肝窦阻塞综合征的研究进展

张明

doi:10.12449/JCH240104

肝窦阻塞综合征的研究进展

DOI: 10.12449/JCH240104

张明^, ,

南京大学医学院附属鼓楼医院消化内科，南京 210008

利益冲突声明：本文不存在任何利益冲突。

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通信作者:
张明， mg0923@163.com （ORCID： 0009-0009-7742-3128）

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出版历程
- 收稿日期: 2023-12-11
- 录用日期: 2023-12-20
- 出版日期: 2024-01-23

Research advances in hepatic sinusoidal obstruction syndrome

Ming ZHANG^{,
,}

Department of Gastroenterology，Affiliated Drum Tower Hospital of Nanjing University Medical School，Nanjing 210008，China

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Corresponding author: ZHANG Ming， mg0923@163.com （ORCID： 0009-0009-7742-3128）

摘要

摘要: 肝窦阻塞综合征（HSOS）也被称为肝小静脉闭塞病，是一类由各种原因导致的肝血窦阻塞和肝小静脉闭塞纤维化的肝脏血管性疾病。本文系统阐述了HSOS的认识过程和命名演变、病因和发病机制、临床表现、诊断与鉴别诊断、预防和治疗等方面的研究进展。HSOS可发生于接受骨髓造血干细胞移植清髓处理、放射/化学治疗和摄入含吡咯生物碱药物的人群，常见临床表现为腹胀、肝区胀痛、腹水、黄疸、肝大等。针对不同病因，HSOS的诊断标准也不相同，需要与其他药物性肝病、肝静脉流出道梗阻等疾病相鉴别。去纤苷和低分子肝素分别对造血干细胞和吡咯生物碱相关的HSOS具有治疗作用，奥沙利铂化疗导致的HSOS目前尚无有效治疗药物。
- 肝窦阻塞综合征 /
- 造血干细胞移植 /
- 奥沙利铂
Abstract: Hepatic sinusoidal obstruction syndrome （HSOS）， also known as hepatic veno-occlusive disease， is hepatic vascular disease of hepatic sinusoidal obstruction and hepatic venular occlusion and fibrosis due to various causes. This article systematically elaborates on the research advances in HSOS from the aspects of understanding and naming， etiology and pathogenesis， clinical manifestation， diagnosis and differential diagnosis， prevention， and treatment. HSOS can occur in patients receiving bone marrow hematopoietic stem cell transplantation， radiotherapy/chemotherapy， and medication containing pyrrolidine alkaloids， and the common clinical manifestations of HSOS include abdominal distension， distending pain in the liver area， ascites， jaundice， and hepatomegaly. The diagnostic criteria for HSOS vary with etiology， and it needs to be differentiated from other diseases such as drug-induced liver diseases and hepatic venous outflow tract obstruction. Defibrotide and low-molecular-weight heparin have a therapeutic effect on HSOS associated with hematopoietic stem cells and pyrrolidine alkaloids， respectively， and there are currently no effective drugs for HSOS caused by oxaliplatin chemotherapy.
- Hepatic Sinus Obstruction Syndrome /
- Hematopoietic Stem Cell Transplantation /
- Oxaliplatin

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肝细胞癌（HCC）是临床常见的恶性肿瘤之一。HCC早期治疗以手术切除为主，但侵袭性HCC的治疗策略目前选择有限，索拉非尼、仑伐替尼及程序性细胞死亡受体1及其配体免疫抑制剂治疗HCC的效果不佳，临床有效率不足30%。因此，亟需进一步探究HCC的发病机制与治疗靶点。随着基因组学研究的发展，对HCC肿瘤生物学的认识逐渐深入，但HCC的泛素化特征尚不明晰。本研究旨在揭示HCC的泛素化特征，并探寻可指导侵袭性HCC临床诊断和治疗的潜在生物标志物。

陆军军医大学第一附属医院（重庆西南医院）谢传明教授、张雷达教授与重庆医科大学侯宇教授等通过对85例HCC患者肿瘤及相邻正常肝组织进行蛋白质组学、磷酸化修饰组学和泛素化修饰组学测序与分析发现，COL4A1、LAMC1和LAMA4在无病生存期较差患者中高表达。磷酸化与泛素化修饰在代谢和转移相关信号通路中存在关联。利用泛素化组学和蛋白质组学数据对HCC进行分子分型，发现具有不同临床特征的3个亚型：S-‍Ⅰ、S-‍Ⅱ和S-Ⅲ。S-‍Ⅰ亚型以代谢相关蛋白高表达为特征，预后最好；S-Ⅲ亚型与增殖/转移信号通路密切相关，预后最差，表现为总生存期最短和复发率最高；而S-‍Ⅱ亚型则介于两者之间。研究发现，生物标志物TUBA1A、BHMT2、BHMT和ACY1的表达表现出不同的泛素化水平，与HCC患者预后不良密切相关，表明靶向这些蛋白质或其泛素化修饰蛋白可能对临床治疗有益。此外，研究证实TUBA1A K370去泛素化可驱动HCC发生与转移，这主要归因于AKT介导的USP14激活。TUBA1A K370去泛素化标志着一类高侵袭性HCC亚型。值得注意的是，靶向AKT-USP14-TUBA1A复合物可促进TUBA1A降解，并在体内阻断HCC发生。

总之，本研究从泛素化组学、磷酸化组学和蛋白质组学角度对HCC进行了全面的整合分析，该研究不仅加深了对HCC中泛素化特征的了解，并为开发新的HCC生物标志物和潜在的治疗靶点提供了依据。

摘译自LIN XT, LUO YD, MAO C, et al. Integrated ubiquitomics characterization of hepatocellular carcinomas[J]. Hepatology, 2024. DOI: 10.1097/HEP.0000000000001096. [Online ahead of print]

(陆军军医大学第一附属医院肝胆外科谢传明报道）

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