李梦雨　金红　徐明鑫

[关键词] 液体活检;循环肿瘤细胞;细胞外囊泡;循环肿瘤DNA;精准医疗

[中图分类号] R743.3          [文献标识码] A          [文章编号] 1673-9701（2021）27-0189-04

Progress in clinical research of liquid biopsy in cancer

LI Mengyu1   JIN Hong2   XU Mingxin2

1.The First Clinical Medical School， Mudanjiang Medical College， Mudanjiang   157011， China; 2.Department of Laboratory Medicine， Hongqi Hospital Affiliated to Mudanjiang Medical University， Mudanjiang   157011， China

[Abstract] Cancer is a serious threat to human health， and the global cancer burden is increasing. With the advancement of science and technology， people have begun to analyze cancer from the genome level. Under the background of precision medicine， liquid biopsy， the blue ocean of genetic testing， has also risen rapidly. Compared with traditional biopsy， this technology has the advantages of low cost， convenience and speed， and solves the problem of clinical sampling. In the future， it is expected to be applied to the fields of early screening， dynamic monitoring， and personalized medicine for cancer patients， and has a broad medical prospect. This article first introduces the types of liquid biopsy based on different body fluids， and then integrates and analyzes the latest technology and methods of liquid biopsy based on recent research and practice at home and abroad， and discusses the new clinical research progress of liquid biopsy in cancer.

[Key words] Liquid biopsy; Circulating tumor cells; Extracellular vesicles; Circulating tumor DNA; Precision medicine

由于人口增長老龄化等因素，全球近一半的癌症病例和超过一半的癌症死亡病例将发生在亚洲，中国作为人口大国更是深受癌症的荼毒[1]。随着人们在基因组层面对疾病认识的刷新，精准医疗孕育而生，其基础就是对肿瘤进行精确的病理诊断。组织活检虽是诊断肿瘤的金标准，但其有着很大的局限性：①创伤性大，不宜重复获取;②肿瘤具有异质性，使组织活检所得基因信息片面。相比之下，液体活检无创且易管理，依赖于肿瘤细胞等可能释放到体液中的物质来获取肿瘤的全面信息，完美克服了肿瘤异质性的问题，不仅有利于癌症的早期诊断，还有助于医生制订更精准有效的疗方[2]。本文就液体活检在癌症中的研究新进展进行综述。

1血液类型的液体活检

液体活检常依附于血液检查。肿瘤或转移灶融入血液中的循环肿瘤细胞（Circulating tumor cells， CTCs）、细胞外囊泡（Extracellular vesicles，EVs）、循环肿瘤DNA（Circulating tumor DNA，ctDNA）和循环RNA[主要是微小RNA（miRNA）]是目前已知的检测肿瘤和癌症辅疗的关键标志物。

1.1 CTCs

CTCs 指从原发性肿瘤或转移灶脱落并释放入血的肿瘤细胞，少数CTCs 可逃逸机体的免疫作用在血液循环中存活并播种新的转移灶[3]。中性粒细胞和CTCs相互联合可促进血液细胞周期的发展，扩大CTCs的转移潜能，但CTCs的生物学特征和脆性及如何定义白细胞与CTCs之间相互作用的分子特征尚未可知，故研究人员可从此角度出发探讨其机制，可能对癌症的治疗有重要意义。……