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错配修复缺陷 - 版本历史
2026-04-19T12:47:51Z
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2025年12月24日 (三) 15:35 77921020
2025-12-24T15:35:03Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">←上一版本</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">2025年12月24日 (三) 15:35的版本</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l5" >第5行：</td>
<td colspan="2" class="diff-lineno">第5行：</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>| colspan="2" | </div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>| colspan="2" | </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div class="infobox-image-wrapper" style="padding: 25px; background-color: #f8fafc; border: 1px solid #f1f5f9; border-radius: 12px; text-align: center;"></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div class="infobox-image-wrapper" style="padding: 25px; background-color: #f8fafc; border: 1px solid #f1f5f9; border-radius: 12px; text-align: center;"></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">[Image of the DNA Mismatch Repair proteins MLH1, MSH2, MSH6, and PMS2 forming functional complexes]</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div style="font-size: 0.85em; color: #94a3b8; margin-top: 10px; font-weight: normal;">MMR 蛋白复合体修复 DNA 错配过程示意图</div></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div style="font-size: 0.85em; color: #94a3b8; margin-top: 10px; font-weight: normal;">MMR 蛋白复合体修复 DNA 错配过程示意图</div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div></div></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div></div></div></td></tr>
<tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l25" >第25行：</td>
<td colspan="2" class="diff-lineno">第25行：</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>'''错配修复缺陷'''（Mismatch Repair Deficiency, dMMR）是指细胞内负责修复 DNA 复制错误的错配修复（MMR）系统功能丧失的生物学状态。该系统主要由 MLH1、MSH2、MSH6 和 PMS2 四种核心蛋白组成，负责纠正 DNA 聚合酶在复制过程中产生的碱基错配或滑动错误。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>'''错配修复缺陷'''（Mismatch Repair Deficiency, dMMR）是指细胞内负责修复 DNA 复制错误的错配修复（MMR）系统功能丧失的生物学状态。该系统主要由 MLH1、MSH2、MSH6 和 PMS2 四种核心蛋白组成，负责纠正 DNA 聚合酶在复制过程中产生的碱基错配或滑动错误。</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">[Image of DNA replication errors leading to mutations in the absence of Mismatch Repair proteins]</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>当 MMR 系统由于基因突变（如[[林奇综合征]]）或启动子甲基化（如散发性肿瘤）而失效时，肿瘤细胞会积累大量的体细胞突变，特别是[[微卫星不稳定性]]（MSI）的产生。dMMR/MSI-H 亚型肿瘤具有高度的免疫原性，是预测[[免疫检查点抑制剂]]疗效的关键生物标志物。</div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>当 MMR 系统由于基因突变（如[[林奇综合征]]）或启动子甲基化（如散发性肿瘤）而失效时，肿瘤细胞会积累大量的体细胞突变，特别是[[微卫星不稳定性]]（MSI）的产生。dMMR/MSI-H 亚型肿瘤具有高度的免疫原性，是预测[[免疫检查点抑制剂]]疗效的关键生物标志物。</div></td></tr>
<tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l44" >第44行：</td>
<td colspan="2" class="diff-lineno">第44行：</td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div style="overflow-x: auto; width: 90%; margin: 25px auto;"></div></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><div style="overflow-x: auto; width: 90%; margin: 25px auto;"></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>{| class="wikitable" style="width: 100%; border-collapse: collapse; border: none; box-shadow: 0 4px 15px rgba(0,0,0,0.08); font-size: 0.95em; background-color:</div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>{| class="wikitable" style="width: 100%; border-collapse: collapse; border: none; box-shadow: 0 4px 15px rgba(0,0,0,0.08); font-size: 0.95em; background-color: <ins class="diffchange diffchange-inline">#fff;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|+ style="font-weight: bold; font-size: 1.1em; margin-bottom: 12px; color: #2c3e50; text-align: center;" | dMMR 临床应用与技术特征分析</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|- style="background-color: #eaeff5; color: #2c3e50; border-bottom: 2px solid #dce4ec;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">! style="text-align: left; padding: 12px 15px; width: 22%;" | 评估维度</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">! style="text-align: left; padding: 12px 15px;" | 临床客观表现与技术特征</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|- style="border-bottom: 1px solid #f1f5f9;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; font-weight: 600; color: #546e7a; background-color: #fcfdfe;" | 诊断判读标准</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; color: #374151; line-height: 1.6;" | 通过免疫组化（IHC）检测四种蛋白。