医疗剧《豪斯医生》助医生确诊疑难病例

医疗剧《豪斯医生》助医生确诊疑难病例

By a strange coincidence, two leading medical journals on Thursday published case studies of the same arcane medical mystery. In one, doctors solved the riddle only after the patient, a middle-aged woman, got so sick she had to have a heart transplant. But in the other, a physician who teaches at the University of Marburg in Germany found the clues in Season 7, Episode 11, of the Fox television show “House.”

上周四，两份主要的医学期刊出于某种离奇的巧合，刊发了两篇关注同一种医学谜题的病例研讨。在一个病例中，医生们是在中年女病人病情严重，需要接受心脏移植后，才得以解决迷团。而在另一个病例中，一位在德国马尔堡大学(University of Marburg)执教的医生从福克斯电视台(Fox)剧集《豪斯医生》(House)第7季第11集中得到了线索。

It turned out that Dr. Gregory House, the cantankerous, fictional diagnostician modeled on Sherlock Holmes, had used his powers of deduction to diagnose the very same ailment in a woman played by the actress Candice Bergen on an episode that first aired in 2011.

剧中的格里高利·豪斯(Gregory House)是位以夏洛克·福尔摩斯为原型的诊断专家，为人刁钻，在2011年首播的这集电视剧中，他通过排除法为一位由坎迪斯·伯根(Candice Bergen)饰演的女病人确诊病情，而德国的这位医生发现，他的病人患上的恰恰是同一种疾病。

In this case of life imitating art — or at least television — a paper in The Lancet, a London-based medical publication, described how an ailing man in Germany had gone from doctor to doctor, seeking a diagnosis as his condition worsened.

这篇发表在《柳叶刀》(The Lancet，总部设在伦敦的医学期刊)的报告讲述了一个现实生活效仿艺术——或者说是电视——的病例：一位德国男性病人遍寻名医，病情不断恶化，却迟迟得不到确诊。

His problems began about three years ago. He had low thyroid hormone levels, inflammation of his esophagus and fever of unknown origin. His loss of vision was so profound he was almost blind, and his loss of hearing so severe he was almost deaf. Most perilous of all, his heart had weakened so much it could not pump hard enough to supply blood to his body.

他的问题始于三年前。他的甲状腺激素水平很低，食道发炎，毫无来由地发烧。他的视力严重下降，到了近乎全盲的程度，同时听力严重受损，几乎全聋。最危险的情况在于，他的心脏出现了严重衰竭，无法把血液泵送到全身。

Heart failure usually follows coronary artery disease, but this man’s arteries were fine. Doctor after doctor was stumped.

心脏衰竭通常是因冠状动脉疾病而引起的，但这位病人的动脉状况良好。医生们接二连三地败下阵来。

Finally, in May 2012, the man, then 55, arrived at a University of Marburg clinic run by Dr. Juergen R. Schaefer, who specializes in puzzling cases and happens to be a major fan of “House.” In fact, Dr. Schaefer uses “House” in teaching medicine, and he realized his patient’s symptoms were eerily similar to those of Ms. Bergen’s character on the show. In that episode, she, too, had heart failure. Dr. House’s diagnosis: cobalt poisoning from her artificial metal hip.

终于，到了2012年5月，这位当时55岁的男性病人来到马尔堡大学诊所，诊所主管是擅长解决疑难杂症的于尔根·舍费尔(Juergen R. Schaefer)医生，而他碰巧是《豪斯医生》的忠实粉丝，甚至在平时教授医学课时会拿这部电视剧为教材。他意识到病人的症状跟剧集中伯根女士扮演的角色像得出奇。在这一集中，她同样出现了心脏衰竭。而豪斯医生的诊断是：由人造金属髋关节而引发的钴中毒。

Dr. Schaefer’s patient had had an artificial ceramic hip that failed, and it was replaced with a metal one in November 2010, shortly before his symptoms began. So Dr. Schaefer tested the man’s cobalt level and discovered it was a thousand times the level considered normal.

舍费尔医生的这位男性病人曾移植过陶瓷人造髋关节，但手术未能成功，2010年11月换成了金属髋关节，不久后症状开始出现。于是舍费尔检查了这位病人血液中的钴含量，结果发现比正常水平高出了1000倍。

A scan showed the metal in his hip was eroded. The reason, Dr. Schaefer speculated, was that when the man’s doctor removed the broken ceramic hip, he inadvertently left behind tiny particles of ceramic. Those particles, Dr. Schaefer said, acted like sandpaper: “You destroy the metal part with each movement.”

扫描结果显示，他髋关节中的金属受到了侵蚀。舍费尔推测认为，当手术医生移除了破裂的陶瓷髋关节时，不小心留下了一些陶瓷碎片。舍费尔说，这些小碎片就像是砂纸那样：“每活动一下，都会磨损金属部分。”

The man had his metal hip replaced with another ceramic one, after which his cobalt level plunged. His heart function improved, but he still needed a defibrillator implanted. His fever and esophagus problems went away. But his hearing and eyesight barely got any better.

