Joseph S. Alpert， M.D.     
Professor of Medicine， University of Arizona Health Sciences Center
Tucson， Arizona; Editor-in-Chief， American Journal of Medicine

美国亚利桑那医学中心医学教授
《American Journal of Medicine》杂志主编


International Circulation:

In 2008， you and your colleagues published an article on the new universal definition of myocardial infarction， which is based on troponin elevation along with ischemic symptoms， typical electrocardiogram changes， or imaging evidence of loss of viable myocardium. What is your opinion on the benefit of the new consistent universal definition? 

 《国际循环》：2008年，您和您的同事发表了一篇关于心肌梗死诊断新标准的文章，新的诊断标准基于肌钙蛋白升高、缺血症状、典型心电图改变和有活力心肌丢失的影像学证据。您认为这一新的统一的诊断标准有何意义？
 

Prof.  Joseph Alpert: The new universal definition clarifies and organizes our ability to diagnose myocardial infarction. Before this document was published in 2000 and revised in 2007， different doctors and different hospitals were defining MI in many different ways. Clinical trials were also not uniform in their defintion of MI so that it was difficult to compare results from one trial to another. The universal definition means that we are now beginning to speak the same language all over the world with respect to MI. Clinicians and clinical scientists in China will be able to see how their patients differ or are the same as patients in Australia， Europe， North America， etc. when they use the universal definition. The definition has made huge strides in the last two years in that it is being widely used clinically and in many scientific trials. 

Alpert教授：新的统一诊断标准澄清了对心肌梗死诊断的认识。在此文献2000年发表和2007年修订之前，不同的医生和医院以不同的方式定义心肌梗死。在心肌梗死的定义方面，临床试验也没有统一，这也为不同试验结果的对比带来困难。统一的诊断标准意味着就心肌梗死的诊断而言，我们在全世界范围内消除了分歧。当应用统一的诊断标准与澳大利亚、欧洲、北美等地的患者相比时，中国的临床医生和临床科学家将能够看到不同地域患者的异同。在临床和许多科学试验中此诊断标准被广泛应用，因而在过去的两年中它也产生了巨大的进展。
 

International Circulation: Recent research has indicated that frailty is a clinical manifestation of cardiovascular disease， especially of heart failure. What do you think about this standpoint? How do we understand the connection between frailty and cardiovascular disease?    

《国际循环》：最近的研究显示乏力是心血管疾病特别是心力衰竭的临床表现。请问您是如何看待这个观点？我们如何理解乏力和心血管疾病之间的联系？
 

Prof.  Joseph Alpert:  The world’s population is aging rapidly. In the US， more people will become age 85 today than will be born. China too is experiencing a marked aging of its population. These individuals are often quite weak， frail， and have a variety of degenerative diseases at the end of their lives. Their care is different from that of younger patients with the same illness because of their fraility and their concomitant illnesses. They cannot tolerate medicines and/or surgery in the same way that younger patients can. Their care is a whole new and interesting field. Finally， they require a great deal of supportive care that can be very expensive for their families and for their communities. This problem will continue to increase as the population ages in coming years. 

Alpert教授：世界人口正迅速步入老龄化。在美国，85岁以上的人口数即将超过新生儿数。中国也正经历人口的老龄化。这些个体经常相当虚弱、乏力，并在他们生命的最后阶段患有许多退行性疾病。由于虚弱和伴随疾病，老年患者的治疗不同于患有相同疾病的年轻患者。他们不能耐受与年轻患者相同的药物和（或）外科手术。对老龄患者的治疗是一个全新和有趣的领域。最终，他们需要大量支持疗法，这对于他们的家庭和社区来说是昂贵的医疗负担。这一问题随着未来人口老龄化的发展会逐渐加剧。
 

International Circulation: Regenerative medicine represents a promising perspective on therapeutic angiogenesis in patients with cardiovascular disease， including heart failure. Do you think stem cells and genetic therapies are ready for "prime time"?  

 《国际循环》：再生治疗为心血管疾病包括心力衰竭患者提供了一个有前景的治疗方法。您认为干细胞治疗和基因治疗的时代来到了吗？
 

Prof.  Joseph Alpert: Regenerative medicine， stem cell， and progenitor cell therapy are very， very exciting new approaches to illness， but they are a long way from becoming "prime time" therapies. There are many problems to solve before they can be used on a daily basis. How permanent will these new cells be once introduced into organs? How much will these new therapies cost? How safe are they? What are the long term results and outcomes with these therapies? All of these questions must be carefully answered before these therapies are "prime time". Animal experiments are very promising in this area but we are a long way from using them in humans on a routine basis. 

Alpert教授：再生医学、干细胞和祖细胞治疗是非常令人振奋的新方法，但要成为“黄金治疗方案”还有很长的路要走。在能够被常规应用前，还有很多的问题需要解决：这些新细胞被导入组织后会持续存活多久？这些新方法的花费如何？它们的安全性如何？长期结果和预后如何？所有这些问题都必须谨慎回答。此领域的动物实验得到了很好的结果，但常规应用于人体还有待更进一步的研究。