cfDNA基本知识,单克隆免疫性球蛋白相关性肾病

cfDNA基本知识,单克隆免疫性球蛋白相关性肾病

原标题:图解 | 单克隆免疫性球蛋白相关性肾病(进阶版)

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定义

Circulating free DNA or Cell free DNA
(cfDNA):循环游离DNA或许细胞游离DNA,释放到血浆中的降解的DNA片段。

“目录号: HY-14739

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图表来源于网络

骨干部家属性

  • 长度
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    Azad A A, Volik S V, Wyatt A W, et al. Androgen Receptor Gene
    Aberrations in Circulating Cell-Free DNA: Biomarkers of
    Therapeutic Resistance in Castration-Resistant Prostate
    Cancer.[J]. Journal of Urology, 2015, 194(3):704-704.

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在1陆七bp左右(对应染色小体长度)有1个峰,并且其余的峰有着十.伍bp的周期波动,对应着核小体要旨DNA的螺距

Snyder M W, Kircher M, Hill A J, et al. Cell-free DNA comprises an in
vivo nucleosome footprint that informs its tissues-of-origin[J].
Cell, 2016, 164(1-2):57.

  • 生物学来源
  1. 凋亡和坏死

    Jahr S, Hentze H, Englisch S, Hardt D, Fackelmayer FO, et
    al. (2001) DNA fragments in the blood plasma of cancer patients:
    quantitations and evidence for their origin from apoptotic and
    necrotic cells Cancer Res 61:1659–65. pmid:11245480
    Giacona M B, Ruben G C, Iczkowski K A, et al. Cell-free DNA in
    human blood plasma: length measurements in patients with
    pancreatic cancer and healthy controls[J]. Pancreas, 1998,
    17(1):89.

  2. 移植物大概胎儿的游离DNA(参考文献见下)

  3. 自主激活的DNA的刑满释放解除劳教

    Stroun M, Lyautey J, Lederrey C, Olson-Sand A, Anker P (2001)
    About the possible origin and mechanism of circulating DNA
    apoptosis and active DNA release. Clin Chim Acta 313:139–42.
    pmid:11694251

  • 应用
  1. 胎儿的DNA会游离到孕妇的血流中,怀男孩的孕妇产妇妇血液能够检查测试到Y染色体,还可用于产前检验,二壹和1八三体

    Lo YMD, Corbetta N, Chamberlain PF, Rai V, Sargent IL, Redman
    CWG,et al. Presence of fetal DNA in maternal plasma and serum.
    Lancet
    1997;350:485–7
    cfDNA基本知识,单克隆免疫性球蛋白相关性肾病。Bianchi DW, Parker RL, Wentworth J, Madankumar R, Saffer C, Das
    AF,et al. DNA sequencing versus standard prenatal aneuploidy
    screening.N Engl J Med 2014;370:799–808

  2. 器官移植免疫性排斥发生的细胞过逝,DNA会释放到血液中,由此用于器官移植状态的监察和控制

    Beck J, Oellerich M, Schulz U, Schauerte V, Reinhard L, Fuchs U,
    et al.Donor-derived cell-free DNA is a novel universal biomarker
    for allograft rejection in solid organ transplantation. Transplant
    Proc 2015;47:2400–3

  3. cfDNA浓度与外伤、便秘的摧残程度有关

    Butt AN, Swaminathan R. Overview of circulating nucleic acids in
    plasma serum. Ann N Y Acad Sci 2008;1137:236–42

  4. 高浓度cfDNA也用于ICU身故的预测,也可用于预测脓毒症和脓毒性休克,无菌性炎症,心肌梗死和无影象学结果的脑出血病者患病意况。

    Volik S, Alcaide M, Morin R D, et al. Cell-free DNA (cfDNA):
    Clinical Significance and Utility in Cancer Shaped By Emerging
    Technologies[J]. Molecular Cancer Research Mcr, 2016:898-908.

