中医药研究论丛

211.9 从台湾肝癌发现高比例带有马兜铃酸特有的基因突变特徵研究的新闻事件:谈医疗人员如何正确宣扬研究成果
TJ TCM.21(1) : 97-110, 2018
从台湾肝癌发现高比例带有马兜铃酸特有的基因突变特徵研究的新闻事件:谈医疗人员如何正确宣扬研究成果
Paper Critique and Comment on Unfair Publicized in Research Results for Medical Personnel: from Headline News “About 80% of HCC in Taiwan is Associated with Aristolochic Acid”
陈金女1 陈旺全2 陈朝荣1,3 林展弘4 李德彦1 赖荣年5,6,7*
1 中国医药大学中西医结合研究所,台中,台湾
2 中华民国中医师公会全国联合会,台北,台湾
3 中国医药大学附设医院蛋白质体核心实验室,台中,台湾
4 台北市中医师公会,台北,台湾
5 中国医药大学中医学系,台中,台湾
6 中国医药大学附设医院中医部,台中,台湾
7 全国中药不良反应通报系统整合及通报教育训练,台北,台湾
【摘要】
2017 10 月国际期刊《科学转译医学》(Science Translational Medicine)报导从台湾肝癌组织检体中发现高比例带有马兜铃酸特有的基因突变特徵(Aristolochic acid mutational signature) 的研究,这个研究结果的确可以引起科学家们的注意,怀疑马兜铃酸会导致肝癌的可能性,由於这是一篇探索型
的研究,Rozen 团队无法断定马兜铃酸存在肝癌检体的事实,就是导致肝癌的原因;因此,无论是仔细论述科学研究主要发现的结、讨论(discussion)或精简呈现整篇论文重要发现的摘要(abstract),都没有用到马兜铃酸causes肝癌或马兜铃酸induces 肝癌等马兜铃酸会导致肝癌的字眼,林口长庚医院研究团队根据这篇研究,召开记者会宣称「台湾高达近8 成的慢性肝炎肝硬化病患,可能使用过含有马兜铃酸的草药,可能和肝癌的发生有关」,这个新闻的发布内容,徒然增加民众在没有详读科学论文的无谓恐慌。
将研究论文「Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia」依据其研究目的、研究方法、研究结果及结论做简易翻译,并针对研究论文中的各个段落进行分析及讨论。
经详读该研究的目的、设计及发现,记者会中的新闻稿如果修改为「北台湾二个医学中心肝癌检体的研究发现,高达近8 成肝癌的病患,可能曾经使用过含有马兜铃酸的物质,至於含有马兜铃酸的物质和肝癌的发生有没有因果关系,仍须进一步研究」,是比较符合该研究的论述;我们建议:医疗从事人员宣扬科学研究成果的推论,应该以解决问题的态度,平实阐述研究成果为宜。
【关键词】马兜铃酸突变特徵(AA signature),马兜铃酸,误用中药,科学论文评论(paper critique),肝癌(hepatocellular carcinomas)
Chin-Nu Chen1 Wang-Chuan Chen2 Chao-Jung Chen1,3 Lin-Tsan Hon4
Der-Yen Lee1 Jung-Nien Lai5,6,7*
1Graduate Institute of Integrated Medicine of China Medical University, Taichung, Taiwan.
2National Union of Chinese Medical Doctors’ Association. R.O.C., Taipei, Taiwan.
3Proteomics core lab of China Medical University Hospital, Taichung, Taiwan
4Taipei Chinese Medical Association, Taipei, Taiwan
5School of Chinese Medicine of College of Chinese Medicine of China Medical University,
Taichung, Taiwan
6Department of Chinese Medicine of China Medical University Hospital, Taichung, Taiwan
7Center for Integrating Taiwan National Adverse Chinese Medicine Reactions Reporting System
and Training on Reporting, Taipei, Taiwan
【Summary】
In a sensible sensitive address to the department of gastroenterology and hepatology, Chang Gung Memorial Hospital emphasized aristolochic acids might be the cause of hepatocellular carcinoma (HCC) in Taiwan, based on “Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia”. Rise of the bias originates from the exploratory retrospective research the study submitted. The aim of this article is to appraise the published paper and instruct relatively fair research findings.
We found this type of study design is given the prevalence of aristolochic acid signature in Taiwan HCC, rather testing for a causal inference. It would be more appropriate to set the press topic as “approximately 80% of HCC samples collected from two northern medical centers might be in contact with substances that contain aristolochic acid, and further researches are suggested to clarity the causal relationship between HCC and aristolochic acid”. Propagating scientific result objectively is recommended to medical personnel.
KeywordsAA mutational signature, aristolochic acid, herbal remedies, paper critique, hepatocellular carcinomas