Name: NEJM 本週 — 2026 年 1 月 8 日 (NEJM This Week — January 8, 2026)
Uploaded: 2026-01-11T13:56:51.000Z
Duration: 25 min 11 s

This week we explore new options in cardiovascular fish oil supplementation in dialysis patients, RSV vaccination, and

本週我們要探討洗腎患者心血管魚油補充的新選擇、RSV 疫苗接種，以及

cutting edge cellular therapy for leukemia.

We discuss advances in lung cancer treatment, approaches to functional dyspepsia, and

我們討論肺癌治療的進展、功能性消化不良的處理方式，以及

a complex case of severe infection after travel.

Perspectives examine access to and cost of weight loss drugs, the promise and risks of AI in clinical care, and

觀點探討減重藥物的取得管道與成本、AI 在臨床照護中的潛力與風險，以及

what it means to care for others while carrying personal loss.

在承受個人損失的同時照顧他人的意義。

A New Clinical Decisions asks which would you choose?

新臨床決策單元詢問您會選擇哪一種？

Transcatheter or surgical aortic valve replacement?

經導管或外科主動脈瓣膜置換術？

This feature about a woman with asymptomatic severe aortic stenosis offers a case vignette accompanied by two essays, one supporting treatment with transcatheter aortic valve replacement and the other supporting surgical aortic valve replacement.

這篇關於一位無症狀嚴重主動脈瓣狹窄女性的特寫，提供了一個案例故事，並附有兩篇論文，一篇支持經導管主動脈瓣置換術，另一篇支持外科主動脈瓣置換術。

Visit nejm.org to vote and to see how others chose Evolocumab in patients without a previous myocardial infarction or stroke By Erin Bahula from Brigham and Women's Hospital, Boston and co authors the proprotein convertase subtilisinquexin type 9 PCSK9 inhibitor evolocumab reduces the risk of major adverse cardiovascular events among patients with a previous myocardial infarction, stroke, or symptomatic peripheral artery disease.

前往 nejm.org 投票，並看看其他人如何選擇 Evolocumab，適用於先前沒有心肌梗塞或中風的患者。作者為波士頓 Brigham and Women's Hospital 的 Erin Bahula 及共同作者，PCSK9 抑制劑 evolocumab 可降低先前有心肌梗塞、中風或有症狀周邊動脈疾病患者的主要不良心血管事件風險。

This study evaluated the effect of evolocumab on the risk of MACE among patients without a previous myocardial infarction or stroke.

這項研究評估了 evolocumab 對先前沒有心肌梗塞或中風的患者發生 MACE 風險的影響。

More than 12,000 patients with atherosclerosis or diabetes and without a previous myocardial infarction or stroke who had a low density lipoprotein cholesterol level of at least 90 mg per deciliter were randomly assigned to receive evolocumab or placebo.

超過 12,000 名患有動脈粥狀硬化或糖尿病，且先前沒有心肌梗塞或中風，低密度脂蛋白膽固醇水準至少為 90 mg/dL 的患者，被隨機分配接受 evolocumab 或安慰劑。

PCSK9 inhibition with evolocumab led to a lower risk of first cardiovascular events than placebo among these patients with a 25% lower risk of the primary composite of death from coronary heart disease, myocardial infarction or ischemic stroke and a 19% lower risk of the expanded primary composite endpoint 4 point mace, which included ischemia driven revascularization.

使用 evolocumab 進行 PCSK9 抑制，與安慰劑相比，可降低這些患者首次心血管事件的風險，主要複合終點（冠狀動脈心臟病死亡、心肌梗塞或缺血性中風）風險降低 25%，擴大的主要複合終點（4 點 MACE，包含缺血驅動的血管再建術）風險降低 19%。

Chadi Ndumele and Roger Blumenthal from the Johns Hopkins Chickarone center for the Prevention of Cardiovascular Disease, Baltimore, write in an editorial that these findings from the trial by Bohula and co authors represent an important step forward in clinical knowledge.

