补充替代医学与现代医学中英文对照.ppt
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补充替代医学与现代医学中英文对照.ppt
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中国中医科学院西苑医院心血管中心史大卓ShiDazhuoXiyuanHospital,ChinaAcademyofChineseMedicalsciences,补充替代医学与现代医学ComplementaryandAlternativeMedicine&WesternMedicine,现代医学的迅速发展DevelopmentofContemporarymedicine传统中医学的优势SuperioritiesofTCM传统中医药学对现代医学发展的启示Theilluminationforcontemporarymedicaldevelopment,Variousinterventionsfordiseasesincludingmodernmechanicalmeasurementsandnewdrugsbringnewhopeforpreventionandtreatment.However,lookingatthewholepictureofmodernmedicinewefindthatwhatwecandoisstillverylimited.,现代各种干预疾病的机械措施和新药物,为疾病预防和治疗带来了新的希望,但环顾现代疾病谱的整个画面,发现我们能够做的还非常局限。
中国糖尿病人数超过印度,不要说肿瘤、AIDS、糖尿病,即使普通病毒性感冒,西药也是对症治疗,对病理过程基本无作用。
Dontmentioncancer,AIDS,diabetes,eventhoughthecommonviralinfluenza,thewesternmedicinehasnoobviouseffectonthepathologicalprocess.,1.冠心病(Coronaryheartdisease),血运重建治疗(RevascularizationTreatments),新药物和新技术不断出现,并应用于临床,尤其是抗血小板和调节脂质代谢方面,基因治疗、干细胞移植、生物支架技术的应用,显示有良好的应用前景,Genetherapy,stemcelltransplantationandbiologicalstentshowagoodprospect.,Newdrugsandnewtechnologies,especiallyantiplateletandregulationoflipidmetabolismareemergingandapplyinginclinicalpractice.,炎症反应(inflammationreaction),氧化应激损伤(oxidativestress),内皮功能障碍(endothelialdysfunction),抗药性(Drugresistance),无复流慢复流(noreflow&slowreflow),再灌注损伤(ischemia-reperfusioninjury),冠脉内血栓(thrombusformationincoronaryartery),远期血管狭窄(longtermvascularstenosis),(interventionaltherapy)(conventionaltreatmentofwesternmedicine),缺乏理想干预手段,成为影响长期预后的瓶颈(Nogoodtreatments&bottleneckoflong-termprognosis),LimSY,etal.CircJ.2004;68(10):
928-932,存在问题(Problems),介入治疗,西药常规,冠心病(CHD),发病率和死亡率不断增加(Incidenceandmortalityincreasedconstantly)发病年龄年轻化(Incidencebecomemuchyounger)公共卫生的首要重大疾病之一(Oneofthemostmajordiseasesofpublichealth),心脏病中住院人数第一largestnumberininpaiteintswithheartdisease,住院疾病平均费用第一Firstaveragecostforinpatients,在心脏病中死亡率第一Firstmortalityofheartdisease,心脏病院外死亡比例第一Firstmortalityinoutsidethehospitals,ACS,介入治疗后1年心脏事件的发生率18(Theincidenceofcardiaceventsafter1yearinterventionwas18%.)(NEnglJMed2006;355
(1):
1093),心血管病致残和死亡主要原因(leadingcauseofcardiovasculardisabilityanddeath),介入治疗和药物涂层支架(InterventionaltherapyandDES),不稳定心绞痛(Unstableangina),非ST段抬高心梗(NSTEMI),ST段抬高心梗(STEMI),2.慢性心衰(Chronicheartfailure),5年的死亡率达到67%左右(5-yearmortalityratewas67%),NEnglJMed2010;362:
228-38,3.心律失常(Arrhythmia),抗心律失常药,除受体阻滞剂外的病因治疗外,直接抑制心律失常的药物对长期预后皆有负面作用。
心律失常目前基本是病因治疗、对症治疗、介入治疗,Antiarrhythmicdrugs,exceptthe-blocker,drugsfordirectinhibitionofarrhythmiahavenegativeeffectsonlong-termprognosis.Thecurrenttreatmentofarrhythmiaisetiological,symptomatictreatmentandinterventiontherapy,4.恶性肿瘤(malignancy),手术、化疗、放疗(operation,chemotherapy,radiotherapy)肿瘤血管靶向治疗(tumorvasculartargetingtherapy)生物疗法(biotherapy)介入治疗(interventionaltherapy)我国肿瘤患者5年的生存率仅10%左右,90%以上恶性肿瘤患者,死于肿瘤的扩散、转移(5-yearsurvivalrateofcancerinChinawasonly10%.90%cancerpatientswerediedoftumorproliferationandmetastasis),现代医学迅速发展的主要方面Mainaspectsofthedevelopmentofmodernmedicine,诊断技术Diagnostictechniques影像学指导下的介入技术Interventionaltechnologiesundertheguidanceofimaging)外科手术(Surgery)靶向和定位干预Targetingandpositioningintervention