虹洪ㄧ #纭哥#

虹璁猴

缁涓ㄦ锛瀵硅虹楂变汉缇*杩琛CT绛ワ姣4涓汉灏变1渚洪ㄧ锛浣朵腑90%ｈ骞舵病ｇ

缁浠ュ璇ュ浜锛灏辫

蹇借茬涓

浣CT绛蹇瑕锛瀵逛变汉缇わCT绛ヨ搁X浣虹姝讳骸20%*楂变汉缇わ姝ゅ瀹涔楂辨ｈ涓猴55-74宀锛冲30路骞寸哥涓昏缇NLST绌讹瀵圭绌朵汉缇や澶缁璁哄搴褰

缂璧凤

ㄧヤ颁涓瀛锛璇寸涓诲浜哄涓夸缁锛涓骞村杩灞浜绠＄ㄩ涓绘浜插浜洪ㄧ锛荤浠у缓璁浜涓轰涔ｈ寮虹琛ㄧず娌荤挎讹荤浠跺寤鸿涓绉娌荤

绗瀵硅虹绛ヤ存辨磋叮锛姝ゆ轰缁鸿繁娉锛甯藉瑙ｅ崇被浼肩

灏轰涓村璇Evidence锛缁烘

寮瀛锛    I will prescribe regimens for the good ofmy patients according to my ability and my judgment and never do harm toanyone.Hippocrates锛The Oath of Medicine        灏灏借繁瀛ゆ靛涓虹瀹惰╃淇℃★骞朵缁涓缁浠讳浜哄甫ヤ激瀹甯娉㈠搴瑾瑷

Part I 浣妫洪ㄧ舵?

浠充虹绛ラ杩浠锋澶绌垛NLST绌剁稿虫版

NLST锛炽缇藉藉虹绛ョ绌躲(National Lung Screening Trial) 锛绌堕瀵硅虹楂辨ｈ锛杩琛3骞翠CT搁X绛ャ

绌跺辩撼53 454浜猴朵腑CT绛ョ26 722浜猴绛ヤ腑虫у锛缁村4mm虹锛姣渚涓24.2%锛虫4涓汉灏辨1浜轰虫у

ｄㄨ24.2%浜虹兢涓澶灏虹

509ｈ杩‘璇涓鸿虹锛109杩х浼ゆфワ姣濡绌垮烘椿妫锛纭锛杩31ｈ杩浼ゆх妫ワ姣濡CTPET/CT锛纭昏649ｈ缁纭涓鸿虹锛CT妫ユ缁ｈ扮10%宸

濡3骞存ョ娆℃板璧锋ワ辨17 702娆妫ユ跺虫х锛纭虹姣渚灏辨村浣

Part II 缁浠ュ锛

涓涓娈典腑浠ラ锛楂变汉缇*涓CT涓缁10%芥舵

浜轰瑙寰杩涓浠跺楂锛甯告蹇锛辨瀹浜涓灏辨浜涔锛

楂变汉缇よ涓跺瑕锛瀵逛楂变汉缇わ绌剁璁哄搴璋ㄦ

Lightly, caressingly, Marie Antoinettepicked up the crown as a gift. She was still too young to know that life nevergives anything for nothing, and that a price always exacted for what fatebestows. She did not think she would have to pay a price.Stefan Zweig, Marie Antoinette: The Portrait of an Average Woman