若 MLH1、MSH2、MSH6 或 PMS2 中任一蛋白出现细胞核染色缺失，即判定为 dMMR；若四种蛋白均正常表达，则为 pMMR。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|- style="border-bottom: 1px solid #f1f5f9;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; font-weight: 600; color: #546e7a; background-color: #fcfdfe;" | 免疫治疗获益</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; color: #374151; line-height: 1.6;" | dMMR 肿瘤被视为“免疫热肿瘤”，伴随高 [[TMB]] 和丰富的新抗原浸润。临床研究证实，此类患者对 PD-1/PD-L1 抑制剂展现出极高的客观缓解率（ORR）和持久的无进展生存获益。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|- style="border-bottom: 1px solid #f1f5f9;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; font-weight: 600; color: #546e7a; background-color: #fcfdfe;" | 遗传性风险</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; color: #374151; line-height: 1.6;" | dMMR 是[[林奇综合征]]的核心筛查指标。对于 MSH2、MSH6 缺失或 MLH1 缺失伴 BRAF 阴性的结直肠癌患者，需强制进行生殖系突变检测以排查遗传风险。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|- style="border-bottom: 1px solid #f1f5f9;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; font-weight: 600; color: #546e7a; background-color: #fcfdfe;" | 辅助化疗决策</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="text-align: left; padding: 12px 15px; color: #374151; line-height: 1.6;" | 在 II 期结直肠癌中，dMMR 患者预后较好，但不能从氟尿嘧啶（5-FU）单药辅助化疗中获益。这一客观事实直接决定了此类患者应避免不必要的单药辅助化疗。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|}</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"></div></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">== 关联核心概念 ==</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* **[[MSI-H]] (高度微卫星不稳定性)**：dMMR 在基因组层面的直接结果，两者检测结果高度一致。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* **[[pMMR]] (错配修复功能完整)**：dMMR 的对立状态，通常对应免疫冷肿瘤。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* **[[林奇综合征]] (Lynch Syndrome)**：由 MMR 基因生殖系变异引起的常染色体显性遗传病。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">== 参考文献 ==</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* [1] Le DT, et al. PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. New England Journal of Medicine, 2015.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* [2] Diaz LA Jr, et al. PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer. New England Journal of Medicine, 2022.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* [3] NCCN Guidelines Version 1.2025: Detection of Mismatch Repair (MMR) Proteins by Immunohistochemistry.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* [4] Sinicrope FA. Lynch Syndrome-Associated and Sporadic Colon Cancer with Microsatellite Instability. Gastroenterology, 2018.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* [5] 错配修复功能缺陷及微卫星不稳定性临床检测中国专家共识（2025 修订版）：IHC 检测规范与结果判定一致性准则。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">{{reflist}}</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"><div style="clear: both; margin-top: 40px; border: 1px solid #a2a9b1; background-color: #f8f9fa; border-radius: 4px; overflow: hidden;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"><div style="background-color: #dee2e6; text-align: center; font-weight: bold; padding: 6px; border-bottom: 1px solid #a2a9b1; color: #374151;">肿瘤学与分子诊断技术导航</div></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">{| style="width: 100%; background: transparent; border-spacing: 0; font-size: 0.85em;"</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|-</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">! style="width: 15%; padding: 8px; background-color: #f1f5f9; text-align: right; border-bottom: 1px solid #fff;" | 标志物</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="padding: 8px; border-bottom: 1px solid #fff;" | [[MSI]] • [[dMMR]] • [[TMB]] • [[PD-L1]] • [[新抗原]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|-</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">! style="width: 15%; padding: 8px; background-color: #f1f5f9; text-align: right; border-bottom: 1px solid #fff;" | 诊断技术</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="padding: 8px; border-bottom: 1px solid #fff;" | [[IHC]] • [[PCR]] • [[NGS]] • [[全外显子测序]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|-</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">! style="width: 15%; padding: 8px; background-color: #f1f5f9; text-align: right;" | 治疗手段</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">| style="padding: 8px;" | [[免疫检查点抑制剂]] • [[派姆单抗]] • [[纳武利尤单抗]] • [[个体化疫苗]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|}</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"></div></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">[[Category:病理学]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">[[Category:肿瘤学]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">[[Category:遗传学]]</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">[[Category:免疫疗法]]</ins></div></td></tr>
