???? ???????? ?????, ??????? ??? ?????????-?????? ??????????? ????? ????????? ???????????? ??? ???? ???? ?????? ?????? ??????
?????? ??? ??????????? ????? ????????????? ????? ??????, ??????? ?????? ??????????? ?????? ?????? ???????? ???? ????? ?????? ?????? ?????????? ?????????, ???? ???????????? ?????? ????????????? - ??????? - ??? ????? ?????????-?????? ??????????? ????? ????????? ??????? ??????????? ??????????????? ????? ??????? ??????????? ??? ???????? ???? ????? ?????????? ?????? ?? ??????? ??????? ???????? ?????? ?????? ???? ?????? ????? ???????? ?????? ???????? ?????? ??????, ?? ???? ??????????? ????? ???????? ?? ???? ?????? ?????? ???? ?? ???????? ???????? ???????? ???? ?? ??????? ?????? ????????? ???????? ?????????????? ????? ??? ???? ???????? ???: ????? ??????, ?????? ??????????, ????????? ???????? ??? ????? ?????????
?
????? ???????: ??????? ????? ???: ?????? ???? ?????????-?????? ?????
?.? ?????????????? ???????? ????????? ????????
?????????? ???????????, ?????? (??????????????) ???????? ??? ???? "????? ??????" ?????? ??????? ???? ????? ????? ??? ???????, ?????? ??????? ??? ???? ??????, ?? ???????? ???????????? ??? ????????? ??????? ????? ??????? ???????????? ???????? ??????? ??????, 2018 ???? ????? ???????? ????????? ??????? ???? ?????? ???????? ???? ??????????? ???????? ?? ???????? ???????????? ????????? ??? ?????? - ?????? ?? ?????????? ??? ??????? ????? ?? ??????? ???????? ????? ???????? ??? ????????? ??? ????????? ????? ????????? ???? ???? ???? ???? ????, ??? ????????? ???????? ??? ?? ?????? ????? ?? ???????? ???? "????? ???? ??????????? ??????? ???" ?? ???????????????? ????? ???? ??, ??? ???????? ????????? ??????? ???? ???? ???? ????????????? ???? ?????
?
?.? ????????? ????? ????????????
????????? ??????? ??????, ????????? ???????? ??? ?????? ??? ???? ??????????? ??????? ????? ???????? ????? ??? ???, ???? ?????????????? ????? ????? ?????? ?????? ???????? ???? ????????, ??????? ??????????? ???? ???????-6-????? (M6P) ???? ???, ?? ?????????? ?????? ????????? ???? ???? ??? ????? ????? ????? ???? ?????????? ????????? ???????? ?????????? ??????? ????????? ?? ?????????? ?????? ???????: ??????????? ????????????? ??????? ?????????? ???? ??????????????????? ????? ????, ??? ????????????? ????? ????????? ???? ????? ?? ??????????? ????????? ??????? ??? ??????? ????? ????????????? ??????? ???? ?????, ??? ?? ?????????-?????? ???????? ?????????? ??? ?? ???????? ?????? ??????? ?????? ??????
?
???????? ???????: ????????? ???????: ??????????? ???????? ????????? ???????? ??????
?.? ???????? ??????: ????????? ????? "????? ??????" ?????? ?????? ???? ????
?????? ????? ?????????? ?????? (?? ???? ???????? ?????? ???????? ?????? ???? ??????????????? ??? ?????? ???) ????? ??????? ??????? ????????? ????? ??????? ????? ??????? ???????? ????? ??????? ??????? ?????????? ??????? ???? ??????? ?? ???????? ????? ?? ??????? ????????? ???? ?????? ???? ??, ??? ??????????? ?????? ???????? ???? M6P ???? ??? ??? ????? ????? ?????? ??????? ??? ???? ?? "????-?????" ???? ??????? ?????????????? (GLUT) ?? ??????????? ??? ??? ??, ??? ??????????? ??????????? ??????????? ???? ??????? ????? ??????????? ???, ??? ??? ????????????? ??? ???????????????? ??????? ?????? ??? ?????????????? ?????????? ???? ????, ?? ??? ??????? ????????? ???? ????? ???? ?????? ??? (????? 1)?
?
?.? ????????????: ?????? ?????????????????????? ????????????
???? ???? ????? ????????????? ??? ?????????? ???????? ???? ???????? ??? ???? ???? ?? ??????? ????????????? ???? ?????????? ??? ??????? ????????? ???? ?????????? ?????????????? ?????? ???? ????? ????????? ???? ???? ?? ??????? ????? ???????? ??? ???????????? ????????? ?????????, ??????? MYC ?? ???????? ??????? ????????????? ?????? ????? ???? ??? ?? ???????????????? ????????? ??????????????? ?????????? ???? ?? ?????????? ????????????? ?????? ?????? ????? ??????????? ??? ????? ??????????????? ?????? ???, ???????? ?????????? ?????? ??????? ???? ???? ????????? ?????? ?????? ????
?
?.? ????? ????????: PD-L1 ?? "????????? ????" ?????? ???
??? ?????????? ????? ??, ??? ?? ???????? ????? ?? ??????? ?????? ????? ?????? ?????????? ?????? ???? ????? ?? ??????????????? ?????????? ???????, ??????? ??????? ?????? ?? ??????? PD-L1 ????????? N-????????????? ????????? ????????? ??? ??? ???? ???? ??? ?????? ???????????? ???? ????? PD-L1 ???????, ?? ???? ???????? "?????????????? ????" ??????, ?????????? ??? ?????? ?????? ???????? ????, ??? ??? T ????? ??? ???? ????? ??????? ???? ???????? ???? ?????, ??????? ??? ????????-PD-1 ???????????? ???????? ?????? ???????? ????? 78% ? ??????????, ?? ??? ??????? ????? ???? ???? (????? 2)?
