$ $A $$ ²0²36• \6 83·····················································1 —×U54)2 (—)U54)ëë2 ()?ëŠCë2 (÷):2LŠ4 ×U54):J6 (—)U54)FQ6 ()Kë,R7 (÷)FMALT017 (A)F8 (G)7ƒ10 ÷×U54):+ë`11 (—)>ƒ[11 ()X!ƒ13 (÷)'*D$18 (A)/Š19 (G);9W24 A×U54):+327 (—)WE^327 ()^#3·································29 (÷)-X.330 (A);9W338 (G)ë"Z340 (V44 &:ëOT”_"\;ë46 ɋ3 ȄDzéƞêɣƒ备Ʌ—艾ǜĽN,ɮ͚̀-̪Ħëƺ ͠-̀Уȕ̡āǡCͤ策Š(MALT)ǡCǧë̀SɖɦɡΤLʳ˼ȄDzéƞ安并êɣŠ1994ȡ,ëʼn并͗ƌĵë(lARt)ťȄDzéƞǜ˼lLJϙ;Ͻ(˼ɦLJ̀ ëƯ¨ϙ;Ͻ),óyȄDzéƞêɣʝ̀ë—ĿΞÉ(N;ΞÉ)ʎ 补ë̀ĽNëϥ,ƀășɋçëȄDzéƞêɣǮŮɺ%ʏȡƒ比̛ϯë̙ë,Ё˕ɩ|Εìêɣʴȹ,ɐRˡ əȄDzéƞêɣʴȹĻāǓĽNëob贝fi˄Ϻ补ë½ʊŠńƷˀ¿表-ɦȎɡ部ŢƤ白ɗ͏ˀ标g,Ƣ表N;ΞÉëèΞ˼ϮëϥfiĽNÉƲʐĵϭţoʮ 补ë0ʏʺ阿1ëĥëɠ(3μɦȎɡ部ëŢƤËS泵̚¿表ëθǰ̂Ϛ,3s0ŢƤSɺ-ΞÉ˼Ϯ1ljȢ, Ƀāϲ半ϥΆ̤ɦȎŢƤë]ɣNë¹ë步ǧëÉƲ,ƒŠǙ˼补̺餐G˼ƒŢƤ˼补̺ëʷǪɺǀ,WŠ比̮ΞÉèΞʎ2ŢƤ补ë̿«(019–030ȡ)3补ƒ并ë便ɂɶ`-ëÅŠǙ-ëë¿NǮëNʹǮ˓》Ǜëɠ胞ɗ ˼˓ìɦȎɡ部ƒ播ʴȹë保̐ɦ弊剥̐ȟǒ-ž—TƢ表 ȄDzéƞÉƲ÷Ћ-˓ìɦȎŢƤʴȹ-͘gɦɡ3Š, ˒Eƒë¿S2补ëȄDzéƞêɣÉƲ3ƒȱʭ —-ȄDzéƞ (—)ȄDzéƞë¿安 ̀Ȟëì˂ŠƈRǏΕ˸ʊëëʊ”˃Ͼ20《ɅRµ比̀Ȟ”S˸ʊëëR,̀ȞЋ˼—ðëƞȝƒ ¨ϐŠƈëæȢë不ˣŠϺŠƒŸ,1Ƽ̪Ħëƺ̀͠Ȟf”ĽNͨƝ˿Θêɣ;ʿ̡āǓ 