从循证医学到精准医学的思考

A paradigm shift from evidence-based medicine to precision medicine

20世纪临床医学最大的进步,是从以个人经验及直觉为基础的传统个性化治疗,进化到基于基础及临床研究数据的循证医学,如同一场革命,短时间内,改变了临床医师的思维方法与实践模式。但是,基于对疾病模糊的诊断、分期、评估而实施的临床研究,常常产生模糊的结论,远离临床实际,甚至起到误导作用。许多疾病治疗指南的"半衰期"仅有10年。学者们试图以"改良"来弥补当今循证医学的先天不足,但效果甚微。因此,21世纪的今天,临床医学需要另一次理念的革命,超越循证医学,从分子生物学本质思考疾病,依据驱动因子将疾病重新分类,实现对疾病精准的诊断、分期、评估,以达到精准的预防及治疗,从而迈向精准医学的时代。

The major progress achieved in clinical medicine in 20th century- was the transformation from personal experience and intuition-based traditional individualized treatment to basic and clinical research evidence-based medicine （EBM）. This transformation symbolized a revolution and, in a short time, led to critical changes in the pattern of clinical thinking and the way of practice. However, clinical studies based on fuzzy diagnostic criteria, arbitrated staging and evaluation system of diseases, tend to bring forth obscure conclusions being far away from real clinical practice, and sometimes, even misleading. It is not uncommon that the half-life of many guidelines tbr disease treatment relayed on the evidences of＇ those obscure conclusions is only less than 10 years. In order to overcome the innate weakness of EBM, scientists strived to modify the models, but little effects have been got yet. Therefore, a paradigm shift to exceed EBM needs to be seriously considered in clinical medicine. We should reflect on the nature of disease from molecular biology, and redefine the disease based on its molecular drivers and underlying mechanisms. A new taxonomy of disease needs to be developed by building a knowledge network of biomedical research. With pursuing to precise diagnosis, staging and evaluation of disease in order to achieve precise prevention and treatment, the era of precision medicine is coming toward us.