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      俞夢孫院士:展望人類健康系統工程
      來源: | 作者: | 發布時間:2015-8-29 12:55:23
      俞夢孫院士:展望人類健康系統工程

       
      世界衛生組織在《21世紀的挑戰》報告中強調:“21世紀的醫學,不應該繼續以疾病為主要領域,應當以人的健康作為醫學的主要發展方向。”

      人類健康工程的提出
       
      當前的醫學模式主要以疾病的診斷和治療技術作為主要的研究方向。這種醫學模式的發展趨勢是醫學的現代化、專門化、精細化和商業化。醫學的現代化體現在醫院的信息化和規模化,導致高新技術的過度應用;醫學的專門化表現在分科的細化,導致專科醫生匠人化,失去了整體性,反而易導致錯誤行為;醫學的精細化體現在分子基因診斷、分子基因治療等方面,客觀上增進了學科發展,所達到的目標卻漸行漸遠;醫學的商業化使醫學成為人均產值最高和投資熱點行業,這完全改變了醫學的初衷。其現實后果是全球性的醫療危機:非傳染性慢病成為人類健康和生命的主要威脅,雖然各國醫療衛生界均投入了大量人力、財力,但從總體上控制不住非傳染性慢病的發展,醫療費用消耗已經遠遠大于社會經濟發展速率,呈現一種不可持續的態勢。
       
      造成以上種種現象的原因是醫學變成了疾病醫學,以疾病的治療和診斷為主。而實際上已經形成的共識是:疾病是整體失調狀態的局部體現;局部體現成什么病,則與性格、行為、遺傳等有關,是第二位的。韓啟德院士曾經在香山科學會議上指出:“我們應該看到還原論思想帶來的科學進步、帶來的現代醫學的發展和對生命體由表及里的認知,但也必須清楚:在還原論的指導下,我們對生命和疾病的認識是局部的、分離的,缺乏系統的、綜合的、整體的和本質的認識和理解。”
       
      這說明,當前醫學的工作重點應從關注疾病為主轉向關注整體狀態為主。所以,世界衛生組織在《21世紀的挑戰》報告中強調:“21世紀的醫學,不應該繼續以疾病為主要領域,應當以人的健康作為醫學的主要發展方向。”
       
      關于醫學的發展,中國生物醫學工程學會的一批老專家一直在關注,已有近30年的歷史。20世紀80年代曾提出過“省錢的生物醫學工程”概念。2002年提出的“戰略前移、重心下移”概念,已被政府接受,成為未來中國醫學發展的綱領。但是對于呈井噴樣的慢病怎樣應對,一直未找到切入點。直到2008年,筆者讀到錢學森的復雜系統理論之后,聯想到慢病的具體發病規律,找到了解決慢病肆虐的切入點:恢復自組織能力。這是解決慢病問題,解決困擾人們整整一個世紀的難題的人類健康工程的內涵。它的具體內容包括相互聯系的兩大部分:一是用健康醫學模式替代目前的疾病醫學模式;二是用健康物聯網方式,在全社會范圍內推進健康醫學模式。
       
      人類健康工程從研究人的自組織功能開始
       
      從系統科學角度看,人體是一個開放的復雜系統,而開放的復雜系統通常應具備五種主導系統運行的系統學原理,它們是:自組織原理、開放性原理、能量原理、層次結構或網絡化原理、進化原理。在這五種系統學原理中,自組織原理是這五種原理的核心,因為自組織原理本身就具備了開放的性質,也是能量耗散的結果,而且自組織過程一定是多層次網絡化的,并且自組織的結果一定具有進化意義。因此,我們只要認識清楚人的自組織功能,也就相當于對人的復雜系統規律有所了解。
       
      從健康和疾病角度看,人的自組織功能主要表現在如下三方面:自組織系統自發地走向“目的點”的能力是人體強大的維持和促進健康的能力;自組織系統動態內穩機制的存在是人體健康地適應環境的基礎,是自組織系統自發地走向“目的環”的體現;自組織系統表現出的自修復能力,是回到“目的點”的能力,因此是人體祛除病痛、恢復健康的最安全、最有效的途徑。
       
      健康醫學模式
       
      人體是一個在內外各種因素作用下的動態內穩態系統。按照系統理論研究結果,內穩態范圍可分為線性非應激區和非線性應激區兩部分。前者屬對稱倒易關系,處于線性非平衡態的穩定狀態,后來被普利高津證明是一種最小熵產生原理。因此,線性非應激區是生命的常態,是穩定的、對稱的、低功耗的。
       
      但生命在一定條件下具有適應環境的能力。當外因(風、寒、暑、濕、燥、火)或內因(七情)對機體的刺激作用超出人體的線性定態性穩態范圍,而進入內穩態的非線性區,使原有的對稱性開始破壞,屬于應激反應區。這時,機體會產生普遍性適應綜合征(GAS),會在反應之后表現為全面的回歸。這正如普利高津所說的那樣,機體在遠離平衡態,進入非線性區之后,會產生新的適應環境的有序功能和有序結構,并產生較高的有序性耗散。但生命體的自組織功能存在自發地走向低耗散、恢復低耗散下的對稱性的能力,并在新的環境下,重新建立起上述的線性穩態區,達到再一次的低功耗狀態。
       
      這就告訴我們,人體對新環境的適應,一定存在兩個階段:其一,是功能習服階段,或稱耗散性習服階段;另一個,是結構習服階段,或稱低耗散習服階段。這種應激反應所引發的是新的有序結構,一般不會產生不利于整體有序運動的新的無序結構,因此,我們稱這類反應是生理性應激反應,是人體適應新環境所必須經歷的應激反應。我們應該恰當利用它,使它成為促進人體穩態水平提高的主要途徑。
       
      隨著社會經濟發展,非傳染性慢病的肆虐成為當前人類生活的主要矛盾。慢病本質上是自組織功能弱化,是體內形成了持續內部應激原的結果,是系統穩態水平下降、失調、失穩的表現。
       
      解決這一問題的突破口有兩個相互聯系的內容:一是用健康醫學模式對待非傳染性慢病,二是用健康物聯網方式應對井噴樣慢病發病態勢。
       
      健康醫學模式提出的理論依據有如下兩點:健康人所具備的自組織自修復能力是人體祛除病痛最安全最有效的途徑;各類慢性病生成的條件是:“狀態失穩”與“遺傳因素”同時存在、即二者“相與”的結果。上述理論依據表明:消除慢病的唯一原理是使上述兩個條件不“相與”,而唯一可行的途徑是重塑自組織功能,充分運用恢復過來的自修復能力祛除各類慢病,變“狀態失穩”為“狀態穩定”。這就是健康醫學模式的理念。
       
      以人為中心的SIR模式是實施健康醫學模式的具體形態,其內容不僅指科技,也包括與人文的結合。在具體實施時不排除能直接祛除病灶而又不損害整體的辦法,但主要的努力應放在通過序參量的調整、自組織功能的重建上。
       
      作者簡介:
       
      俞夢孫,中國工程院院士,空軍航空醫學研究所航空醫學工程研究中心主任、北京大學健康系統工程研究所所長。
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