  5. 肿瘤来源的cfDNA,能够窥见肿瘤相关的剧变、杂合子缺点和失误(LOH)、基因扩大与扩充、癌病毒DNA、抑癌基因运转子区的超二甲苯化,因而得以兑未来无创条件向下探底究肿瘤DNA

    Stroun M, Anker P, Maurice P, Lyautey J, Lederrey C, Beljanski M.
    Neoplastic characteristics of the DNA found in the plasma of
    cancer patients.
    Oncology 1989;46:318–22
    Chen XQ, Stroun M, Magnenat JL, Nicod LP, Kurt AM, Lyautey J, et
    al.Microsatellite alterations in plasma DNA of small cell lung
    cancer patients.
    Nat Med 1996;2:1033–5
    Chiang P-W, Beer DG, Wei W-L, Orringer MB, Kurnit DM. Detection
    oferbB-2 amplifications in tumors and sera from esophageal
    carcinoma
    patients. Clin Cancer Res 1999;5:1381–6
    Mutirangura A, Pornthanakasem W, Theamboonlers A, Sriuranpong
    V,Lertsanguansinchi P, Yenrudi S, et al. Epstein-Barr viral DNA in
    serum of
    patients with nasopharyngeal carcinoma. Clin Cancer Res
    1998;4:665–9
    Esteller M, Sanchez-Cespedes M, Rosell R, Sidransky D, Baylin SB,
    HermanJG. Detection of aberrant promoter hypermethylation of tumor
    suppressor
    genes in serum DNA from non-small cell lung cancer patients.
    Cancer Res1999;59:67–70.

  6. 核小体在TSS区是还是不是占据,影响cfDNA的吃水,由此能够用来揆度基因的公布情况

    Ulz P, Thallinger G G, Auer M, et al. Inferring expressed genes by
    whole-genome sequencing of plasma DNA.[J]. Nature Genetics,
    2016, 48(10):1273.

Cell Cycle/DNA
DamageNF-κBMetabolic
Enzyme/Protease-

前段时间有战友已对该文实行总论翻译,个人认为各论部分也万分值得阅读与收藏,特整理为多少个表格,便于翻看。

一96七年间,第二遍发现了乳腺导管内原位癌(DCIS)。在美利哥,每年有陆仟0例DCIS病例,约占新确诊外阴痛病例的百分之二拾伍。即使DCIS属于癌前病变,可是须要积极治疗。假使不看病,DCIS能够发展为浸润性癌,引起死亡。二〇〇六年的回想性传播疾病例分析结果展现,在少数病例中,无积极治疗的宫颈癌归西率约为百分之10-1/5。近年来的数目显示,积极治疗后的DCIS离世率唯有叁.三%。这种差别与百分之十的同侧浸润性乳房纤维瘤复发率(IBT奥迪Q叁)有关,即便接受医疗(无放射治疗)的患儿也是这么。近期,根据多少个里程碑式试验结果来规定DCIS治疗方案。乳房肿瘤切除必须与放射治疗合用,以便收缩部分复发率(尤其是浸润性复发),随后加用抗雌激素治疗提高部分控制率。但是对DCIS的诊治特点和基因特点有越多询问后,治疗相关风险不仅涉及到临床强度和不良反应,而且涉及到身体、心绪、经济等各地方。

Choline Fenofibrate (ABT-335)是fenofibric
acid的胆碱盐,可与rosuvastatin结合职能于血脂很是。

(友情提醒:图片可点开放大,看得更精通)

显著放射疗法治疗DCIS的身价

PPARCytochrome
P450

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陆个里程碑式试验鲜明了放射疗法治疗DCIS的地点。四个随机试验比较了乳房肿瘤切片后救助放射性治疗和无放射性治疗的机能,分别是United States江山男科协助医疗乳腺和肠道项目(NSABP)B-一柒试验、SweDIC试验、澳大哈利法克斯(Australia)癌症琢磨和医疗团队拾8伍三质量评定、大不列颠及英格兰联合王国癌症研商合作社团考试。各样试验都说明加用放射疗法能减少5/10的同侧浸润性子宫内膜增生复发率(IBT大切诺基)。全部多少个商讨都认证了加用放疗能肯定滑坡浸润性复发、收缩乳腺囊性增生病亡故率。不过那一个考试或对这么些考试的云集分析结果未能证实放射疗法能拉开伤者总生存时间。

