中醫藥研究論叢

211.9 從臺灣肝癌發現高比例帶有馬兜鈴酸特有的基因突變特徵研究的新聞事件:談醫療人員如何正確宣揚研究成果
TJ TCM.21(1) : 97-110, 2018
從臺灣肝癌發現高比例帶有馬兜鈴酸特有的基因突變特徵研究的新聞事件:談醫療人員如何正確宣揚研究成果
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”
陳金女1 陳旺全2 陳朝榮1,3 林展弘4 李德彥1 賴榮年5,6,7*
1 中國醫藥大學中西醫結合研究所,台中,台灣
2 中華民國中醫師公會全國聯合會,台北,台灣
3 中國醫藥大學附設醫院蛋白質體核心實驗室,台中,台灣
4 台北市中醫師公會,台北,台灣
5 中國醫藥大學中醫學系,台中,台灣
6 中國醫藥大學附設醫院中醫部,台中,台灣
7 全國中藥不良反應通報系統整合及通報教育訓練,台北,台灣
【摘要】
2017 10 月國際期刊《科學轉譯醫學》(Science Translational Medicine)報導從臺灣肝癌組織檢體中發現高比例帶有馬兜鈴酸特有的基因突變特徵(Aristolochic acid mutational signature) 的研究,這個研究結果的確可以引起科學家們的注意,懷疑馬兜鈴酸會導致肝癌的可能性,由於這是一篇探索型
的研究,Rozen 團隊無法斷定馬兜鈴酸存在肝癌檢體的事實,就是導致肝癌的原因;因此,無論是仔細論述科學研究主要發現的結、討論(discussion)或精簡呈現整篇論文重要發現的摘要(abstract),都沒有用到馬兜鈴酸causes肝癌或馬兜鈴酸induces 肝癌等馬兜鈴酸會導致肝癌的字眼,林口長庚醫院研究團隊根據這篇研究,召開記者會宣稱「台灣高達近8 成的慢性肝炎肝硬化病患,可能使用過含有馬兜鈴酸的草藥,可能和肝癌的發生有關」,這個新聞的發布內容,徒然增加民眾在沒有詳讀科學論文的無謂恐慌。
將研究論文「Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia」依據其研究目的、研究方法、研究結果及結論做簡易翻譯,並針對研究論文中的各個段落進行分析及討論。
經詳讀該研究的目的、設計及發現,記者會中的新聞稿如果修改為「北台灣二個醫學中心肝癌檢體的研究發現,高達近8 成肝癌的病患,可能曾經使用過含有馬兜鈴酸的物質,至於含有馬兜鈴酸的物質和肝癌的發生有沒有因果關係,仍須進一步研究」,是比較符合該研究的論述;我們建議:醫療從事人員宣揚科學研究成果的推論,應該以解決問題的態度,平實闡述研究成果為宜。
【關鍵詞】馬兜鈴酸突變特徵(AA signature),馬兜鈴酸,誤用中藥,科學論文評論(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