Article(id=1211269040002166842, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.03.15, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1589731200000, receivedDateStr=2020-05-18, revisedDate=1612281600000, revisedDateStr=2021-02-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718643427, onlineDateStr=2025-12-26, pubDate=1616860800000, pubDateStr=2021-03-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718643427, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718643427, creator=13701087609, updateTime=1766718643427, updator=13701087609, issue=Issue{id=1211269034906088369, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='3', pageStart='213', pageEnd='318', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718642212, creator=13701087609, updateTime=1766718779849, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269612247838856, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269612247838857, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=306, endPage=310, ext={EN=ArticleExt(id=1211269041226903622, articleId=1211269040002166842, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress of cancer-associated fibroblasts in gastric cancer, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Gastric cancer is the fifth leading incidence and the third leading cause of death in the world. Gastric cancer patients in China are often in advanced stages and have a poor prognosis. Cancer progression depends not only on the cancer cells themselves, but also on the physiological state and composition of the tumor microenvironment in which they are located. Cancer-associated fibroblasts as the major cell type in the tumor microenvironment played an important role in cancer progression. This paper mainly expounds the origin and classification of cancer-associated fibroblasts, and its research progress on gastric cancer invasion and metastasis, growth, angiogenesis, matrix remodeling, immunomodulation and cancer suppression, and summarizes the relevant anti-tumor strategies by targeting cancer-associated fibroblasts in gastric cancer, to provide more information for use of cancer-associated fibroblasts in targeted therapy of gastric cancer.

, correspAuthors=Yuan-Yi Xu, authorNote=null, correspAuthorsNote=
*E-mail:
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胃癌是全球发病率第五、病死率第三的癌症。在中国,胃癌患者就诊时多为晚期且预后较差。癌症进展不仅取决于癌细胞自身,还取决于其所处的环境即肿瘤微环境的生理状态与构成改变,其中癌相关成纤维细胞作为肿瘤微环境中重要的细胞类型,在癌症进展中发挥着重要作用。该文阐述癌相关成纤维细胞的来源和分型,以及对胃癌侵袭转移、生长、血管生成、基质重塑、免疫调节及抑癌等方面作用的研究进展,总结靶向胃癌中癌相关成纤维细胞的相关抗肿瘤策略,以期为癌相关成纤维细胞应用于胃癌的靶向治疗提供更多信息。

, correspAuthors=徐远义, authorNote=null, correspAuthorsNote=
徐远义,E-mail:
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郭嘉欣,硕士研究生,主要从事消化道肿瘤免疫方面的研究。E-mail:

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郭嘉欣,硕士研究生,主要从事消化道肿瘤免疫方面的研究。E-mail:

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郭嘉欣,硕士研究生,主要从事消化道肿瘤免疫方面的研究。E-mail:

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胃癌癌相关成纤维细胞研究进展
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郭嘉欣 , 徐远义 *
解放军医学杂志 | 综述 2021,46(3): 306-310
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解放军医学杂志 | 综述 2021, 46(3): 306-310
胃癌癌相关成纤维细胞研究进展
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郭嘉欣 , 徐远义*
作者信息
  • 宁夏医科大学基础医学院病理系,银川 750004
  • 郭嘉欣,硕士研究生,主要从事消化道肿瘤免疫方面的研究。E-mail:

通讯作者:

徐远义,E-mail:
Research progress of cancer-associated fibroblasts in gastric cancer
Jia-Xin Guo , Yuan-Yi Xu*
Affiliations
  • Department of Pathology, School of Basic Medicine, Ningxia Medical University, Yinchuan 750004, China
出版时间: 2021-03-28 doi: 10.11855/j.issn.0577-7402.2021.03.15
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胃癌是全球发病率第五、病死率第三的癌症。在中国,胃癌患者就诊时多为晚期且预后较差。癌症进展不仅取决于癌细胞自身,还取决于其所处的环境即肿瘤微环境的生理状态与构成改变,其中癌相关成纤维细胞作为肿瘤微环境中重要的细胞类型,在癌症进展中发挥着重要作用。该文阐述癌相关成纤维细胞的来源和分型,以及对胃癌侵袭转移、生长、血管生成、基质重塑、免疫调节及抑癌等方面作用的研究进展,总结靶向胃癌中癌相关成纤维细胞的相关抗肿瘤策略,以期为癌相关成纤维细胞应用于胃癌的靶向治疗提供更多信息。