相关产品

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DCIS治疗去放射性治疗的尝试

Talarozole-GW9662-Rosiglitazone-Retinoic
acid-Abiraterone
acetate-Troglitazone-Pioglitazone
hydrochloride-Elafibranor-GW
501516-CDDO-Im-Cobicistat-Fenofibrate-FICZ-T0070907-Wy-14643-

cfDNA基本知识,单克隆免疫性球蛋白相关性肾病。前面包车型大巴情节参见

鉴于放射疗法未能延长伤者总生存时间,商讨人士观望了低风险DCIS病人不用放射性治疗的功力。美利坚同车笠之盟西边肿瘤合营组(ECOG)E5194试验纳入肿瘤大小≤2.伍cm的低级别/中等级别DCIS伤者、肿瘤大小≤壹.0cm的高级别DCIS病人共700名。肿瘤边缘中性(neuter gender)最小距离为3mm。随同访问12年后,50%级DCIS病者爆发同侧浸润性乳腺囊性增生病复发率(IBTLacrosse)为14%、三级DCIS病人爆发IBTOdyssey为二五%。在那时期两组的复发率都维持安静状态。

生物活性

图解 | 单克隆免疫性球蛋白相关性肾病

丹娜法伯医院的考试提供了另1份数据。该试验纳入肿瘤大小<二.五cm、肿瘤边缘中性(neuter gender)≥1cm、一半级DCIS术后病人。在那一个低危害伤者中,8年的有的复发率>1三%,当中三分之一的伤者是浸润性复发。

Description

参考文献:

肿瘤放射治疗组(奥德赛TOG)980四考试同样评估了无放射性治疗时DCIS治医疗效果果。与ECOG和丹娜法伯的单组试验分歧,该试验病者接受保乳手术(BCS)后随便分入有放射治疗组和无放射治疗组。该考试低危害定义与ECOG试验稍有两样,肿瘤大小≤2.5cm、肿瘤边缘阴性最小距离为三mm、八分之四级DCIS病者。由于低收入不显明,提前终止了考试。可是即使在低危机人群中,放射疗法能显然降低同侧浸润性输卵管炎复发率(IBT猎豹CS陆)(七年随同访问,有放射性治疗1%
vs
无放射性治疗柒%;P<0.00一)。其余,病者对放疗的耐受性突出。两组的3级急性毒性发生率相同(约四%),放射性治疗组晚期毒性反应产生率<壹%。奥迪Q7TOG
9804考试回应了ECOG试验结果,低风险病人1旦不用放射性治疗每年净增复发风险1%。须求专注的是,那个研商未有不奇怪使用抗雌激素治疗。抗雌激素治疗比例分别为丹娜法伯试验0%、ECOG试验三成、RubiconTOG
980四检验两组加起来6二%。假如持有的病者都接受抗雌激素治疗,那么扶助放射性治疗功效不那么肯定。然则正是在严俊监测的侦查中激素治疗依从性也不高。专门评估内分泌治疗的NSABP
B-35试验中病者依从性只有11分7。

Choline Fenofibrate (ABT-335) is the choline salt of fenofibric acid
under clinical development as a combination therapy with rosuvastatin
for the management of dyslipidemia. IC50 value:Target:Several clinical
trials have been developed with Choline Fenofibrate on Reverse
Cholesterol Transport, Macular Edema and Hypertriglyceridemia.

1、 Kourelis TV, Kumar SK, Gertz MA, Lacy
MQ,Buadi FK, Hayman SR, et al.:
Coexistentmultiplemyeloma or increased bone
marrowplasma cells define
equally high-risk populationsin
patients with immunoglobulinlight
chain amyloidosis. J Clin Oncol
31:4319–4324,
2013.

DCIS治疗去不掉放射性治疗

Clinical Trial

2、 Nasr SH, Valeri AM, Cornell LD, Fidler
ME,Sethi S, D’Agati
VD, et al.: Renal monoclonalimmunoglobulin deposition disease:
A reportof 64 patients from a single
institution.Clin J Am Soc Nephrol 7: 231–239,
2012.

有点人认为,由于并未有人身自由临床试验能证实协助放射性治疗能拉开伤者总生存时间,那么很多DCIS患者乳房肿瘤切片后不用接受放射性治疗。在随同访问进程中仔细监测病情,如有指征时放射性治疗可作为挽救性治疗。可是放射性治疗无法拉开病者生活时间不等于没意义。十年的DCIS相关急性化脓性乳腺炎特定归西率唯有三%。

NCT00463606

3、 Lin J,Markowitz GS, Valeri AM, Kambham
N,Sherman WH, Appel GB, et al.: Renalmonoclonal immunoglobulin deposition
disease:The disease spectrum. J Am Soc
Nephrol12: 1482–1492, 2001.

