9闈剁偣鐨勫叏鏂伴檷鑴傝嵂鐗╁凡缁忛棶涓栵紝骞朵笖瀵逛粬姹€绫昏嵂鐗╄捣鍒颁簡寰堝ソ鐨勮ˉ鍏呬綔鐢ㄣ€傜壒鍒槸浜虹兢涓湁鐩稿綋姣斾緥锛?0%-15%锛夌殑浜烘棤娉曡€愬彈浠栨眬绫昏嵂鐗╃殑鍓綔鐢紝灏ゅ叾鏄倢鑲夌郴缁熸瘨鎬э紝瀵硅繖缇や汉鑰岃█PCSK9绫昏嵂鐗╃殑浠峰€兼槸闅句互浼伴噺鐨勩€傚悓鏍凤紝鍦≒CSK9鑽墿鐨勫紑鍙戝巻绋嬩腑锛岄拡瀵圭綍瑙侀仐浼犵柧鐥呯殑鐮旂┒鏇存槸璧峰埌浜嗘崊鐮寸涓€灞傜獥鎴风焊鐨勫疂璐典綔鐢ㄣ€?/p> 杩欎竴娆★紝棣栧厛鍚屾牱鏄湪鏋佸皯鏁颁汉绫绘惡甯﹁€呬腑鍙戠幇ASGR1鍩哄洜鍙樺紓鍜岃鑴傝皟鑺傛湁鍏筹紝瀹嬩繚浜疄楠屽鐨勭爺绌舵洿鏄畬鏁存彮绀轰簡ASGR1鍦ㄨ儐鍥洪唶澶栨帓涓殑浣滅敤锛屼篃鍦ㄥ皬榧犳ā鍨嬩腑璇佹槑浜咥SGR1鎶椾綋鍜屽皬鏍搁吀鑽墿鐨勬垚鑽€с€傛帴涓嬫潵锛屾垜浠綋鐒舵湡寰呴澏鍚慉SGR1鐨勮嵂鐗╀篃鑳藉鍜屼粬姹€绫昏嵂鐗┿€丳CSK9绫昏嵂鐗╀竴鏍凤紝鍦ㄤ汉绫诲鎶楅珮琛€鑴傜殑鎴樺満涓婂ぇ鏀惧紓褰┿€?/p> 杩欐洿鏄竴涓鐪熺殑鎻愰啋锛屽嵆渚挎垜浠殑鐩爣鏄В鍐冲ぇ浼椾汉缇や腑鐨勬櫘閬嶅仴搴烽棶棰橈紝浣嗘垜浠粷涓嶅簲璇ュ拷鐣ョ綍瑙侀仐浼犵柧鐥呯爺绌剁殑娣辫繙褰卞搷鍜屽法澶т环鍊笺€?/strong> 璇戝悕瀵圭収琛細 浣庡瘑搴﹁剛铔嬬櫧锛圠DL, low density lipoprotein锛?/p> 楂樺瘑搴﹁剛铔嬬櫧锛圚DL, high density lipoprotein锛?/p> 浠栨眬锛圫tatin锛?/p> 绔嬫櫘濡ワ紙Lipitor锛岄€氱敤鍚岮torvastatin锛?/p> 渚濇姌楹﹀竷锛圗zetimibe锛?/p> 鑳嗘眮閰歌灟鍚堝墏锛圔ile acid sequestrants锛?/p> 鍒楀噣锛圠iflozin锛?/p> 绯栧熀鍖栧垎瀛愶紙GalNac锛?/p> 婧堕叾浣擄紙lysosome锛?/p> 瀹舵棌鎬ч珮鑳嗗浐閱囪鐥囷紙Familial hypercholesterolemia锛?/p> 缇庝紣浠栨眬锛圡evastatin锛?/p> 杩滆棨绔狅紙Akira Endo锛?/p> 绗竴涓夊叡锛圖aiichi Sankyo锛?/p> 浣庡瘑搴﹁剛铔嬬櫧鍙椾綋锛圠DL receptor锛?/p> 娲涗紣浠栨眬锛圠ovastatin锛?/p> 聽鍙傝€冩枃鐚細锛堜笂涓嬫粦鍔ㄥ彲娴忚锛?/p> [1] Penn Medicine. (2018, Aug 02).聽Statins: What You Should Know. https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2018/april/statins-what-you-should-know [2] Harvard Health Publishing. (2017, Feb 06).聽How it鈥檚 made: Cholesterol production in your body. https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body [3] Luo, J., Yang, H., & Song, B.-L. (2020). Mechanisms and regulation of聽cholesterol homeostasis.聽Nature Reviews. Molecular Cell Biology,聽21(4), 225鈥?45. [4] Lopaschuk, G. D., & Verma, S. (2020). Mechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors.聽JACC. Basic to Translational Science,聽5(6), 632鈥?44. [5] Debacker, A. J., Voutila, J., Catley, M., Blakey, D., & Habib, N. (2020). Delivery of Oligonucleotides to the Liver with GalNAc: From Research to Registered Therapeutic Drug.聽Molecular Therapy,聽28(8), 1759鈥?771. [6] Nioi, P., Sigurdsson, A., Thorleifsson, G., Helgason, H., Agustsdottir, A. B., Norddahl, G. L., Helgadottir, A., Magnusdottir, A., Jonasdottir, A., Gretarsdottir, S., Jonsdottir, I., Steinthorsdottir, V., Rafnar, T., Swinkels, D. W., Galesloot, T. E., Grarup, N., J酶rgensen, T., Vestergaard, H., Hansen, T., 鈥?Krarup, N. T. (2016). Variant ASGR1 Associated with a Reduced Risk of Coronary Artery Disease.