Zhaoyin Wang,1 Qingquan Dai,1 Shaozhang Yan,1 Xinyue Sun,2 Gang Wang,2 Ziwei He,3 Yinxiong He,1 Zhe Wang,4 Liwei Wang,1 Chuang Liu,1 Tingting Liu,1 Ruiyun Gao,1 Puguang Zhao,1 Kuanyu Wang2 

1Graduate School, Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China; 2The Second Department of Surgery, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China; 3Medical Affairs Department, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China; 4Endoscopic Diagnosis and Treatment Center, The Third Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China

Correspondence: Kuanyu Wang, The Second Department of Surgery, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China, Email wangkuanyu_1964@163.com
摘要： 微波消融（microwave ablation，MWA）是一种微创热消融技术，其通过迅速升高组织温度（约60–100 ℃），利用介电滞后效应实现对甲状腺肿瘤的有效消融。高强度电磁加热可导致不可逆的蛋白变性、细胞膜破坏及凝固性坏死。在消融区内，线粒体和内质网遭受严重热损伤，并伴随DNA双链断裂，最终诱导细胞通过凋亡、焦亡及铁死亡等多种程序性细胞死亡方式发生死亡。与此同时，坏死组织可触发显著的炎症反应，促进细胞碎片清除及组织重塑。损伤相关分子模式（damage-associated molecular patterns，DAMPs）及热休克蛋白（heat shock proteins，HSPs）从死亡细胞中释放，介导免疫原性细胞死亡（immunogenic cell death，ICD），并促进树突状细胞激活及细胞毒性T淋巴细胞（CTL）应答，从而诱导系统性抗肿瘤免疫。此外，热损伤破坏局部血管结构，引发短暂性缺血与缺氧，激活缺氧诱导因子-1α（HIF-1α）信号通路，并通过转化生长因子-β（TGF-β）及血管内皮生长因子（VEGF）信号促进血管修复与纤维化过程。外周免疫状态的改变及免疫相关基因的激活提示，MWA 可能与免疫检查点抑制治疗产生协同效应。总体而言，MWA 不仅能够实现局部肿瘤的有效消融，还可重塑肿瘤免疫微环境，为甲状腺肿瘤中热消融联合免疫治疗策略的开发提供了理论依据。