胃癌  /  癌相关成纤维细胞  /  肿瘤微环境  /  靶向策略

Gastric cancer is the fifth leading incidence and the third leading cause of death in the world. Gastric cancer patients in China are often in advanced stages and have a poor prognosis. Cancer progression depends not only on the cancer cells themselves, but also on the physiological state and composition of the tumor microenvironment in which they are located. Cancer-associated fibroblasts as the major cell type in the tumor microenvironment played an important role in cancer progression. This paper mainly expounds the origin and classification of cancer-associated fibroblasts, and its research progress on gastric cancer invasion and metastasis, growth, angiogenesis, matrix remodeling, immunomodulation and cancer suppression, and summarizes the relevant anti-tumor strategies by targeting cancer-associated fibroblasts in gastric cancer, to provide more information for use of cancer-associated fibroblasts in targeted therapy of gastric cancer.

gastric cancer  /  cancer-associated fibroblast  /  tumor microenvironment  /  targeting strategy
郭嘉欣, 徐远义. 胃癌癌相关成纤维细胞研究进展. 解放军医学杂志, 2021 , 46 (3) : 306 -310 . DOI: 10.11855/j.issn.0577-7402.2021.03.15
Jia-Xin Guo, Yuan-Yi Xu. Research progress of cancer-associated fibroblasts in gastric cancer[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (3) : 306 -310 . DOI: 10.11855/j.issn.0577-7402.2021.03.15
胃癌(gastric cancer,GC)是全球发病率第五、病死率第三的癌症[1]。与美国和英国相比,中国的癌症发病率较低,但死亡率较高,其中36.4%的死亡病例来自于消化道肿瘤,而美国和英国消化道肿瘤死亡病例仅占癌症死亡总数的5%左右[2]。近年来,随着胃癌早期筛查技术的推广、手术和放化疗技术的进步以及靶向药物的研发,胃癌的治疗水平有了一定的提高,但肿瘤复发、治疗不良反应及耐药反应等情况仍严重影响胃癌患者的生存质量及长期生存率。
研究发现,癌症进展是由癌细胞的固有特性(如基因突变)和外部不稳定性[如在肿瘤微环境(tumor microenvironment,TME)中的变化]共同决定的[3]。与癌细胞不同,TME内的基质细胞遗传稳定性更强、耐药性更低,其中癌相关成纤维细胞(cancer-associated fibroblasts,CAFs)因其数量优势、基因稳定以及功能多样性的特点而被认为是有潜力的抗癌治疗靶点。近年来研究显示,胃癌中CAFs在胃癌发生发展的各个阶段都起着重要的促进作用,具有重要的研究价值。因此深入了解CAFs的起源和分型,以及在胃癌发生发展中的作用和机制,是开发靶向CAFs的抗癌药物的重要前提。
癌症不是仅限于恶性肿瘤细胞的疾病,而是一种以整个细胞周围环境根本性失调为特征的疾病,这种周围环境称为TME,是一个由细胞与非细胞成分构成的复杂的动态体系[4-5]。TME的细胞成分包括成纤维细胞、间充质干细胞、内皮细胞、周细胞等基质细胞,以及巨噬细胞、淋巴细胞等免疫细胞[6];非细胞成分包括大量细胞外基质、细胞因子、生长因子、趋化因子和蛋白酶等[7]。癌症进展过程中,癌细胞与TME之间存在相互作用:一方面癌细胞不断分泌因子调控TME,使其变成有利于肿瘤发生发展的微环境,使TME成为癌症扩散的“温床”;另一方面TME为了应对环境条件的改变和肿瘤的致癌信号,在癌症发展过程中不断变化,调控癌症进展,导致癌的异常生长、血管生成、转移和耐药[8-11]
