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一种非传染性疾病的病理趋同理论。

A pathological convergence theory for non-communicable diseases.

作者信息

Padrón-Monedero Alicia

机构信息

National School of Public Health Institute of Health Carlos III Madrid Spain.

出版信息

Aging Med (Milton). 2023 Nov 5;6(4):328-337. doi: 10.1002/agm2.12273. eCollection 2023 Dec.

Abstract

The current paradigm considers the study of non-communicable diseases (NCDs), which are the main causes of mortality, as individual disorders. Nevertheless, this conception is being solidly challenged by numerous remarkable studies. The clear fact that the mortality, by virtually all NCDs, tends to cluster at old ages (with the exception of congenital malformations and certain types of cancer, among a few others); makes us intuitive to assume that the common convergence mechanism that exponentially increases mortality by almost all NCDs in older ages is cell aging. Moreover, when we study NCDs, we are not analyzing which disorders cause the mortality of the populations, rather that which disorders kill us before others do, because the aging of the individuals causes inevitably their death by one cause or another. This is not a defeatist perspective, but a challenging and efficient one. These intuitive assumptions have been supported by studies from the pathophysiologic, epidemiologic, and genetic fields, leading to the affirmation that, as NCDs share genetic and pathophysiological mechanisms (derived from mostly the same risk factors), they should no longer be considered independently. Those studies should make us reconsider our current conceptions of studying NCDs as individual disorders, and to hypothesize about a paradigm that would consider most NCDs (cancer, neurological pathologies, cardiovascular diseases, type II diabetes mellitus, chronic respiratory diseases, osteoarthritis, and osteoporosis, among others) different manifestations of the same process: the cell aging.

摘要

当前的范式将作为主要死亡原因的非传染性疾病(NCDs)的研究视为个体疾病。然而,这一观念正受到众多卓越研究的有力挑战。几乎所有非传染性疾病导致的死亡率往往在老年时聚集(先天性畸形和某些类型的癌症等少数情况除外),这一明确事实使我们直观地认为,几乎所有非传染性疾病在老年时使死亡率呈指数级增长的共同趋同机制是细胞衰老。此外,当我们研究非传染性疾病时,我们并非在分析哪些疾病导致了人群的死亡,而是在分析哪些疾病比其他疾病更早地夺去我们的生命,因为个体的衰老不可避免地会导致他们因某种原因死亡。这不是一种失败主义的观点,而是一种具有挑战性且高效的观点。这些直观的假设得到了病理生理学、流行病学和遗传学领域研究的支持,从而得出这样的论断:由于非传染性疾病共享遗传和病理生理机制(大多源自相同的风险因素),它们不应再被独立看待。这些研究应促使我们重新思考当前将非传染性疾病作为个体疾病进行研究的观念,并设想一种范式,该范式将大多数非传染性疾病(癌症、神经病理学、心血管疾病、II型糖尿病、慢性呼吸道疾病、骨关节炎和骨质疏松症等)视为同一过程的不同表现形式:细胞衰老。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15a4/10792334/516a8148889a/AGM2-6-328-g001.jpg

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