中国中医药信息杂志
中國中醫藥信息雜誌
중국중의약신식잡지
CHINESE JOURNAL OF INFORMATION ON TRADITIONAL CHINESE MEDICINE
2015年
6期
9-11
,共3页
适应性治疗策略%辨证论治%个体化诊疗
適應性治療策略%辨證論治%箇體化診療
괄응성치료책략%변증론치%개체화진료
adaptive treatment strategy%treatment based on syndrome differentiation%individualized treatment
中医辨证论治是建立在整体观理念上体现个体化诊疗和动态治疗的技术。然而，目前中医临床试验经常采用的随机对照设计并不能体现辨证论治的个体化诊疗和动态治疗观。适应性治疗策略是根据个体患者不断变化的状态调整治疗措施的一组决策规则，整个决策过程体现了个体化治疗和动态治疗。从这个角度来看，中医辨证论治的过程就是一个适应性治疗决策的过程。因此，在开展中医临床疗效评价时，引入开发最优适应性治疗策略的设计方法可以真实客观反映不同治疗策略的疗效。在已发表的国外文献中可以看到已有一些探索开发适应性治疗策略的临床研究，而国内真正使用适应性治疗策略的临床研究还鲜有报道。本文详细介绍了适应性治疗策略的概念及其重要组成部分，并概述了3种能够考虑远期疗效并能比较不同适应性治疗策略整体疗效的方法，以期为未来在中医科研工作中开发最优临床路径奠定基础及提供新的科研思路和方法。
中醫辨證論治是建立在整體觀理唸上體現箇體化診療和動態治療的技術。然而，目前中醫臨床試驗經常採用的隨機對照設計併不能體現辨證論治的箇體化診療和動態治療觀。適應性治療策略是根據箇體患者不斷變化的狀態調整治療措施的一組決策規則，整箇決策過程體現瞭箇體化治療和動態治療。從這箇角度來看，中醫辨證論治的過程就是一箇適應性治療決策的過程。因此，在開展中醫臨床療效評價時，引入開髮最優適應性治療策略的設計方法可以真實客觀反映不同治療策略的療效。在已髮錶的國外文獻中可以看到已有一些探索開髮適應性治療策略的臨床研究，而國內真正使用適應性治療策略的臨床研究還鮮有報道。本文詳細介紹瞭適應性治療策略的概唸及其重要組成部分，併概述瞭3種能夠攷慮遠期療效併能比較不同適應性治療策略整體療效的方法，以期為未來在中醫科研工作中開髮最優臨床路徑奠定基礎及提供新的科研思路和方法。
중의변증론치시건립재정체관이념상체현개체화진료화동태치료적기술。연이，목전중의림상시험경상채용적수궤대조설계병불능체현변증론치적개체화진료화동태치료관。괄응성치료책략시근거개체환자불단변화적상태조정치료조시적일조결책규칙，정개결책과정체현료개체화치료화동태치료。종저개각도래간，중의변증론치적과정취시일개괄응성치료결책적과정。인차，재개전중의림상료효평개시，인입개발최우괄응성치료책략적설계방법가이진실객관반영불동치료책략적료효。재이발표적국외문헌중가이간도이유일사탐색개발괄응성치료책략적림상연구，이국내진정사용괄응성치료책략적림상연구환선유보도。본문상세개소료괄응성치료책략적개념급기중요조성부분，병개술료3충능구고필원기료효병능비교불동괄응성치료책략정체료효적방법，이기위미래재중의과연공작중개발최우림상로경전정기출급제공신적과연사로화방법。
Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which is the core technology that can embody the characteristics and advantages of TCM diagnosis and treatment. This is based on holistic view to illustrate individual diagnosis and treatment and dynamic treatment. However, RCT, which is frequently used in TCM clinical studies, can not reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies in clinical researches can adjust therapy in patients according to the changes of diseases, so it can reflect individual diagnosis and treatment and dynamic treatment. From this perspective, the process of treatment based on syndrome differentiation is a process of decision-making of adaptive treatment. So the method for developing adaptive treatment strategies can effectively evaluate the efficacy of different treatment strategies in TCM clinical studies. Adaptive treatment strategies have been used in some clinical studies from some published foreign literatures. However, the use of adaptive treatment strategies in domestic clinical researches is seldom reported. This article discussed the concept of adaptive treatment strategies and their important components in detail. In addition, it presented three methods which can take the delayed effects of the current treatment action into consideration and can compare the overall effect of different adaptive treatment strategies, with a purpose to lay some foundation for future TCM researches in the development of optimal clinical pathway and provide new ideas and methods for researches.