濂归ｆ跺杩澶勾杞伙涓ラ借璧浜绀肩╋╁凡涓濂戒浠锋笺ㄥ

浠舵挎负浜娌荤虹浠轰浜浠ｄ环锛姣濡浼ゃ搴缁绛锛浣ユ负浜х剧翠碉杩涓剧芥病缁浣甯ヤ换浣涓

浠ョ杩涓姝ユョ浠ｄ环骞跺锛濡浼ゅ虹搞琛哥锛

锛ㄩ杩ョ673渚ｈ锛骞跺涓28.4%锛涓ラ骞跺涓14.4%60澶╁辨7ｈ姝讳骸锛姝讳骸涓1%

互澶浼ゆф锛绌垮哄妫姘绠￠锛锛辨402ｈ杩琛浜互澶浼ゆфワ骞跺涓8.0%锛朵腑9ｈㄦ浣60澶╁姝讳骸

杩浜苟冲存姝讳骸锛崇杩浜浣妫ュ苟涓浠冲剁ｆ疯交捐瀹涓锛NLST绌朵腑锛灏辨2ｈ4绠￠妫ョｈ骞朵虹存浜ュ苟

杩风缁锛浣浠ユ锛

骞跺濡褰遍舰锛璺璇樊涓凤娉瀹ㄩ垮

璁镐璁や负浣涓诲荤烘村楂瓒浣跺杩浜涓澶ソ璇达涓涓稿涓锛ｈ韩典苟褰卞绱

濡浣瑙ｅ宠涓撅绛妗寰绠锛楂璇纭浣浼ゅ

濡CT涓缁ｈ藉复1%妫ユ浜＄锛浠朵芥锛涓洪ｆ蜂瀵艰磋澶蹇瑕浼わfirst, do not harm锛浣荤缁涓村躲剧CT涓瑰锛浠ュ缁舵у哄惧ゆ

у芥уぇ锛浠户缁瀵锛舵у芥уぇ锛浠氨涓锛绌垮猴锛妯℃１涓ゅ锛瀹澶ヤ涓

NLST绌朵汉缇や腑锛杩荤浠ゆ辨673ｈ浜缁509ｈ纭涓鸿虹锛涓烘舵х姣渚涓76%锛姘绠￠绌垮烘ｈ402锛辨109ｈ纭虹锛虫х涓27%

╀灏杩5400ｈ锛界CT涓缁锛浣杩瑰冲缁鸿浠绉涓ヨ锛荤瀛ㄤ娇寰瓒杩80%ｈ浠ュや蹇瑕浼ゆфャ

浠ワ缁浠ュ锛

存娉锛ㄨㄧ缁不荤

*濡浣ゆ舵т灞浜璁ㄨ达涓汉璁や负涔涓灞浜瀹广

Part III CT绛ュ箍堕

㈢跺ㄤNLST绌剁锛璇磋杩涓绌跺ソ浜

绌跺缇33涓腑蹇辩撼虹楂变汉缇* 53 454浜猴哄CT绛ョ哥绛ョ锛姣绛3骞淬缁璁锛虫у锛CT缁24.2%锛哥缁6.9%锛筹CT芥哥村缁锛涓X绛ョ告锛CT绛ョ虹稿虫浜＄浣20%CT绛ョ虹浜烘版村

澶锛规撼15涓浜虹PLCO绌剁锛X绛ュ苟涓介浣虹姝讳骸

*虹楂变汉缇わ55-74宀锛冲30路骞寸哥濡宸叉锛堕翠瓒杩15骞淬

哥璁＄锛骞冲姣ぉ哥锛哥堕达骞达=哥路骞达    Part IV 绛ユ藉跨わ

寰剧骞朵

杩虫хワCT缁浜649渚虹锛惰杩44渚ㄩ存х绛ョ涔跺灞涓轰虹锛姝ゅ367缁璇负虹ｈ杩浜绛ワ涓虹ユ杩浜浠ュ灞涓鸿虹

绛ユ堕村涓灞浜璁ㄨ淬

Part Final    

辩姣э芥娴姘澹    

涓村涓璇崇锛浣扮锛缁冲锛娌＄扮锛绌舵涓村缁璇娈电涓姝ワ楣浜哄璇淬涓绘不冲凡缁浠ユ涓虹瀹锛浣涓ョ灏辨瀵瑰╂杩琛

瀹涓藉路辫╀渚т钩洪叉уわ浠ュ涔靛发杈电锛涓哄舵哄甫BRCA1哄锛涔宠虹靛发椋╁负87%50%

荤ㄥ洪ㄧ寤鸿浣跺芥涓轰缁涓舵介杈76%锛NLST33瀹朵腑蹇翠版锛寤鸿浣瑙瀵跺涓哄ゆ缁芥ч锛涓瑕1%浜＄椋┿

濡寮ョ荤澧璇锛藉氨村澶浜

涓昏

NLST绌跺锛http://www.ncbi.nlm.nih.gov/pubmed/21714641

JAMA虹绛ョ患杩帮http://www.ncbi.nlm.nih.gov/pubmed/22610500

锛

NCI瀹缃NLST绌堕〉http://www.cancer.gov/types/lung/research/nlst

杞戒釜浜哄井淇″锛杩荤绘．锛id: sadanyisen锛锛瑰