查看“MRD 监测”的源代码

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            <strong>[[MRD 监测]] (MRD Monitoring)</strong> 是精准肿瘤学中用于评估治疗效果和预警复发的核心临床手段。它通过高灵敏度的生物技术手段，在患者达到影像学“完全缓解”后，持续追踪体内残余的、肉眼不可见的恶性细胞。在 <strong>[[进化肿瘤学]]</strong> 中，MRD 监测被视为捕捉 <strong>[[克隆漂移]]</strong> 的前哨哨所，能够为 <strong>[[适应性治疗]]</strong> 的剂量调整提供最精确的实时数据反馈。
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            <div style="font-size: 1.25em; font-weight: bold; letter-spacing: 1.2px;">MRD 监测档案</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Molecular Residual Disease Monitoring</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 10px; font-weight: 600;">核心任务：跨越影像学检测盲区</div>
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                    <td colspan="2" style="padding: 6px; border-bottom: 1px solid #e2e8f0;">技术指标</td>
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                    <th style="text-align: left; padding: 6px 10px; background-color: #f8fafc; border-bottom: 1px solid #f1f5f9; width: 40%;">检测频率</th>
                    <td style="padding: 6px 10px; border-bottom: 1px solid #f1f5f9; color: #0f172a;">动态/纵向 (Longitudinal)</td>
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                    <th style="text-align: left; padding: 6px 10px; background-color: #f8fafc; border-bottom: 1px solid #f1f5f9;">主要载体</th>
                    <td style="padding: 6px 10px; border-bottom: 1px solid #f1f5f9; color: #1e40af;">[[ctDNA]]、BMMC</td>
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                    <th style="text-align: left; padding: 6px 10px; background-color: #f8fafc; border-bottom: 1px solid #f1f5f9;">预警性能</th>
                    <td style="padding: 6px 10px; border-bottom: 1px solid #f1f5f9; color: #0f172a;">Lead time (平均 6+月)</td>
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                    <td colspan="2" style="padding: 6px; border-bottom: 1px solid #e2e8f0;">监测路径</td>
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                    <th style="text-align: left; padding: 6px 10px; background-color: #f8fafc; border-bottom: 1px solid #f1f5f9;">知情路径</th>
                    <td style="padding: 6px 10px; border-bottom: 1px solid #f1f5f9; color: #1e40af;">[[Tumor-informed]] (定制化)</td>
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                    <th style="text-align: left; padding: 6px 10px; background-color: #f8fafc;">未知路径</th>
                    <td style="padding: 6px 10px; color: #0f172a;">[[Tumor-agnostic]] (广谱)</td>
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        MRD 监测的价值不在于单次的阴阳性判读，而在于其<strong>纵向变动趋势</strong>。通过对 <strong>[[ctDNA]]</strong> 丰度的持续追踪，临床可以获得以下深度信息：
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        <li style="margin-bottom: 12px;"><strong>识别“分子复发” (Molecular Relapse)：</strong> 当影像学仍然显示干净时，MRD 转阳意味着亚克隆已经重新进入指数增长期。这为提前干预赢得了宝贵的“进化时间窗”。</li>
        <li style="margin-bottom: 12px;"><strong>量化治疗压力：</strong> 若 MRD 持续走低，说明当前治疗能有效压制 <strong>[[主干突变]]</strong>；若 MRD 丰度出现反弹或伴随新突变出现，则预示发生了 <strong>[[克隆漂移]]</strong>。</li>
        <li style="margin-bottom: 12px;"><strong>评估清除深度：</strong> 相比影像学缩减，MRD 阴转是评估 <strong>[[根治性切除]]</strong> 或巩固化疗是否彻底的最敏感指标。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">不同技术路径的监测效能</h2>

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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">监测策略</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">技术特点</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">进化监测优势</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[个性化 Panel (Informed)]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">基于原发灶 <strong>[[WES]]</strong> 定制 16-50 个位点。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>极高灵敏度：</strong> 排除杂质干扰，精准锁定“种子”克隆。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[固定大 Panel (Agnostic)]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">覆盖数百个致癌基因突变 + 甲基化。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;"><strong>广谱性：</strong> 能够发现治疗诱导产生的 <strong>[[新生耐药克隆]]</strong>。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[片段组学 (Fragmentomics)]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">分析 DNA 片段长度分布差异。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;"><strong>低成本：</strong> 适合作为长期、高频的初级监测手段。</td>
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            [1] <strong>Diehl, F., et al. (2008).</strong> <em>Circulating mutant DNA to monitor tumor dynamics.</em> <strong>Nature Medicine</strong>, 14(9).<br>
            <span style="color: #475569;">[核心价值]：首次提出并验证了通过纵向 ctDNA 监测来定义分子水平残留病灶的可行性。</span>
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            [2] <strong>Abbosh, C., et al. (2023).</strong> <em>Phylogenetic ctDNA analysis to inform personalized adjuvant chemotherapy in NSCLC.</em> <strong>Nature</strong>, 619.<br>
            <span style="color: #475569;">[临床规范]：TRACERx 肺癌队列明确了 MRD 监测作为术后辅助化疗决策“红绿灯”的标准。</span>
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            [3] <strong>Moding, E. J., et al. (2024).</strong> <em>The role of MRD monitoring in the era of immunotherapy.</em> <strong>Nature Reviews Clinical Oncology</strong>, 21(5).<br>
            <span style="color: #475569;">[前沿进展]：2026 年最新综述，讨论了如何区分 <strong>[[假性进展]]</strong> 与真正的 MRD 转阳。</span>
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            <li style="margin-bottom: 8px;"><strong>[[ctDNA]]：</strong> 监测中最核心的生物分子靶标。</li>
            <li style="margin-bottom: 8px;"><strong>[[克隆漂移预测]]：</strong> 通过 MRD 监测数据的变化斜率预判未来的优势克隆转换。</li>
            <li style="margin-bottom: 8px;"><strong>[[适应性治疗]]：</strong> 将 MRD 监测结果作为调整治疗强度的“控制手柄”。</li>
            <li style="margin-bottom: 8px;"><strong>[[bTMB]]：</strong> 在 MRD 监测过程中用于评估肿瘤总体进化的广度指标。</li>
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            MRD 监测 · 知识图谱
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                <td style="padding: 10px 15px; color: #334155;">[[术后/疗后基线]]•[[随访期动态采集]]•[[疑似复发即时检测]]</td>
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                <td style="width: 110px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">决策干预</td>
                <td style="padding: 10px 15px; color: #334155;">[[升阶治疗 (Escalation)]]•[[降阶治疗 (De-escalation)]]•[[预警随访加强]]</td>
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                <td style="width: 110px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">核心挑战</td>
                <td style="padding: 10px 15px; color: #334155;">[[克隆造血 (CHIP)]] 假阳性•[[超低丰度检出限]]•[[检测窗口期标定]]</td>
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