)预防医学PreventiveMedicine,难解决全身病理生理改变Difficulttoresolvethesystemicpathophysiologicalchanges,不得已而为之的预防医学,Themedicinehastobethepreventivemedicine,现代医学的迅速发展DevelopmentofContemporarymedicine传统中医学的优势SuperioritiesofTCM传统中医药学对现代医学发展的启示Theilluminationforcontemporarymedicaldevelopment,Ithasbeensomewhatsurprisinginthiseraoftriumphformodernmedicinetoseetherapidgrowthofalternative/complementarymedicine,whichisusedbyasmanyasoneinthreeAmericans.Althoughmostofthosestillrefrainfrominformingtheirregularphysiciansaboutthatuse,thereisagrowingtendencyamongphysicianstoacknowledgeandevenembracecertainformsofalternative/complementarymedicineScience2002;295(11):
233.,1.传染病infectiousdisease,上世纪50年代石家庄、北京流行乙型脑炎,用伤寒论指导治疗取得很好治疗效果;50soflastcentury,treatmentofJapaneseencephalitisinShijiazhuangandBeijingwithTCMshowedabettereffectsthanwithWM.上世纪60年代流行麻疹并发肺炎,中医治疗结果不仅疗效优于西医;60soflastcentury,treatmentofmeaslescomplicatedbypneumoniawithTCMshowedabettereffectsthanWM,国家“七五”项目流行性出血热研究,中药组病死率为1.1,西医组病死率为5.08(P0.01);NationalSeventhFiveproject-studyofepidemichemorrhagicfever,mortalitywas1.1%inTCM,5.08%inWMSARS的中医研究,获得国家科技进步二等奖。
ThestudyTCMonSARswontheStateScienceandTechnologyProgressAward,335casesenrolled335例入选,Controlgroup对照组169cases,Treatmentgroup治疗组166cases,308casescompletedwith145repeatangiography308例完成试验,145例重复冠脉造影,Randomize随机,3caseslost脱落,12casesexclude剔除,3caseslost脱落,9casesexclude剔除,154cases,154cases,2.中药预防PCI后再狭窄PreventingrestenosisafterPCIwithTCM,Note:
Comparedwithcontrolgroup,*P0.05,随访半年两组冠脉造影结果比较(Comparisonofsixmonthsfollow-upresultsofcoronaryangiography),注:
与对照组比较,*P0.05,两组冠脉造影结果比较(Comparisonofcoronaryangiographyintwogroups),注:
与对照组比较,*P0.05,Comparisonofrecurrentangina(RA)两组复发心绞痛的比较,*,*,Comparisonofclinicalend-pointevent两组临床终点事件的比较,Note:
Therewassignificantdifferencebetweenthetwogroups(p0.05).,多中心、双盲随机、安慰剂对照方法,证明活血化瘀中药制剂预防冠心病介入治疗后再狭窄形成和心绞痛复发,改善患者长期预后。
Multi-center,double-blind,randomized,placebo-controlledmethodsprovedthatTCMcanpreventtherestenosisafterPCIandrecurrenceofangina,andimprovelong-termprognosisofpatients.,在IRA恢复再通冠脉血流灌注良好的情况下仍有25以上患者发生微循环血流NoreflowAfterrestoringcoronaryreperfusionofIRA,therearemorethan25%ofpatientswithoutmicrocirculatorybloodflow,3.益气养阴活血法改善AMI血运重建后心肌灌注TonifyingQi,nourishingyinandpromotingthebloodcirculationtoimprovemyocardialperfusionafterrevascularizationforAMI,临床设计:
多中心、双盲随机、安慰对照Design:
Amulticenter,double-blind,randomized,controlledplacebo)治疗方法:
治疗组100例在西医的基础上加心悦胶囊、丹参片;对照组采用西医常规治疗Treatment:
Treatmentgroup,100cases,addingDanshenTabletandXinyuecapsuletowesternmedicine;Controlgroup,conventionalWesternmedicine观察指标:
声学超声造影显示的心肌组织灌注、生命质量和终点事件Index:
acousticultrasoundimagingshowedmyocardialperfusion,thequalityoflifeandend-pointevents,实际入选例数(actualnumberofselectedcases):
182例(91)脱落例数(numberoflossfollow-upcases):
