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中国肾移植受者尿路上皮癌发病率明显高于正常人,研究发现肾移植术后并发尿路上皮癌的患者在肾衰前大多有服用含有马兜铃酸(AA)成份中成药的历史。目前认为AA的致癌机制可能是AA在体内形成AADNA加合物,通过AADNA加合物使原癌基因H-Ras基因发生AT颠换突变而活化,以及抑癌基因P53基因突变失去正常功能。对于肾移植术后尿路上皮癌高发是否由AA导致、以及和CSA的关系,需要不断深入的研究。作者就肾移植受者出现尿路上皮癌和AA的关系,以及Ras、P53基因突变的可能关系做一综述。
In China, the incidence of urothelial carcinoma in renal transplant recipients is significantly higher than that in normal subjects. The study found that patients with urothelial carcinoma after renal transplantation mostly had prior history of renal failure with proprietary Chinese medicines containing aristolochic acid (AA) . At present, it is thought that the carcinogenesis mechanism of AA may be that AA forms AADNA adduct in vivo, which activates the AT transversion mutation of the proto-oncogene H-Ras gene through AADNA adduct, and the mutation of the tumor suppressor gene P53 loses its normal function. Whether high incidence of urothelial carcinoma after renal transplantation is caused by AA and its association with CSA requires intensive research. The author reviews the relationship between urothelial carcinoma and AA in renal transplant recipients and the possible relationship between Ras and P53 gene mutations.