成纤维细胞是一种多功能细胞,是间质组织的重要组成部分,它们通常保持静息状态,仅在组织受损后发生组织重塑和修复期间获得暂时活性,之后会凋亡或恢复到休眠状态[12]。癌症中也会发生慢性组织修复反应,癌细胞在组织中持续增殖引发局部组织损伤,继而导致针对癌细胞的慢性宿主修复反应即癌症纤维化,表现为活化的成纤维细胞控制的持续修复行为[13-14]。癌周围活化的成纤维细胞被称作CAFs,它是具有成纤维细胞表型的增生和代谢活性的细胞,参与癌症进展的所有过程,寿命长且可塑性高,也是TME的关键组成部分[11,15]。组织病理学分析表明,CAFs的丰富度与不同种类癌症的预后有关[16]
大量证据表明,CAFs是复杂而异质的细胞群体,这种异质性可能归因于CAFs的众多来源途径,其来源根据肿瘤的组织学类型分为六大类[13,17,18]:(1)大多数CAFs由组织驻留的成纤维细胞活化而来。这些成纤维细胞会通过响应TME中丰富的生长因子如转化生长因子β(transforminggrowthfactor-β,TGF-β)、碱性成纤维细胞生长因子2(fibroblast growth factor 2,FGF2)和血小板衍生因子(platelet-derived growth factor,PDGF)而募集并激活[13]。(2)CAFs也可能源自骨髓间充质干细胞(marrow-derived mesenchymal stem cells,MSCs)。有研究使用体内外示踪实验证实了在骨髓癌、胰腺癌和胃癌等癌症中,MSCs可以分化成大量的CAFs[17-18]。(3)CAFs还可源自上皮细胞。后者可通过上皮间质转化(epithelial to mesenchymal transition,EMT)失去细胞间连接和极性,并发生细胞骨架重组和形态变化,获得间充质表型和侵袭能力,进而转变为CAFs[19]。(4)在肿瘤基质中的内皮细胞可以通过自分泌和旁分泌TGF-β信号介导的内皮间质转化(endothelialtomesenchymal transition,EndMT)变为CAFs[20]。(5)脂肪细胞也可转化为CAFs。由于脂肪细胞与成纤维细胞均属于同一间充质谱系,因此也被认为是CAFs的来源之一。(6)其他一些不常见的来源,如肌成纤维细胞、血管平滑肌细胞、周细胞、纤维细胞等均可转化为CAFs[20]
与静息状态的成纤维细胞相比,CAFs体积增大、凸起增多、细胞核有凹陷或切迹,在电镜下可以看到大量的粗面内质网、游离核糖体、高尔基体和应力纤维,这些结构赋予CAFs更强的增殖和迁移活性以及合成分泌细胞外基质的能力[13]。许多细胞标记物如α平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、成纤维细胞活化蛋白(fibroblast activation protein,FAP)、成纤维细胞特异性蛋白1(fibroblast specific protein 1,FSP1)、血小板衍生生长因子受体(platelet-derived growth factor receptor,PDGFR)α和β都可以用于鉴定CAFs,但没有一种具有完全的特异性,这也凸显了CAFs异质性的特点[5,17,21]
CAFs是多种细胞亚群的集合,可响应不同的刺激,在TME中显示出独特的分泌表型和生物学功能。有学者将CAFs分为5个亚型:F1和F2亚型分别表现出抑制和促进肿瘤的作用,并具有相互转化的潜力;F3亚型可能具有高度的生长因子分泌活性,从而影响肿瘤免疫力、血管生成和癌细胞增殖;F4亚型具有产生和重塑细胞外基质(extracellular matrix,ECM)的能力;其他功能的CAFs为F5型[13]。因此将细胞标记物、空间分布、生物学功能结合起来对CAFs进行鉴定更为可靠。
CAFs的高度异质性使其在疾病中表现出双向功能:一方面,它们会诱导血管生成、炎症、能量供应、免疫抑制、侵袭和转移,最终导致肿瘤进展;另一方面,有证据表明成纤维细胞的抗肿瘤特性可以调节细胞外基质生成、上皮细胞的生长和分化,以及对组织损伤的反应等过程[21]