于是这位病人又接受一次手术，将金属髋关节重新换成陶瓷关节，此后他体内的钴水平急剧下降。他的心脏功能得以改善，但仍需要植入起搏器。发热和食道问题消失了。但听力和视力几乎没有一点好转。

Needless to say, the doctors in the other case, published in The New England Journal of Medicine, had not seen that episode of “House.”

不消说你应该也能猜得出，发表于《新英格兰医学期刊》(The New England Journal of Medicine)的另一个病例，主管医生们没看过《豪斯医生》剧集。

The patient, a woman in Denver who asked not to be named to protect her privacy, said she began feeling ill on a vacation in Hawaii a few years ago.

病人是位住在丹佛的女性，为保护隐私要求不透露她的姓名，她介绍说，自己是在几年前去夏威夷度假时，开始感觉到身体不舒服的。

“I was tired all the time,” she said. When she returned from her travels, she discovered she had gained 10 pounds on her 4-foot-10, 95-pound frame, for no apparent reason. Her abdomen was swollen, as were her arms and legs.

“我老是觉得累得不行，”她说。结束旅行回家时，她发现自己1.47米高、43公斤重的纤细身材毫无来由地一下子重了4.5公斤。她的小腹和四肢都出现浮肿。

Her doctor ordered a CT scan, which showed fluid accumulating around her heart. He drained the fluid, but she still felt ill. Normally, someone with such a condition, cardiomyopathy, has an enlarged heart, but hers was a normal size.

她的医生安排了一次CT扫描，发现心脏周围出现积水。积水抽除后她还是不舒服。通常出现这种心肌症的人心脏都会变得肥大，但她的心脏大小很正常。

“It was kind of a puzzle to my first cardiologist,” she said.

“对于我的第一位心脏病医生来说，这真是个谜题，”她说。

By 2011, her heart was failing. She went to the Anschutz Medical Campus of the University of Colorado, Denver, where her doctor, Larry A. Allen, a heart failure and transplant specialist, confessed he was baffled.

到了2011年，她的心脏快不行了。她去了位于丹佛的科罗拉多大学(University of Colorado)的安舒茨医学院，这次她的医生是心脏衰竭和移植权威拉里·亚伦(Larry A. Allen)，他承认，自己当时完全没招了。

“We did a work-up looking at possible causes and even rare causes,” he said. “Nothing showed up.”

“我们做了各种检查，考虑了所有可能的原因，甚至各种罕见病，”他说，“可还是查不出原因。”

On Sept. 10, 2011, she underwent a heart transplant.

2011年9月10日，病人接受了心脏移植手术。

Sometime later, the orthopedist who had replaced her hips with metal implants took some routine blood tests and found something curious. Her cobalt level was more than 300 times normal. Cobalt poisoning can seriously damage organs, particularly the heart. The cause of her problems was suddenly clear.

过了段时日，曾为她做过金属髋关节置换手术的骨科大夫要给她进行例行血检，结果发现了些奇怪的问题。她血液中的钴含量比正常值高了300倍。钴中毒可严重伤害内脏器官，尤其是心脏。她身上出现的各种离奇问题一下子有了个清晰的答案。

About a year after her heart transplant, she had both artificial hips replaced with ones that had a polyethylene liner. Her postoperative course was rocky, but her cobalt level declined.

心脏移植一年后，她的两个人造金属髋关节都换上了聚乙烯垫片。术后她的恢复过程起起伏伏，不过钴水平降了下来。

“I have much of my old energy back,” she said in an interview.

“我觉得自己又渐渐恢复了活力，”在采访中她说。

In their article describing the case, Dr. Allen and his colleagues wrote that cobalt poisoning was first described in the 1960s in people who had been drinking beer that had foam stabilizers that contained cobalt.

亚伦医生和同事们在这篇病例报告中介绍说，钴中毒首次被人提出，是在20世纪60年代，当时人们喝的啤酒中有含钴的泡沫稳定剂。

But its link to metal-on-metal hip implants leaves questions, they said. Their patient had nothing obviously wrong with her prosthetic hips. And, Dr. Allen said, “literally tens of thousands of people had these hips without her problems.”

但他们在文中说，钴中毒跟金属对金属(metal-on-metal)髋关节假体联系在一起，仍然让人们心存疑问。这位病人的人造髋关节看来并没有明显的问题，而且亚伦医生说，“有上万人植入了类似的髋关节，但没有出现她这样的问题。”

But Dr. Allen said the patient’s case was a good reminder. However rare cobalt poisoning might be, it is something to consider when people with metal-on-metal hip implants have symptoms suggestive of it.

不过亚伦医生也说，这位病人的病例可以起到很好的提示作用：不管钴中毒有多么罕见，如果病人在植入金属对金属髋关节假体后，出现了相关的症状，就有必要考虑这种可能性。

And, yes, he said, maybe if he had just seen Dr. House in action he would have considered it.

同时他也说，如果他看到了豪斯医生的诊治过程，肯定会早点考虑这个诊断的。

“Unfortunately,” he said, “I have seen about two half-episodes of ‘House.’ ”

“不巧的是，我统共就看过两集《豪斯医生》，而且每集只看了一半，”他说。