相比总生存时间上的显然性差距,供给丰富大的样本量。那就是依照人口的数目变得实惠的原由。大数据不仅能够提供国家基本景况,而且可以让医师有足够的样本量评估治疗方案是或不是对病魔产生强烈医疗效果。

AstraZeneca

4、 Bhutani G, Nasr SH, Said SM, Sethi
S,Fervenza FC,Morice WG, et
al.:Hematologiccharacteristics of proliferative
glomerulonephritideswith nonorganized monoclonalimmunoglobulin deposits. Mayo Clin
Proc90: 587–596,2015.

对米利坚DCIS治疗和医疗效果的监测、流行病学、最后效果的切磋(Sagara等)结果给了些提醒。两千0名病者的去世率约为二%。但是加用放射性治疗能降低驾鹤归西率,有放射性治疗一.8%
vs
无放射性治疗2.一%。固然有那么些立异,约有百分之四十的DCIS病者从未接受过放射性治疗。值得注意的是放射性治疗改良病人生活时间与以下二个要素有关:高级别肿瘤、年龄小于5七虚岁、较大肿瘤。那些发现是各自随机对照试验中得不到涉及的。

Hypercholesterolemia-Dyslipidemia

5、 Ramos-CasalsM, Stone JH,CidMC, Bosch
X:The cryoglobulinaemias. Lancet 379: 348–360,
2012.

Smith等在二〇〇六年第3遍建议了展望评分方法,涉及检查判断年龄、肿瘤级别、肿瘤大小、粉刺病史等要素。Sagara等的考查结果展现,预测后果评分6分或四分(包蕴6分以上评分)伤者使用放射性治疗后减去了70%的病逝率,预测后果评分5分患儿中也存在5%的反差(P=0.0三)。那么些意识在中期宫颈息肉合营组织浸润性癌荟萃分析中获得验证,成为早期浸润性毛滴虫病伤者接受保乳手术和放射性治疗能减小寿终正寝率的要紧证据。

April 2007

6、 Nasr SH, Fidler ME, Cornell LD, Leung
N,Cosio FG, Sheikh SS, et al.:
Immunotactoidglomerulopathy: Clinicopathologic and
proteomicstudy. Nephrol Dial Transplant 27:4137–4146, 2012.

展望因素能够帮忙医务卫生职员区分哪些伤者更适合做放射性治疗。前面所讲的Smith预测验评定分是立见成效的估计工具;另3个评分工具Van
Nuys预测指数,但未曾大规模利用,未有拿走外界普遍承认。肿瘤基因分析成为区分低、中、高危机DCIS伤者的新办法。先前提到的ECOG亚组分析结果展现,低、中、高危机DCIS病人浸润性复发率分别为四%、1二%、1玖%。最近的大样本量基因分析再一次申明Oncotype
DX
DCIS评分能够猜测局地复发。近日,关怀点在低危害伤者的高复发率(10年复发率为一三%)和性价比。预测工具或肿瘤基因检查测试能够区分哪些病者受益于支持放射性治疗的数据较少。在部分病例中,这几个工具得以扶持医师和病人决定是不是利用放射疗法。

Phase 3

7、 Sethi S, Cuiffo BP, Pinkus GS, Rennke
HG:Crystal-storing histiocytosis involving
thekidney in a low-grade B-cell
lymphoproliferativedisorder.AmJ Kidney Dis 39:
183–188,2002.

另3个关心点是扶助放射性治疗DCIS的治疗周期。随机临床试验结果显示,全乳房大分割放射性治疗(3周)与行业内部放射性治疗(5周)的疗效和安全性相同。加拿大单宗旨试验和区域分析研讨也着眼了大分割放射疗法治疗DCIS病人效果。别的,乳腺局地加速放疗时间低于1周(帮助放射性治疗),且从未下滑局地控制率,可视作特定DCIS病人的科班治疗方案。特定DCIS伤者接受大分割和乳腺局地加快放射性治疗能压缩治疗时间超过拾一分之5,既能治疗肿瘤,又能担保胸部完整性。

NCT00839293

8、 Gupta V, El TersM, Kashani K, Leung N,
NasrSH: Crystalglobulin-induced nephropathy.
JAm Soc Nephrol 26: 525–529, 2015.

