即将举行的网络研讨会:实现无需离心的流式细胞术样品制备工作流程的标准化
精准治疗是一种科学的医学范式,它以传统经验医学的精髓为基础,融合了循证医学、基因组医学、数字医学、数据医学、整合医学、个体化医学等诸多先进医学元素,显著提高了疾病预测、防控、诊断和治疗等医疗实践过程的确定性、可预测性和可控性。但精准治疗并不等同于高科技的集体应用,而是强调针对某些患者和病情,精准选择和应用合适的诊疗方法,避免盲目应用或滥用高科技带来额外的医源性损害和医疗资源浪费。
以基因组学技术为例,它是精准医学众多重要技术要素之一,但不是实现精准医学的充分必要条件。基因组信息需要与表观遗传学、代谢组学和临床表型(症状、体征、生化、影像和病理特征)高效整合,形成完整的个体生物学数据集,以满足疾病异质性的实证分析需求,为精准医疗提供依据。同样,精准治疗也不能简单等同于个体化医学,而是将标准化和个体化相统一的医学模式。个体化医疗强调每个患者因人、因时、因地,需要在不同的地方制定独特的诊疗方案。一方面,精准治疗是通过识别同一疾病中具有不同特征的少数民族疾病亚型,给予已知的、规范的、经证实有效的干预治疗。不是所有的同病患者都需要独特的治疗方法;另一方面,针对特定个体患者,在疾病分类和治疗的基础上,结合患者独特的生理、病理、心理和社会特征,量身定制“相似但不同”的诊疗方案,兼顾疾病共性和患者异质性。
建立在高确定性基础上的精准治疗,是在疾病控制与医疗源性损害控制的相互制衡中,系统优化各因素、全过程、全局的医疗实践,以患者最佳康复为目标的最佳临床实践。与精准医学不同,以经验为主的传统医学实践明显具有不确定性,这也是诊疗过程难以控制、干预结果难以预测的原因。传统医疗往往存在片面强调单一要素、碎片化、局限性来改善医疗实践的倾向,难以照顾到以患者最佳康复为目标的诊疗流程的系统性优化。
接近性损伤是指对身体内的目标病灶实施治疗措施,对路径上的正常组织和器官造成的无辜损伤。控制该入路损伤引起的医源性损伤,可以加速患者的康复,甚至提高治疗效果。对于体内实体瘤的治疗,在适当选择的情况下,介入治疗可以替代手术,内镜手术可以替代开放手术,可以减少手术创伤,达到与开放手术相同的效果。然而,微创方法须建立在精确治疗目标病变和充分保护目标器官的基础上。
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