</table>
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77921020：建立内容为“<div class="medical-infobox" style="font-size: 0.85em;"> {| style="width: 100%; background: none; border-spacing: 0;" |+ style="font-size: 1.35em; font-weight: bo…”的新页面
2025-12-24T15:34:27Z
<p>建立内容为“<div class="medical-infobox" style="font-size: 0.85em;"> {| style="width: 100%; background: none; border-spacing: 0;" |+ style="font-size: 1.35em; font-weight: bo…”的新页面</p>
<p><b>新页面</b></p><div><div class="medical-infobox" style="font-size: 0.85em;"><br />
{| style="width: 100%; background: none; border-spacing: 0;"<br />
|+ style="font-size: 1.35em; font-weight: bold; margin-bottom: 10px; color: #1a202c;" | 错配修复缺陷 (dMMR)<br />
|-<br />
| colspan="2" | <br />
<div class="infobox-image-wrapper" style="padding: 25px; background-color: #f8fafc; border: 1px solid #f1f5f9; border-radius: 12px; text-align: center;"><br />
[Image of the DNA Mismatch Repair proteins MLH1, MSH2, MSH6, and PMS2 forming functional complexes]<br />
<div style="font-size: 0.85em; color: #94a3b8; margin-top: 10px; font-weight: normal;">MMR 蛋白复合体修复 DNA 错配过程示意图</div><br />
</div><br />
|-<br />
! style="text-align: left; padding: 6px 0; border-bottom: 1px solid #f1f5f9; color: #64748b; font-weight: normal;" | 核心定义<br />
| style="padding: 6px 0; border-bottom: 1px solid #f1f5f9; font-weight: 600; text-align: right;" | 错配修复基因突变或表达缺失<br />
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! style="text-align: left; padding: 6px 0; border-bottom: 1px solid #f1f5f9; color: #64748b; font-weight: normal;" | 关键蛋白<br />
| style="padding: 6px 0; border-bottom: 1px solid #f1f5f9; text-align: right;" | MLH1, MSH2, MSH6, PMS2<br />
|-<br />
! style="text-align: left; padding: 6px 0; border-bottom: 1px solid #f1f5f9; color: #64748b; font-weight: normal;" | 基因组表型<br />
| style="padding: 6px 0; border-bottom: 1px solid #f1f5f9; text-align: right;" | 高度微卫星不稳定性 (MSI-H)<br />
|-<br />
! style="text-align: left; padding: 6px 0; color: #64748b; font-weight: normal;" | 诊断金标准<br />
| style="padding: 6px 0; text-align: right;" | 免疫组化 (IHC)<br />
|}<br />
</div><br />
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'''错配修复缺陷'''（Mismatch Repair Deficiency, dMMR）是指细胞内负责修复 DNA 复制错误的错配修复（MMR）系统功能丧失的生物学状态。该系统主要由 MLH1、MSH2、MSH6 和 PMS2 四种核心蛋白组成，负责纠正 DNA 聚合酶在复制过程中产生的碱基错配或滑动错误。<br />
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[Image of DNA replication errors leading to mutations in the absence of Mismatch Repair proteins]<br />
<br />
当 MMR 系统由于基因突变（如[[林奇综合征]]）或启动子甲基化（如散发性肿瘤）而失效时，肿瘤细胞会积累大量的体细胞突变，特别是[[微卫星不稳定性]]（MSI）的产生。dMMR/MSI-H 亚型肿瘤具有高度的免疫原性，是预测[[免疫检查点抑制剂]]疗效的关键生物标志物。<br />
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== 机制与生物学逻辑 ==<br />
dMMR 通过损害基因组的保真度，驱动肿瘤发生并塑造独特的免疫环境：<br />
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<div style="text-align: center; margin: 30px 0; padding: 15px; background: #fdfdfd; border-top: 1px solid #eee; border-bottom: 1px solid #eee;"><br />
<span style="font-family: 'Times New Roman', serif; font-size: 1.1em; font-weight: bold; color: #2563eb;">MMR 蛋白功能丧失 (dMMR)</span><br />
<span style="margin: 0 15px; color: #94a3b8; font-size: 1.4em;">→</span><br />
<span style="font-family: 'Times New Roman', serif; font-size: 1.1em; color: #d93025; font-weight: bold;">超突变表型 & MSI-H</span><br />
<span style="margin: 0 15px; color: #94a3b8; font-size: 1.4em;">→</span><br />
<span style="font-family: 'Times New Roman', serif; font-size: 1.2em; font-weight: bold; color: #059669;">大量新抗原产生与免疫激活</span><br />
</div><br />
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== 临床性能客观评估 ==<br />
基于临床病理规范及免疫治疗研究数据，dMMR 的技术特征分析如下。<br />
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<div style="overflow-x: auto; width: 90%; margin: 25px auto;"><br />
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