ACR指南和NCCN指南

Abbott

9、 Vankalakunti M, Bonu R, Shetty S, Siddini
V,Babu K, Ballal SH: Crystalloid
glomerulopathyin monoclonal gammopathy of renalsignificance (MGRS). Clin Kidney J 7: 296–298,
2014.

美利坚合众国放射性治疗组织(AC中华V)和美利坚私营国江山综合癌症网络(NCCN)指南补助协理放射性治疗作为拥有DCIS伤者常规疗法。因为,未有明了数据注脚能够甩掉放射性治疗。但是年龄较大和/或有显明合并症病者单做乳房肿瘤切片。那一个指南开中学涉嫌的熏陶治疗决策的成分有,病人年龄、合并症、局部复发的或者性(基于肿瘤级别、边缘、受体状态)等。要求牢记的是3级以上或边缘中性(neuter gender)肿瘤病人复发危机高。

Healthy

10、 Rajkumar SV, Dimopoulos MA, Palumbo
A,Blade J, Merlini G, Mateos M-V, et al.:
Internationalmyelomaworking group updatedcriteria
for the diagnosis of multiple myeloma.Lancet
Oncol 15: e538–e548, 2014.

结论:探讨者认为保乳手术救助放射性治疗是半数以上乳腺导管内原位癌病人的正式治疗方案。放射性治疗不仅减弱部分复发,而且还足以减弱浸润性复发。预测后果评分和肿瘤基因检查评定等工具尚不能够分别哪些病人接受放射性治疗后减去浸润性复发。

February 2009

11、 Stokes MB, Valeri AM, Herlitz L, Khan
AM,Siegel DS, Markowitz GS, et al.: Light
chainproximal tubulopathy: Clinical and
pathologiccharacteristics in the modern
treatmentera. J Am Soc Nephrol 27: 1555–1565,
2016.

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breast-conserving treatment for ductal carcinoma in situ: first results
of the EORTC randomised phase III trial 10853. EORTC Breast Cancer
Cooperative Group and EORTC Radiotherapy Group. Lancet.
2000;355:528-33.
11.Houghton J, George WD, Cuzick J, et al. Radiotherapy and tamoxifen in
women with completely excised ductal carcinoma in situ of the breast in
the UK, Australia, and New Zealand: randomised controlled trial. Lancet.
2003;362:95-102.
12.Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of
intraductal breast cancer: National Surgical Adjuvant Breast and Bowel
Project B-24 randomised controlled trial. Lancet. 1999;353:1993-2000.
13.Early Breast Cancer Trialists’ Collaborative Group, Correa C, McGale
P, et al. Overview of the randomized trials of radiotherapy in ductal
carcinoma in situ of the breast. J Natl Cancer Inst Monogr.
2010;2010:162-77.
14.Solin LJ, Gray R, Hughes LL, et al. Surgical excision without
radiation for ductal carcinoma in situ of the breast: 12-year results
from the ECOG-ACRIN E5194 study. J Clin Oncol. 2015;33:3938-44.
15.Wong JS, Chen YH, Gadd MA, et al. Eight-year update of a prospective
study of wide excision alone for small low- or intermediate-grade ductal
carcinoma in situ (DCIS). Breast Cancer Res Treat. 2014;143:343-50.
16.McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective
randomized trial for good-risk ductal carcinoma in situ comparing
radiotherapy with observation. J Clin Oncol. 2015;33:709-15.
17.Margolese RG, Cecchini RS, Julian TB, et al. Anastrozole versus
tamoxifen in postmenopausal women with ductal carcinoma in situ
undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised,
double-blind, phase 3 clinical trial. Lancet. 2016;387:849-56.
18.Sagara Y, Freedman RA, Vaz-Luis I, et al. Patient prognostic score
and associations with survival improvement offered by radiotherapy after
breast-conserving surgery for ductal carcinoma in situ: a
population-based longitudinal cohort study. J Clin Oncol.
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19.Smith GL, Smith BD, Haffty BG. Rationalization and regionalization of
treatment for ductal carcinoma in situ of the breast. Int J Radiat Oncol
Biol Phys. 2006;65:1397-1403.
20.Early Breast Cancer Trialists’ Collaborative Group, Darby S, McGale
P, et al. Effect of radiotherapy after breast- conserving surgery on
10-year recurrence and 15-year breast cancer death: meta-analysis of
individual patient data for 10,801 women in 17 randomised trials.
Lancet. 2011;378:1707-16.
21.Silverstein MJ, Poller DN, Waisman JR, et al. Prognostic
classification of breast ductal carcinoma-in-situ. Lancet.
1995;345:1154-7.
22.Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to
predict local recurrence risk for ductal carcinoma in situ of the
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23.Rakovitch E, Nofech-Mozes S, Hanna W, et al. A population-based
validation study of the DCIS Score predicting recurrence risk in
individuals treated by breast-conserving surgery alone. Breast Cancer
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24.Raldow AC, Sher D, Chen AB, et al. Cost effectiveness of the Oncotype
DX DCIS Score for guiding treatment of patients with ductal carcinoma in
situ. J Clin Oncol. 2016;34:3963-8.
25.Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of
Breast Radiotherapy (START) trials of radiotherapy hypofractionation for
treatment of early breast cancer: 10-year follow-up results of two
randomised controlled trials. Lancet Oncol. 2013;14:1086-94.
26.Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of
hypofractionated radiation therapy for breast cancer. N Engl J Med.
2010;362:513-20.
27.Ciervide R, Dhage S, Guth A, et al. Five year outcome of 145 patients
with ductal carcinoma in situ (DCIS) after accelerated breast
radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:e159-e164.
28.Lalani N, Paszat L, Sutradhar R, et al. Long-term outcomes of
hypofractionation versus conventional radiation therapy after
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Int J Radiat Oncol Biol Phys. 2014;90:1017-24.
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consensus statement for accelerated partial breast irradiation.
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Guidelines in Oncology. Breast cancer. Version 2.2017. Updated April 6,
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Accessed July 9, 2017.