?
?????? ???????: ?????????? ???? ???????????: ?????????? ???????? ??????????? ??
?.? ?????-??????????? ??????? ???????
?????? ?????? ?????????, ??????? ????-?????????? ????????-????????? ???????? ???????? ?????? ???? ??????? ?? ??% ??????? ?????? ?? ????? ?????????? ????????? ???? ??????? ??? ????????? ??? ??? ???? ?? ???????? ????? ?????? ??% ??????? ???????? ?????? ??? ????? ?? ??????? ???? ??????????? ????????? ???? ??? ?????????????????, ???????????? ???? ??????? ??? ???, ??????? ????? ????? ??????? ?.? ??? ?????? ???????, ?? ?? ??????????-????????? ??? ??????? ???? ??????? ?????????????? ???? ??????????? ????????? ???????? ??????? ???????? ????????? ???? ???? ?? ??????-??????? ???? ????????? ??? ???????????????? ??? ?????? ??????????? ????? ???????? ??????? ???????? ????????
?
?.? ???? ???????? ???? ?????? ???????
??????????? ?????-??????????? ???? ???? ????????, ??????? ??? ??????????? ????? ??????????? ???????? ???? ???? ???? ???? ????? ????? ????????? ????????? ???????? (NCT05220739) ??? ????? ???? ??????????? ??????? ????? ???? ????????? ??????? ????????? ???? ????? ???????? ???????? ???? ?????? ?? ????? ? ????? ??? ??????? ??????? ??? ???????? ?????? ??? ???? ???????? ???????? ?????? ????? (ctDNA) ?????? ??????????????? ????? ???????? ??????, ??? ??? ?? ?????? ????? ????, ??? ?????? ??% ???? ????? ????????? ????? ????, ?? ????? ???????? ????????? ???? ?????????????? ?????? ?????
?
?.? ??????????? ???????? ??????? ????
???? ????????????? ???? ??? ??????? ??????, ???? ?????????-?????? ?????? ???????? ???? ???? ??????? ???? ??????? ???????? (???????? ? ???? ??????????? ??????? ???????), ?? ????????? ??????????? ??????????? ????????? ????? ?????? ????????, ????????? ??????????? ??????????? ????? ????????? ?????? ?? ??? ?????? ???? ????, ???????? ??????? ?????? ???????????? ?????? ??? ????? ?????????? ?? ?????? ???? ?????? ????? ???????, ??????-???????? ????????????? ????????? ??????-??????????? ????????? ?????? ??% ??????? ?????? ???? ????, ?? ????????? ?????????? ?? ???????? ????
?
?????? ??????? ?????? ??? ????????: ????????? ????? ???? ???????????
?.? ???????? ??????????? "????-???? ???????" ??????
??? ???????? ?? ??????? ???? ??? ???? ??????? ????? ????????? (PMI) ?? ???????? ??????? ???? ????????? ??? ???????-6-??????? ?????????-6-?????? ???????? ???? ????, ?? ???????? ????????????? ????????? ????? ???? ?? "???????? ???????" ?????? ?????? 7% ??????????? ????????? ??????? ?????? ??? ???????, ?? ???????????? ????????? ??????? ????? ?????????????? ?????? ?????
?
?.? ????????? ≠ ??????: ??? ???????????? ?????
???? ????????? GRAS (?????????? ?????? ?????? ???????) ?????? ?????? ?????? ????????? ???? ???????? ??? ??????, ???? ?????????-?????? ???? ?? ???????????? ??????????? ???? ??????? ?????? ?????? ????????? ????????? ??? ???????-?????????? ???? ???? ?? ??????? ???? ?????? ??????? ??? ???????? ???????? ?????? ??? ????, ???? ?????????? ????????? ????????????? (???? ????????????) ????????? ????? ?????? ????? ?? ???? ????????? ???????? ?????????? ??????????? ??? ?????????????????? ???????????????? ???????? ????? ????? ????
?
?.? ????????? ???????? ??? ????????? ??????????? ????? ????
"?????????-?????? ????" ??????? ???????? ?????? ???? ????, ???? ????????? ??????? ????????? ?????? ?????????? ???????? ????????? ??????? ??????? ?????????????? ????? ????? ???? ???????? ???? ????? ???????? ????????? ???? ???? ?????, ??? ????? ?? "????????????? ??????????? ?????? ???????? ?????? ??? ???? ??"? ?????????? ???????????? ?????? ??????? ??? ????? ???????????? ???? ???? ????? ????? ?????? ?????????? ?????? ??????????
?
???????: ?????? ???????? ??????? ?????
????????? ?????????-?????? ?????? ???? ???????? ????? ??? ???? ??????? ???? ?????? ???????? ???, ??? ??????????? ????????? ???? ?????? ???????? ??????????????? ???? ???? ??? ??? ???????? ??????? ?????????????????????? ????????, ?????????? ????? ???? ???? ???? ??? ???? ??????? ???????, ?? "?????? ??????" ????????? ???????? ?????????? ????????? ????? ???? ????? ???? ?????? ????????? ??????, ???? ??? ????????? ?????? ???? ???? ?? ????????? ??? ?????? ??? ??????? ????????? ???????-??????? ???????? ??????????? ?????????-?????? ?? ???? ????? ????? ???? ????? ??? ???? ??????? ??????? ?????: "??? ??????? ???????? ???? ????, ??? ??????????? ??????? ????? ????????? ???? ??????"
?