巴爾的摩約翰霍普金斯大學 Chickarone 心血管疾病預防中心 (Johns Hopkins Chickarone center for the Prevention of Cardiovascular Disease) 的 Chadi Ndumele 和 Roger Blumenthal 在一篇社論中寫道，Bohula 及共同作者的試驗結果，代表臨床知識向前邁進了一大步。

Although PCSK9 inhibitors had been shown to reduce the risk of atherosclerotic cardiovascular disease events among patients with previous myocardial infarction or stroke.

儘管 PCSK9 抑制劑已被證明可降低先前有心肌梗塞或中風的患者發生動脈粥狀硬化性心血管疾病事件的風險。

This new trial has found that PCSK9 inhibition conferred clinical benefit in patients without previous myocardial infarction or stroke.

這項新試驗發現，PCSK9 抑制在先前沒有心肌梗塞或中風的患者中，也提供了臨床益處。

It is also important to recognize what the current trial does not tell us because combining generic high intensity statin therapy and ezetimibe leads to an LDL cholesterol level below 70mg DL in the vast majority of patients with a baseline LDL cholesterol level of less than 160mg per deciliter.

同時，認識到目前試驗未告訴我們什麼也很重要，因為對於基線 LDL 膽固醇水準低於 160 mg/dL 的絕大多數患者，結合高強度他汀類藥物治療和依澤替米布，可將 LDL 膽固醇水準降至 70 mg/dL 以下。

It was the recommended initial strategy in the 2018 Multi Society Clinical Practice Guideline.

這是 2018 年多學會臨床實踐指南中建議的初始策略。

However, only 20% of the patients in the current trial were receiving ezetimibe.

不過，目前試驗中只有 20% 的病患有接受依澤替米布。

Whether similar clinical benefits would be observed in a population of patients receiving more aggressive treatment at baseline with less residual atherosclerotic cardiovascular disease risk is unclear.

在基線治療更積極、殘餘動脈粥狀硬化性心血管疾病風險較低的病患族群中，是否會觀察到類似的臨床益處，目前仍不清楚。

Nevertheless, the investigators should be applauded for this landmark trial.

儘管如此，研究人員仍應為這項劃時代的試驗受到讚揚。

Fish oil supplementation and cardiovascular events in patients receiving hemodialysis By Charmaine Locke from the University of Health Network, Toronto and co authors Cardiovascular disease is the leading cause of death in patients receiving hemodialysis, yet effective preventive therapies remain limited.

魚油補充與接受血液透析病患的心血管事件 By Charmaine Locke (多倫多健康網絡大學) 及共同作者。心血管疾病是接受血液透析病患的主要死因，但有效的預防性療法仍然有限。

Supplementation with N3 polyunsaturated fatty acids, especially eicosapentoenoic acid and docosahexaenoic acid, may have cardiovascular benefits in the general population, but

補充 N3 多不飽和脂肪酸，特別是二十碳五烯酸 (EPA) 和二十二碳六烯酸 (DHA)，可能對一般大眾有心血管益處，但

efficacy among patients receiving hemodialysis is uncertain.

在接受血液透析病患中的療效尚不確定。

In this trial, conducted at 26 sites in Canada and Australia, 1,228 adult patients receiving maintenance hemodialysis were randomly assigned to daily supplementation with fish oil, 4 grams of N3 polyunsaturated fatty acids, or corn oil.

這項在加拿大和澳洲共 26 個地點進行的試驗，將 1,228 名接受維持性血液透析的成人病患隨機分配，每日補充魚油（4 克 N3 多不飽和脂肪酸）或玉米油。

Placebo the rate of serious cardiovascular events among participants receiving maintenance hemodialysis was lower with daily supplementation with N3 fatty acids than with placebo.

接受維持性血液透析的參與者，每日補充 N3 脂肪酸後，嚴重的心血管事件發生率比安慰劑組低。

In an editorial, Finnian McCausland from Brigham and Women's Hospital, Boston and David Charatin from the New York University Grossman School of Medicine ask should fish oil now be recommended for our patients receiving hemodialysis?