1982ȡ,AfiǏ͓ŠŠJ.RobinWarrenëBarryJ.MarshallʦīŠ̀Ɖıř策Š补ÏLjȯͣ》0Dz͈Ϸ1ëƞ,Š˼0ˬɚƞͤ˸ʊë11984ȡťɃŠ˼0Ȅˬɚƞ11989ȡ,0Ȅˬɚƞ1<ô˼0ȄDzéƞ12005ȡ,ȧ”ƒʊljŠŠ保ŠŧʨΗJ.RobinWarrenëBarry J.Marshall,ƒKꃃ¿安ȄDzéƞĻɃS͚̀ë̪Ħëƺ͠ĽN补ëЋƒ ȄDzéƞë¿安ƒȽǛ˽s¸ȡë̀Ȟ̋ƞS¢,ůƢǛɦLJƒëëÉŠ͚̀-̪Ħëƺ͠-̀MALTǡCǧë ̀ë̹Ȳ别Ƣ表̡āë͗ƌ˼ƒë̀ȞëSʄ̡āëĽNƒƢǛS̹ë包,SƒȄDzéƞêɣƒë-σµ-ŠǙë̡āĽNÉƲÇȊŠǛƘfiž表(¾)ʊëŠ˒ë ȄDzéƞʝ—布ƨͣƞ,˕ƒÏLjȯͣƒë白¿˕Šƈ-被ͣ3š胞ɗƨë,ɐʊgĩǺ—+S374˸白͢3š̙ȯͣ48~72̬ʐVƒgoëŖϷƞǴ ȄDzéƞʝ˸̬ëDz͈Ϸîǂ倍ëƞ,ë̽ȯͣëSąŠ̛˸Ɖ̙pS̾-C̾ŠČȨϷ,˕ƒ͘gȯͣʐŗ-被ͣɟÀŠSƥʊʿ板ǒ̙ƞ˕ƒ¿ʊɖ̾Gƞ˕ƒ²比oʲDǼ,SëƞΦ«补ɅāŠЋƒ9̋ë̛ŏȕ,R、ʊ版Иȟ、ʊÑâëȣʿǽ-͢Ħǽëċ͢Ħëǽ,ƒƒΕŝ¨ƞ布ĻŤǑ̡āëσµÇÁ ȄDzéƞĴ;策g±Τ1.6Mb,EëĴ;Τ1600ð ȄDzéƞĴ;策补̸Ĵ;S¨ϐëϙNċ“补¿ĭϥ胞ЋƒȣʿǽĴ; (Ϯ胞˼ureA-ureB)EëȣʿǽëɃƒS³ʐŗȞțʩì˂ëŠƈ9flaA-flaBEëDǼëɃëŠŮɎΦ«ȟǒ9babA-sabA-hopQEëУã;Ͻ,SˮoУã¨ϐĻΘˁϮ̡ģЋƒċ“补¿ĭϥ胞ЋƒvacAëcagAÏLEë2布ϥ胞®ʿ,ΘϙNȈɏ̡āvacAĴ;Së比ȄDzéƞƞϫ补”S,ɃEëëϙëMŠȮͤNG®ʿMSUÏƞϫ补KcagAĴ;̂ΕĴ;策ϙNcagPAI补,cagAĴ;EëëëM®ʿ̡āƒ(CagA)ƒ˟ċcagPAIEëëȄDzéƞIV̽ÏŠ艾ˣ,ϲKëMȞ备Ʌ—艾ǜÏϽʴȹëåGëëMNGcagPAI͡ëƞϫ?倍ëƞϫë比ôɎë®ǒ,kƒë比ª͓ əÏLjëȄDzéƞƞϫ¬”ScagPAIȄDzéƞ¾Θ ɦLJú”ʳ˰ȡŠôƎ,˼ʞRˡˁϮŠƈ,ȄDzéƞĴ;策p安ì±贝ëëë¸ͤë,SRˡɦɡë Κŗ”S ̛ϯb贝Ĵ;(策)Ï냃ëΘɦLJgɂúžĦċ“补ëȄDzéƞϙNĵëë比ϥ胞Ћƒ,<oƒƒΕŸÅ ˺ȞëɦLJɈЖÏë(÷)êɣǨ̿NŠ ȄDzéƞʝ¾播.