11例(6.04),心脏事件发生率(Incidenceofheartevent),SAQ生活质量积分SAQlifequalityscore,负荷正常心肌百分比Thepercentageofnormalmyocardium,声学造影结果(Acousticimagingresults),半年临床观察结果(clinicalobservationresultsofhalfyear),改善左室收缩功能和心肌运动Improvingtheleftheartfunction&myocardialmovement增加正常心肌比率Increasingtheratioofnormalmyocardium改善微循环血流灌注Improvingthemicrocirculationperfusion减少心血管事件的发生Reducingthecardiovascularincidence提高患者的生活质量Improvingthelifequalityofpatients,3.其他(others),清热开窍、活血解毒通腑治疗中风病Treatingstrokewithcleaningheat&enlighten,promotingcirculation&detoxification清热通腑、活血解毒治疗急腹症Treatingsurgicalabdomenpromotingcirculation&detoxificationcleaningheat&smoothinglargeintestinedetoxification靛玉红治疗慢性粒细胞白血病TreatingChronicmyeloidleukemiabydianyuhong“癌灵1号”(三氧化二砷)治疗M3TreatingM3with“ailing1”Arsenictrioxide川芎嗪注射液、丹参酚酸防治心脑血管病TreatingCardiovasculardiseasewithLigustrazineInjectionandSalvianolicacidB康莱特(薏苡仁)治疗肿瘤TreatingTumorwithkanglaite(CoixSeed)青蒿素治疗疟疾TreatingmalariawithArteannuin,“医者意也”,经验性、科学性和艺术性,继承和重复的困难性Difficultinheritance&repeatduetoempirical,scientificandartistic,认识方法的整体、辨证模式,文化和哲学的层面的差异,传播的困难Thecommunicatingdifficultiesduetothedifferencesofunderstandingculturalandphilosophy,存在问题(Problems),现代医学的迅速发展DevelopmentofContemporarymedicine传统中医学的优势SuperioritiesofTCM传统中医药学对现代医学发展的启示Theilluminationforcontemporarymedicaldevelopment,许多疾病是机体代谢、衰老伴随的病理生理变化;Thediseasesitselfarethemetabolism,pathophysiologicalchangesassociatedwithaging参与疾病的基因及转录蛋白质在疾病过程中相互联系、影响,主次难以辨别;Itisdifficulttodistinguishgenesandtranscriptionproteininvolvedindiseaseswhichinteractedduringtheprogressionofdiseases.代谢、免疫、神经内分泌失调等相互并存,局部病变是全身疾病在局部的反应。
Metabolic,immune,neuroendocrinedisorderscoexist,thelocalresponseisalocalresponseofsystemicdisease.,现代慢性疾病复杂性(Thecomplexityofchronicdiseases),前列腺癌基因和mRNA变化:
一个2千万多个mRNA标签的正常前列腺组织和雄性激素敏感癌症细胞株的数据库,证明典型早期癌症阶段和典型的晚期阶段相比,有2000余种mRNA表达发生改变。
GeneandmRNAchangesinprostatecancer:
over2millionmRNAlabelsofthenormalandandrogen-sensitiveprostatecancercelllinedatabase,showthatcomparedwiththetypicalearlycancerstageandlatestageofthetypical,morethan2,000mRNAexpressionhavechanged.,复杂基因、蛋白变化的难预知性Difficultpredictabilityofcomplexgeneandproteinchanges,Science2004;306(22):
640-643,一个功能基因改变会引起多少蛋白变化?
Howmanyproteinchangesinducedbysinglefunctionalgenechanges?
一个功能蛋白改变是多少基因调控的结果?
Howmanygeneregulationresultedinasinglefunctionalproteinchange?
目前检测到的基因、蛋白,哪些发挥了作用?
哪些属潜在变化?
谁是原发基因?
谁是继发基因?
Whichgeneorproteindetectedcurrentlytakesaction?
Whichonebelongstostandbyer?
Whichoneisoriginalgeneorsecondarygene?
当药物干预某一基因、蛋白时,机体会发生哪些适应性变化?
Whengeneorproteinwasintervenedbydrugs,whatadaptivechangesoccur?
现代生物技术仍难以辨识清楚。
Modernbiotechnologyisstilldifficulttoidentifyclearly.,对单基因疾病,可尝试改变或纠正基因结构;对于多基因复杂疾病,则需要从基因和蛋白质的功能调控入手,提高或激发机体自我修复能力,使其达到相对有序状态。
Asforsingle-genedisorders,wecantrytochangeorcorrectthegenestructure;formorecomplexmulti-genesdisease,weneedtocontrolthefunctionsofgenesandproteins,increaseorstimulatethebodytorepairitself,toreachtherelativeorder.,人类在漫长的演化过程中,形成了识别和适应自然界的属性。
Humanbeingshavetheattributesofdistinguishandfittingthenatureduringtheendlessevolvement.毋庸置疑,其基因、蛋白质的多态性和自然界变化存在着相容性,或者说人体的生物信息平衡和自然界息息相关。
withoutdoubt,bothgeneandproteinpolymorphismandthenaturalchangeexistcompatibility,orbiologicaltransformationiscloselyrelatedtonaturalbalance.,人体是一个有机的整体,构成人体的各个组成部分在结构上不可分割,在功能上相互协调、互为补充,在病理上则相互影响。
把人体疾病作为整体来研究是目前医学发展的一个重要的方向。
ChinJInternMed2010;49(7)导读,Humanbeingsareaorganicwholebody,allpartscomposedthehumanindivisibilityinthestru
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