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BMJ:肝硬化筛查是否有必要?

2017-07-13 sunshine2015 来宝网

最近的指导方针是建议筛查高危患者肝硬化,泰恩河畔纽卡斯尔的弗里曼医院的肝病专家马克·哈德森(Mark Hudson)和南安普敦综合医院的尼克·谢伦(Nick Sheron)说。



我们应该筛查肝硬化吗?】最近的指导方针是建议筛查高危患者肝硬化,泰恩河畔纽卡斯尔的弗里曼医院的肝病专家马克·哈德森(Mark Hudson)和南安普敦综合医院的尼克·谢伦(Nick Sheron)说。

他们说,肝病可能会超过心脏病,成为下一年左右工作年龄人口中最常见的死亡原因,主要是因为它没有迹象或症状而出现以选择治疗。酒精和肥胖 - 肝病的最常见原因 - 是有限的


NICE建议每天可能有潜在的危害的饮酒水平 - 每周超过50和35个单位的男性和女性- 可以进行一项测试以排除肝硬化。

他们指出,目前很少有GP可以使用这个测试,“所以不会一夜之间发生。”然而,由于治疗肝脏疾病的一生成本在50,000英镑到12万英镑之间,“这种方法可能是减少成本的,”他们写道。

他们说:“我们需要正确对照的试验,这些研究正在准备中。 “然而,肝脏疾病的负担是这样的,医生不能简单地坐在他们的象牙塔等待肝病患者来找他们。”

但其他专家认为,尽管NICE最近提出了一些建议,“证据不足支持肝硬化筛查计划”。

利兹大学的肝脏专家Ian Rowe和伯明翰大学肝脏研究中心的Gideon Hirschfield说:“为了成功的筛选程序,使用的测试必须简单,便宜,最重要的是准确。

然而,提出筛查肝硬化的检测结果在怀疑患有酒精相关性肝病的人群中表现不佳,导致许多健康人被错误地标记为肝硬化,并进行进一步的医疗干预,身体和精神上都有风险危害。

他们也警告说,“这个测试”并不广泛,并且需要巨大的前期投资才能在社区环境中建立起来。”

因此,他们认为实施肝硬化筛查“将不可避免地导致对其他更有效的干预措施的投资减少,危及人群的整体健康。”

相反,他们说资源应该是针对常规肝脏疾病(如酒精消费和肥胖)的风险因素进行管理,以及投资精心设计的评估筛查策略的临床试验。

原始出处:

Mark Hudson et al. Should we screen for cirrhosis?. BMJ (2017). DOI: 10.1136/bmj.j3233.

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    2017-12-12 gaoxiaoe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1848349, encodeId=92af18483499a, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Dec 12 22:25:00 CST 2017, time=2017-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222592, encodeId=34c0222592a9, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sat Jul 15 13:31:38 CST 2017, time=2017-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222049, encodeId=ed0a222049df, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=d41c2055892, createdName=184****9840, createdTime=Fri Jul 14 06:48:31 CST 2017, time=2017-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=221983, encodeId=1fe6221983bd, content=我觉得不靠谱, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Jul 14 00:06:46 CST 2017, time=2017-07-14, status=1, ipAttribution=)]
    2017-07-15 三生有幸9135

    学习一下谢谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848349, encodeId=92af18483499a, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Dec 12 22:25:00 CST 2017, time=2017-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222592, encodeId=34c0222592a9, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sat Jul 15 13:31:38 CST 2017, time=2017-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222049, encodeId=ed0a222049df, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=d41c2055892, createdName=184****9840, createdTime=Fri Jul 14 06:48:31 CST 2017, time=2017-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=221983, encodeId=1fe6221983bd, content=我觉得不靠谱, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Jul 14 00:06:46 CST 2017, time=2017-07-14, status=1, ipAttribution=)]
    2017-07-14 184****9840

    学习了受益匪浅

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1848349, encodeId=92af18483499a, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Dec 12 22:25:00 CST 2017, time=2017-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222592, encodeId=34c0222592a9, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sat Jul 15 13:31:38 CST 2017, time=2017-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222049, encodeId=ed0a222049df, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kzuf9u71gZhPYMiajRtENwicoAABeQtfXOlic8ibhYSy6DvJZWUDVtjRvTfqBffr1XJ6JLtFB5kHicthl/0, createdBy=d41c2055892, createdName=184****9840, createdTime=Fri Jul 14 06:48:31 CST 2017, time=2017-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=221983, encodeId=1fe6221983bd, content=我觉得不靠谱, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Jul 14 00:06:46 CST 2017, time=2017-07-14, status=1, ipAttribution=)]
    2017-07-14 飛歌

    我觉得不靠谱

    0

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