醫學的進步是先輩們篳路藍縷，一點一滴開拓出來，從青黴素到MRI，從腫瘤化療到幹細胞移植。而現代醫學的基石是一個個裡程碑式的臨床試驗 （landmark trial）。我們的教科書的根本也是基於這些landmark trials。
讓我們來一起閱讀醫學史上的經典。閱讀，不僅僅是學習醫學英語最好的方式，也能更好地理解現代醫學的精髓。
第一篇，我們來領略一下經典的肝硬化的Child-Pugh score是如何誕生的。
The Child-Pugh score: Prognosis in chronic liver disease and cirrhosis
這是一篇發表於1973年的文章，至今都是教課書上、臨床上的經典內容。它主要提示了慢性肝病和肝硬化的臨床預後，要點如下：
1. The Child-Pugh score consists of five clinical features and is used to assess the prognosis of chronic liver disease and cirrhosis.
2. The Child-Pugh score was originally developed in 1973 to predict surgical outcomes in patients presenting with bleeding esophageal varices.
3. The score is used with the Model for End-Stage Liver Disease (MELD) to determine priority for liver transplantation.
試驗結果: Originally developed in 1973, the Child-Pugh score was used to estimate the risk of operative mortality in patients with bleeding esophageal varices. It has since been modified, refined, and become a widely used tool to assess prognosis in patients with chronic liver disease and cirrhosis. The score considers five factors, three of which assess the synthetic function of the liver (i.e., total bilirubin level, serum albumin, and international normalized ratio, or INR) and two of which are based on clinical assessment (i.e., degree of ascites and degree of hepatic encephalopathy). Critics of the Child-Pugh score have noted its reliance on clinical assessment, which may result in inconsistency in scoring. Others have suggested that its broad classifications of disease are impractical when determining priority for liver transplantation; nevertheless, it remains widely used. The Model for End-Stage Liver Disease (MELD) is a newer scoring system that has been developed to address some of the concerns with the Child-Pugh score, and the two systems are often used in conjunction to determine liver transplantation priority.
深度解析與批評: This study, originally published in 1973 in the British Journal of Surgery, sought to determine whether clinical features could help predict surgical outcomes in patients with esophageal varices. A total of 38 consecutive cases of bleeding esophageal varices requiring surgery were included in the study. The severity of liver disease was assessed in each patient based on five clinical features: 1) total bilirubin level, 2) serum albumin, 3) prothrombin time (now measured as the INR), 4) the degree of ascites, and 5) the grade of hepatic encephalopathy. The total point score was then used to determine the patient’s Child-Pugh class. Class A patients (n=7) experienced a 29% operative mortality rate, while Class B (n=13) and Class C (n=18) patients had operative mortality rates of 38% and 88%, respectively. Since its publication, the Child-Pugh score has undergone modifications and is currently used to assess the severity and prognosis of chronic liver disease and cirrhosis. Moreover, it is often used together with the MELD to determine the priority for liver transplantation. The currently used Child-Pugh scoring system has been outlined below.
關鍵詞彙
cirrhosis: [sə'rosɪs] n. 硬化；[內科] 肝硬化
prognosis: [prɑg'nosɪs] n. [醫] 預後; 預知
esophageal: [,isə'fædʒɪəl] adj. 食管的; 食道的
varices: ['vɛrɪ,siz] n. 靜脈曲張; 脈管曲張（varix的複數）
priority: [praɪ'ɔrəti] n. 優先; 優先權; [數] 優先次序; 優先考慮的事
mortality: [mɔr'tæləti] n. 死亡數，死亡率; 必死性，必死的命運
ascites: [ə'saɪtiz] n. [臨床] 腹水
hepatic: [hɪ'pætɪk] adj. 肝的; 肝臟色的; 治肝病的
encephalopathy: [ɛn,sɛfə'lɑpəθi] n. [內科] 腦病
bilirubin: [,bɪlɪ'rubɪn] n. [生化] 膽紅素
prothrombin: [pro'θrɑmbɪn] n. 凝血素; 凝血酶原; 第二因子
這篇發表1973年雖然至今仍然廣泛應用，但被人詬病甚多。
我們來閱讀這篇經典發表30年後的姊妹篇 —— MELD 研究。
Looking forward to hearing comments from Gastroenterologist / Hep
你喜歡這種文獻
往期精華文章：
收好了！獻給醫療人員的倚天劍、屠龍刀
海外行醫數年，醫學英語學習的秘訣都在這裡了
這個誰都知道的疾病，你知道名字的來源嗎？
乾貨 | 手術器械英語，你知道幾個？
關於各個科室和職稱的英文說法你知道多少？
各國醫生主要職稱稱謂，你知道幾個？
這裡是靠譜的醫學詞彙平臺，有趣，有料。
你得到的不僅僅是醫學詞彙！
歡迎投稿：alphamedenglish@126.com