Phase 1

12、 Vignon M, Javaugue V, Alexander MP, El-Karoui
K, Karras A, Roos-Weil D, et al.: Currentanti-myeloma therapies in renal
manifestationsof monoclonal light
chain-associatedFanconi syndrome: A retrospectiveseries of
49 patients. Leukemia 31: 123–129,2017.

NCT00680017

13、 Ravindran A, Fervenza FC, Smith RJ, Sethi
S:C3 glomerulopathy associated with
monoclonalIg: A distinct subtype. Kidney Intdoi:
10.1016/j.kint.2018.01.037.

AstraZeneca

14、 Aishwarya Ravindran, Ronald S. Go, Fernando C.
Fervenza and Sanjeev Sethi. Thrombotic microangiopathy associated with
monoclonal gammophathy. Kidney Int 91:691-698, 2017

Dyslipidemia-Kidney Disease

参考文献

June 2008

The Complexity and Heterogeneity of
Monoclonal Immunoglobulin-Associated Renal Diseases. J Am Soc Nephrol.
2018 Jul;29(7):1810-1823.

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References

[1].Jones PH, Bays HE, Davidson MH et al. Evaluation of a new
formulation of fenofibric acid, ABT-335, co-administered with statins :
study design and rationale of a phase III clinical programme. Clin Drug
Investig.
2008;28(10):625-34.

[2].Mohiuddin SM, Pepine CJ, Kelly MT et al. Efficacy and safety of
ABT-335 (fenofibric acid) in combination with simvastatin in patients
with mixed dyslipidemia: a phase 3, randomized, controlled study. Am
Heart J. 2009
Jan;157(1):195-203.

[3].Zhu T, Awni WM, Hosmane B et al. ABT-335, the choline salt of
fenofibric acid, does not have a clinically significant pharmacokinetic
interaction with rosuvastatin in humans. J Clin Pharmacol. 2009
Jan;49(1):63-71.

[4].Goldberg AC, Bays HE, Ballantyne CM et al. Efficacy and safety of
ABT-335 (fenofibric acid) in combination with atorvastatin in patients
with mixed dyslipidemia. Am J Cardiol. 2009 Feb
15;103(4):515-22.

[5].Campbell J, Mohiuddin SM. The role of a new formulation of
fenofibric acid in the treatment of mixed dyslipidemia in type 2
diabetes. Drugs Today (Barc). 2010
Oct;46(10):757-64.

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