聽The New England Journal of Medicine,聽374(22), 2131鈥?141. [7] Wang, J.-Q., Li, L.-L., Hu, A., Deng, G., Wei, J., Li, Y.-F., Liu, Y.-B., Lu, X.-Y., Qiu, Z.-P., Shi, X.-J., Zhao, X., Luo, J., & Song, B.-L. (2022). Inhibition of ASGR1 decreases lipid levels by promoting cholesterol excretion.聽Nature (London),聽608(7922), 413鈥?20. [8] Endo A. (2010). A historical perspective on the discovery of statins.聽Proceedings of the Japan Academy. Series B, Physical and biological sciences,聽86(5), 484鈥?93. [9] Nair, P. (2013). Brown and Goldstein: The Cholesterol Chronicles.聽Proceedings of the National Academy of Sciences - PNAS,聽110(37), 14829鈥?4832. [10] Yamamoto, T., Davis, C. G., Brown, M. S., Schneider, W. J., Casey, M. L., Goldstein, J. L., & Russell, D. W. (1984). The human LDL receptor: a cysteine-rich protein with multiple Alu sequences in its mRNA.聽Cell,聽39(1), 27鈥?8. [11] Brown, M. S., Faust, J. R., Goldstein, J. L., Kaneko, I., & Endo, A. (1978). Induction of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity in human fibroblasts incubated with compactin (ML-236B), a competitive inhibitor of the reductase.聽The Journal of biological chemistry,聽253(4), 1121鈥?128. [12] Abifadel, M., Varret, M., Rab猫s, J. P., Allard, D., Ouguerram, K., Devillers, M., Cruaud, C., Benjannet, S., Wickham, L., Erlich, D., Derr茅, A., Vill茅ger, L., Farnier, M., Beucler, I., Bruckert, E., Chambaz, J., Chanu, B., Lecerf, J. M., Luc, G., Moulin, P., 鈥?Boileau, C. (2003). Mutations in PCSK9 cause autosomal dominant hypercholesterolemia.聽Nature genetics,聽34(2), 154鈥?56. [13] Cohen, J., Pertsemlidis, A., Kotowski, I. K., Graham, R., Garcia, C. K., & Hobbs, H. H. (2005). Low LDL cholesterol in inpiduals of African descent resulting from frequent nonsense mutations in PCSK9.聽Nature genetics,聽37(2), 161鈥?65. 鍒剁増缂栬緫聽|聽灏忓湱鏈?/p> |