癌的一大特征是具有无限增殖活性,并且癌细胞能通过多种形式维持其增殖能力。一项对1524例胃癌患者TME中细胞表达谱与临床病理特征关系的分析表明,胃癌患者TME中CAFs浸润数量越高,临床预后越差[22]。有研究表明,CAFs通过控制自分泌或旁分泌信号转导一些生长因子及细胞因子,分泌外泌体携带运输非编码RNA、蛋白质类、DNA和代谢产物等物质,进而与癌细胞进行细胞间沟通[23],并可与癌细胞进行物理相互作用如代谢物交换或直接接触,从而促进癌细胞的生长[24]。Li等[25]研究发现,CAFs以miRNA-149/IL-6依赖的方式增强GC细胞的EMT和干性,且在体外和体内试验中miRNA-149的降低均促进了肿瘤的生长。Kuroda等[26]对584例胃癌组织标本进行研究发现,CAFs中血小板反应蛋白4(thrombospondin-4,THBS4)高表达与浸润深度、淋巴结和腹膜转移以及肿瘤体积呈正相关,且THBS4高表达的患者5年总生存率明显低于THBS4低表达的患者。最近的一项研究表明,在胃癌中生长停滞特异性蛋白6(CAF-derived growth arrest-specific 6,GAS6)可通过使受体酪氨酸激酶(anexelekto,AXL)磷酸化,促进胃癌细胞的增殖和迁移,而胃癌组织中AXL磷酸化水平增高与总生存率降低相关[27]
胃癌患者预后不良和生存率低的主要原因是发生转移,约60%的胃癌死亡是由腹膜转移引起的[28]。大量研究表明,CAFs通过释放生长因子或细胞因子等直接或间接促进胃癌细胞的迁移和侵袭。胃癌CAFs高表达miRNA-106b、143和145,并下调miRNA-200的表达,所有这些miRNA都可通过多种级联途径诱导胃癌的侵袭和转移[29]。Wu等[30]的研究表明,胃癌CAFs能分泌大量的IL-6,通过激活JAK2/STAT3途径诱导EMT,增加胃癌细胞的迁移,进而促进胃癌的发展。Shen等[31]的研究显示,胃癌CAFs衍生的血管黏附分子1(vascular cell adhesion molecule 1,VCAM1)可与胃癌细胞中的整合素αVβ1/5相互作用,在体内外促进肿瘤侵袭。另有研究发现,CAFs自噬诱导的肿瘤细胞和CAFs细胞间串扰可促进癌症进展,CAFs内窖蛋白-1(caveolin-1,Cav-1,自噬标志物)较低可以预测胃癌的生存时间较短,而微管相关蛋白1轻链3B(microtubule-associated protein 1 light chain 3B,LC3B,自噬标志物)较高则与浸润性差和生存期长相关[32]
ECM是由不同类型的基质细胞(包括成纤维细胞样细胞、内皮细胞和免疫细胞)组成的复杂的生态系统支架,它不断地被成纤维细胞降解和合成,以响应组织状况的变化[33]。CAFs在ECM重塑、代谢和免疫再编程中起着重要作用,CAFs的标志性功能是产生ECM成分(如胶原蛋白、纤连蛋白、蛋白聚糖、骨膜素和腱生蛋白-C),从而使癌组织结构变得紊乱[34]。此外,CAFs是除癌细胞外基质金属蛋白酶(matrix metalloproteinases,MMPs)的另一大来源,MMPs可以降解ECM中除多糖外的几乎全部成分,是肿瘤获得侵袭转移能力的首要条件[33]
病理性血管生成是癌症的显著特征,胃癌的生长、浸润、转移都强烈依赖于血管供应的氧气和营养物质。CAFs是促血管生成相关因子的重要来源,包括VEGF、TGF-β、PDGF、HGF、肿瘤坏死因子α(tumor necrosis factor,TNF-α)、血管生成素-1(angiogenin-1,Ang-1)、胰岛素样生长因子1(insulin-like growth factors -1,IGF-1)和单核细胞趋化蛋白-1(monocyte chemotactic protein 1,MCP-1)等,这些因子在癌症中可加速血管生成的速率[35]。CAFs可分泌基质细胞衍生因子1(stromal cell-derived factor 1,SDF-1),而SDF-1可将内皮祖细胞募集到肿瘤中,从而促进血管生成[36-37]。Galectin-1是半乳糖凝集素β-半乳糖苷结合蛋白家族的成员,据报道,Galectin-1在胃癌的CAFs中表达上调,并可通过增强胃癌中VEGF的表达和内皮细胞中血管内皮生长因子受体2(vascular endothelial growth factor receptor 2,VEGFR2)的磷酸化加速血管生成[38]。缺氧是TME的显著特征之一,以往研究已证实缺氧可促进CAFs分泌更多的VEGF和Ang,从而促进肿瘤血管生成[39]。Ding等[40]的研究认为,CAFs衍生的HGF通过PI3K/AKT和ERK1/2信号通路增强血管内皮细胞的增殖和迁移能力,促进胃癌的血管生成和血管拟态。
免疫系统是影响癌症发生发展的重要因素。研究表明,CAFs可通过直接作用或旁分泌的方式抑制免疫细胞的浸润,减少免疫系统对癌细胞的识别与杀伤,进而促进癌症进展[39]。CAFs可通过分泌多种细胞因子如TGF-β、PDGF、表皮生长因子(epidermal growth factor,EGF)、音猬因子(sonic hedgehog,SHH)和白介素影响T细胞的浸润、分化、增殖和凋亡,抑制T细胞的免疫功能。此外,CAFs调控的ECM重塑也加强了阻碍T细胞浸润的物理屏障[41-42]。CAFs还可通过促进免疫抑制细胞如髓源性抑制细胞、肿瘤相关巨噬细胞和树突细胞等的分化和浸润诱导肿瘤免疫抑制微环境。有研究表明,CAFs的一种标志物肿瘤神经腹侧抗原-1(neuro-oncological ventral antigen 1,NOVA1)在胃癌TME中表达下调,其下调与M2型巨噬细胞的增加有关,而M2型巨噬细胞的数量与胃癌患者不良预后密切相关[43]。CAFs的表面标志物FAP也参与了肿瘤免疫抑制,有动物模型研究证实,FAP+的CAFs可在胃癌微环境中抑制T细胞的抗肿瘤作用,并可增强免疫检查点阻断剂的抗肿瘤作用[44]
CAFs也能够通过一些未知的机制来延缓癌症的发生。CAFs发挥抑癌的生物学作用取决于多种因素,比如癌症的发展阶段[14]。一些研究表明,miRNA失调可影响CAFs的分泌功能。Xu等[45]发现,胃癌的miR-139外泌体与CAFs和胃癌细胞之间的相互作用有关,miR-139可通过降低TME中MMP11的表达抑制胃癌的进展和转移。由此可知,CAFs的促癌作用远高于其抑癌作用,将CAFs的促癌作用转化为抑癌作用是治疗癌症有潜力的研究方向,但CAFs抑制肿瘤的机制亟需进一步研究探索。
由于CAFs的基因比癌细胞更稳定,对治疗耐受不敏感,目前正在探究能否通过改变CAFs的亚型、数量或功能,以干扰其与癌细胞的相互作用,继而作为一种改善癌症患者治疗效果和预后的途径。目前CAFs的靶向策略有以下几类:(1)靶向CAFs的活化信号。TGF-β是癌细胞产生的可以使组织处驻留的成纤维细胞活化成CAFs的重要因子。有研究将TGF-β抑制剂与常规化疗或免疫疗法结合使用,以阻断与胃肠道肿瘤中CAFs相关的促肿瘤信号[46-47]。(2)CAFs的耗竭。目前正在探索靶向CAFs的药物递释系统,通过用胶束、纳米复合物、脂质体等包裹靶向CAFs特异性表面标志物的药物,可以高效低毒地杀死CAFs[48]。如一些FAP抗体、抑制剂、DNA疫苗和肽-药物复合物等的临床前试验已显示出了良好的效果[5,49]。(3)靶向CAFs调节肿瘤生长浸润、血管生成、基质重塑及免疫抑制等功能。如直接靶向发挥这些功能的CAFs亚群的特异性标记物,或靶向CAFs分泌的相关因子间接抑制其功能[42]。(4)使CAFs恢复为静息状态的成纤维细胞。研究发现,胰腺癌患者缺乏维生素A会导致胰腺星状细胞(PSCs)活化,因此服用维生素A代谢的中间产物全反式维甲酸可能使PSCs恢复为非活性状态[17]
胃癌的进展过程涉及多个步骤和因素,其中关键的因素之一是胃癌细胞与TME中各种成分之间的相互作用,尤其是CAFs作为TME中主导的细胞群体,不仅与癌细胞相互作用,还能通过影响TME中其他细胞成分而间接作用于癌细胞。因此CAFs有成为胃癌早期诊断标志物与后期治疗靶点的潜力。当前针对CAFs的癌症疗法正在探索之中,但仍面临许多挑战,如CAFs缺乏特异性和精确的标志物,导致很难做出特异性靶向策略,且CAFs存在功能异质性和极化动态性,因此需要对抗CAFs治疗反应有更深入的了解以及更精准的靶向手段。未来亟须对CAFs开展更为深入的研究,以便将CAFs的靶向治疗与其他治疗方法相结合,实现增强临床疗效和提高患者生存率的最终目标。
  • 宁夏回族自治区重点研发计划(2019BEG03007)
  • 宁夏回族自治区重点研发计划(2018BEG03010)
  • 宁夏自然科学基金(2020AAC03184)
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2021年第46卷第3期
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doi: 10.11855/j.issn.0577-7402.2021.03.15
  • 接收时间:2020-05-18
  • 首发时间:2025-12-26
  • 出版时间:2021-03-28
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  • 收稿日期:2020-05-18
  • 修回日期:2021-02-03
基金
Key Research and Development Projects of Ningxia Hui Autonomous Region(2019BEG03007)
宁夏回族自治区重点研发计划(2019BEG03007)
Key Research and Development Projects of Ningxia Hui Autonomous Region(2018BEG03010)
宁夏回族自治区重点研发计划(2018BEG03010)
Ningxia Natural Science Foundation(2020AAC03184)
宁夏自然科学基金(2020AAC03184)
作者信息
    宁夏医科大学基础医学院病理系,银川 750004

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徐远义,E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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