˄ɦLJǎƒŮgëêɣëƞ½—,SɦLJ布]ɣNNΟ˕补,ȄDzéƞêɣ变oëêɣɦɡëȔ½fi-êɣs͆ʐŗ½Ǝ¬ʏÏƂɦȄDzéƞSɖêɣǮΤ˼50%(18.9%~87.7%),SRˡ Κ-Rˡɦ ɡêɣǮ比Ůfib贝ȄDzéƞêɣΘʁİŠń3šë½ʊ3š̡ā,ɍ¿ëōë¿表补ëōȄDzéƞêɣ?¿ ëōôf”ʑ̖ĄΘȄDzéƞêɣë¿ʊȈɏ̡āʩŭΝʴȹë-ëŀëëϱŠƈ-Ůbë½ʊ3š-Rëðɦ½ʊ̖ĄͨʝȄDzéƞêɣë˹̜;ʿ补ëȄDzéƞɦɡêɣǮſ50%,RˡɦɡêɣǮS35.4%~66.4%½ŗ,3êɣǮìΕnʠ,oɦêɣǮìΕ¼ˢ 1.]ɣ必 ɦLJʝȄDzéƞêɣë˻—ϾɢˁϮ,]ɣ必Ϯ胞ʝ ȄDzéƞêɣŠ,ƀăSðL«ë˕Ȟͨ比ř》ëR, RëoƒɦLJêɣëë̛”̜ 2.]P˧Š ȄDzéƞë]P˧ŠϮ胞1Ƽ0Ƴ-Ƴ1]Pë0Ð-Ƴ1]P,ʴ必ë-ʑ必ëë保必ë]Pͨʝʩëāϲë ]P˧ŠȄDzéƞƒ˟ċêɣŠëȩ˨ë-ëūʑëƒĻʩ̊ɣëʴëʑë]P,ͨƒ˟ċ̪®RëëȞƉZЋ 保必ë˧Š]Pō˞Ȟ]Pʝ̹¿êɣë编êɣëϥ胞˧Š,ō˞o弊 ½ŗf”ëêɣ˧Š1ƼúƒXë-ëū́ʑ-Rëë½ʊ ̖Ą标Ɏëƒùƶ-ùɼëë,˓iÏXë,Cȉʑƒ<̊ɣëʑȷëƒʩ̊ɣëʴ,比采ΕÉϕȄDzéƞSō˞o弊ŗë]P 3.Ͷêɦɡ ɦLJƒȄDzéƞɀIͶêȉͷƒȟʩ˅ëɦôɭͶêɣȄDzéƞͮ];ʿƒȟİΆ̤ð˕ƒȄDzéƞêɣëͶêë,Ș澳ɦƒȟë比ƒȄDzéƞêɣôìëͮ]Ͷêë ˄Ϻ补ëʁİŠńƷˀ¿表ë保Ǚ½ʊ3š̛ϯåɸ, ȄDzéƞêɣǮpϭȡ̙ëɘʜ,1983-2018ȡ35ȡŗƒ60%ƒɺëS50%ƒ̙,ëȡǣ策êɣǮ̙ëô˼ë̛Rˡ əƒȄDzéƞêɣëΞÉëèΞʎĻɎ±Rˡ,补ëRˡɦɡêɣǮGĦ“±ͨR—ϙ ¾-ȄDzéƞêɣ̡āĽN ȄDzéƞêɣ—+ë比Ǻë-s͆ë˒ë,˟ċΘˁϮ;ʿ-Šƈ;ʿŪģЋƒ备¿̡āĽNȄDzéƞêɣ̡āĽNɁj,1Ƽ̪Ħë̪Ħƒë¸布ĽN,Ƀ补侧f”ë1Ƽ͚̀-̪ĦRë-̪Ħëƺ͠-̀MALTǡCǧ-̀,ƒĻȉͷë̬͋Iśɽëϼ昌-RëΟ;ëɟ˜ëŠ͋ (—)ȄDzéƞ͚̀ ȄDzéƞêɣ备Ʌë͚̀m˼0ȄDzéƞ͚̀1,ηɦɡSÙ͚Në70%ƒɺë比ȄDzéƞϾɢêɣƞϫ¬ë比ϙNë,ë比ȄDzéƞêɣŠƝ”SNljŠëǺëı«ë͚̀åG ȄDzéƞ®ʿĻ¸布ϙN;ϽŠΘϙ͚̀ċ“,ƒ˟ċϏŰ˅ɹ̀УȕɺȱëM,Š笔ɺȱëMʟËëM;Ͻ备Ʌı«ë͚̀êɣ《ɂƒK安˼³ɂëļë͚̀9SgɂêɣŠ补,Ϯ胞p安˼Ǻëı«ë͚̀,Uσ¿表˼ ˾ˆë͚̀Šô半ϥëУȕNG,ɮëɺȱĦʊëɺȱȞǧG ȄDzéƞ͚̀ʝ—布ƒÉ-ƒŠëĽN,˟ċCȉȄDzéƞêɣƒƒÉϕƜfiUÏǺë͚̀ë¿ʊêɣëϙë͚̀ͨƒ˟ċóyȄDzéƞ»ŠΜoƒóyȄDzéƞêɣĞ,Ǻëı«ë͚̀īŠë̀Уȕ͚并ƒˮS̪ƒ, ̀˂ÏŠϭTĮßχf,UÏǺë˾ˆë͚̀ͨƒ》安Ƞ餐 (¾)̪Ħëƺ͠ ̪Ħëƺ͠ʝϔ̀˂/̀ƒǽϾʄ̪Ħ备Ʌëƺ͠,ƒ ̀-ʏ¾ϔëƺ͠侧f”Ƀ¿NĵëϮ胞ΘУȕ˅ɹëУȕϾʄÉΛ-́ß;ʿƒě比ā,ɮȄDzéƞêɣ-ëЙ˕LJƥ͚ͥëëƒ-̀˂ķı̀ƒǽΟ备ɅУȕϾʄ̪Ħ ȄDzéƞêɣʝ̪Ħëƺ͠ëϮ胞N;,ȄDzéƞêɣƒ˅ɹ̀/ʏ¾ϔëУȕȼμ,»ëУȕÉΛ-˅ɹ́߃ěȄDzéƞêɣŠ¿ʊ̪Ħëƺ͠ëæǮʝëêɣŠë6~10:,ȄDzéƞêɣŠ补比15%~20%ƒ¿ʊ̪Ħëƺ͠,̋ȄDzéƞêɣŠĚɽ¿ʊ̀-ʏ¾ϔëƺ͠,90%ƒɺëʏ¾ϔëƺ͠ë70%~80%ë̀ƺ͠ƒȄDzéƞêɣ备Ʌ̪Ħëƺ͠īŠȄDzéƞř》Ǯ̛ͨϯìΕɀ˟ɦɡyǛƒëƒëЙ˕ƥ͚ͥŠɃƒđ”Ο;备Ʌëƺ͠ƒ,óyȄDzéƞƒŠΜfi¸ʳ̪Ħëƺ͠ƒëë̀˂ÏŠëͥ늊̀Уȕ3;ëƒëƺ͠Μ,˝ͥĞͶß¿9óyȄDzéƞƒ̛ϯëëƺ͠ß¿Ǯ,žƺ ͠gɂŠΜ(÷)̀MALTǡCǧ ̀MALTǡCǧʝ—布ë±¹ëë步ǧ,ȄDzéƞ êɣʝɃ侧ϥ胞ëϙN;ʿƗˣƒ,Sɖ比75%~90%ë ̀MALTǡCǧīŠ.˄ȄDzéƞêɣχf̀Уȕ补ͨ”SMALT,ȄDzéƞƥΟȟëķɃ标ϑ/餐Ħ»¿ʊǡCǧë比ȄDzéƞ͡ëë̀MALTǡCǧ,̋DZĖ布Ǡ~ÏɂëNljÏĿ,¬WŠȄDzéƞóyŠǙ9ȄDzéƞóyŠǙĞ,Τ÷Ͻ¾ëƓ̟ë̀MALTǡCǧƒëˮSĩŷ (ʺ)̀ ̀ë¿ʊΘ¸布;ʿ̡ā,1Ƽêɣ-Šƈëͮ];ʿȄDzéƞêɣ¾ëɠʝ̀(Ƀʝ²̀)ëϙN;ʿ,S̀ë¿ʊë¿表ċ“补Ɲ¿ĭϥ胞ëϙNЋƒóƗNlj策ŠŠK安ƒť̀Ï˼ë̽ëëǻ̽2布LJ ̽,ƒë̽侧˼f”șɋϮǨë̀¿ʊ̡āŠʶƒ˼,ƒ͚并źëë̽̀¿ʊŠǎǛχf̀Уȕ-Ǻëı«ë͚̀-Ǻë˾ˆë͚̀-ëĦʊ-ɺȱȞǧGS̀ë—艾ǜ͝Gċ“ȄDzéƞêɣĻɃ备¿ëǺë͚̀ʝ̀ ¿ʊëʦ胞ɋɛ;ʿ,Ƀs͆êɣƒȟϙ̀Уȕƒȟë̞ ˕ëɲƒ(˾ˆ),Ļ̀Uχf̞˕ë̬"ɺȱ<ë̽ëM ˖Ī(ëĦʊ)9ͨƒ笔ˁϮDNA˅ɹ-笔DNAŐĴĦƒèɤëM靶,]ȄDzéƞRŽ备¿̀Уȕ͚并Ã,ɃSɋNGë¿ʊë¿表补ͨʝϮ胞ϙN;ϽȄDzéƞës͆êɣΘˁϮͮ]ͶêëëƒUŠƈ;ʿŪ ģЋƒ,ƛ¨Ǜ̀¿ʊë¿表ž“ ̀ʝë˼f”ë¹ë步ǧ,ͨʝSɖ并ʹ¾ëϮ胞Ο;½—2020ȡSɖ̹̀¿Në109˰ë,;̀ʹ¾77˰ë̀Sɖ¿NǮSf”¹ë步ǧ补̂ǜ¡5̂,备 ¿ʹ¾ʳ̂ǜ¡3̂补ëʝ̀ëìĽNëëō,̀ ¿NǮ̂ǜë比¹ë步ǧ补ë¡4̂-NʹǮë¡3̂2020ȡ补ë̹̀¿Në47.9˰ë,ʹ¾37.4˰ë,ÏLηSɖ̹̀¿ëʹ¾Nëë44.0%ë48.6%补ë̀ϙë ʹ¾NëηSU并ʹ¾Nëë12.4%˄Ϻȡǣ标g,̀ ¿NǮëNʹǮͨϭţʋì补ë̀便ɂ¿安ǮɩŮë,¸ʳNë¿安ʐë˼ž表ɂŠ˯ɂ,ΞĞb,5ȡ̡ƒʊ”ǮΤ35%,ë̛ëΕ”=(80%)ëĎë(75%) ȄDzéƞʝșɋ˻—ɠ¨ëΘ̀¿ʊȈɏ̡āëëƞëNΟ˕1994ȡ,ëʼn并͗ƌĵë(IARC)ťȄDzéƞǜ˼ILJϙ;ϽȄDzéƞêɣŠ补比1%~2%İ¿表˼̀2018ȡSɖΤ比220˰êɣ̡ā̹¿并Në,Ƀ补81˰ƒ;ΕȄDzéƞêɣ,η36.8%óƗ̀ ¿ʊëŷȿÛ,Ϯ胞ƒÏ˼НȄëëНȄ,Ƀ补ëНȄô˼f”2018ȡSɖ̀Në̡āʳƗ̛ʘ:ëНȄ ηSÙë82%,Ƀ补Τ90%ëëНȄƒ;ΕȄDzéƞêɣƜfiUÏ̀Në¿ʊΘȄDzéƞêɣ̡ā,补ëɦɡêɣǮΤ50%,ƒȄDzéƞêɣ备Ʌë̀S补 ëë比ìĽNëSɖêɣ̡ā并Në补Τ78˰(35%) ¿ʊS补ë,Ƀ补34˰ƒ;ΕȄDzéƞêɣ,Τη44%ƲëȄDzéƞêɣʝΞÉ̀¿ʊë侧ϥ胞-侧ƒƲëʥ ´óyȄDzéƞƒ̛ϯëë̀ĻɃɋNG¿ʊë” ̜,ʝɦLJ̀ë—ĿΞÉʎ(阿)ɃƒĽN ȉͷë̬͋Iśɽëϼ昌:ȄDzéƞêɣΘȉͷë͋ ̬Iśɽëϼ昌ë¿ʊ比ā,ƒī比ȉͷë