在一篇社論中，Finnian McCausland (波士頓 Brigham and Women's Hospital) 和 David Charatin (紐約大學 Grossman 醫學院) 提問，我們現在是否應該推薦魚油給接受血液透析的病患？

On the one hand, the reported differences in cardiovascular risk are are impressive, with upper boundaries of 95% confidence intervals well below unity.

一方面，報告的心血管風險差異令人印象深刻，95% 信賴區間的上限遠低於一。

So it seems unlikely that these findings are due to chance.

所以這些發現不太可能是巧合。

Given the lack of efficacious therapies in this population, clinicians may feel compelled to strongly consider recommending the use of N3 polyunsaturated fatty acids in their patients, even in the absence of a significant difference in all cause mortality.

考量到這類病患缺乏有效的療法，即使在全因死亡率沒有顯著差異的情況下，臨床醫師可能會覺得有必要強烈考慮推薦病患使用 N3 多不飽和脂肪酸。

On the other hand, contemporary medicine is replete with examples in which potentially practice.

另一方面，當代醫學充斥著一些例子，其中潛在的臨床實踐。

Changing outsized results of early trials have failed to be replicated.

早期試驗的重大結果未能被重複驗證。

This situation suggests that we should pause before accepting the remarkable results reported by Locke and co authors as gospel.

這種情況顯示，在接受 Locke 和共同作者的顯著結果為絕對真理之前，我們應該先暫停一下。

Issues related to generalizability and a lack of mechanistic understanding of the findings warrant caution.

關於結果的普遍適用性以及對發現的機轉理解不足的問題，都值得我們謹慎。

A confirmatory trial is certainly indicated.

一個確認性試驗絕對是必要的。

RSV prefusion F vaccine for prevention of hospitalization in older adults by Mats Hoiberg Lassen from the Copenhagen University Hospital, Heerleb and Genthofte, Denmark and co authors Respiratory syncytial virus can cause serious illness in older adults.

由丹麥哥本哈根大學醫院 Heerleb 和 Genthofte 的 Mats Hoiberg Lassen 和共同作者所發表的 RSV 融合前 F 疫苗，用於預防老年人住院。呼吸道融合病毒可能導致老年人罹患嚴重疾病。

The bivalent RSV prefusion F protein based vaccine has been shown to prevent RSV associated respiratory illness, but

這種基於雙價 RSV 融合前 F 蛋白的疫苗已被證明可以預防 RSV 相關的呼吸道疾病，但

data from randomized trials with regard to its effect on outcomes involving hospitalization are limited.

從隨機試驗中關於其對住院結果影響的數據有限。

In this pragmatic phase 4 trial with individual randomization, 131,276 participants 60 years of age or older or were assigned to receive RSV pre F vaccine or no vaccine during the 2024-25 winter season.

在這項有個人隨機分派的實用性第四期試驗中，共有 131,276 名 60 歲或以上參與者，在 2024-25 年冬季期間被分配接受 RSV 融合前 F 疫苗或不接種疫苗。

The RSV pre F vaccine as compared with no vaccine, reduced the incidence of hospitalization for RSV related respiratory tract disease as well as the incidence of hospitalization for respiratory tract disease from any cause among adults 60 years of age or older.

與未接種疫苗相比，RSV 融合前 F 疫苗降低了 60 歲及以上成人因 RSV 相關呼吸道疾病而住院的發生率，以及因任何原因導致呼吸道疾病而住院的發生率。

Universal Base edited Car 7T cells for T cell acute lymphoblastic leukemia by Robert Chiesa from the Great Ormond Street Hospital for Children NHS Trust, London and co authors.

倫敦兒童醫療照護 NHS 基金會大奧蒙特街兒童醫院的 Robert Chiesa 和共同作者發表了用於治療 T 細胞急性淋巴母細胞白血病的通用鹼基編輯 CAR T 細胞。

These authors previously reported results from a first in human study of an investigational therapy consisting of universal base edited anti semic CD7 car T cells that were infused in order to secure deep molecular remissions of refractory T cell acute lymphoblastic leukemia prior to allogeneic stem cell transplantation.

這些作者先前曾報告一項人體試驗的結果，該試驗使用一種實驗性療法，由通用鹼基編輯的抗 CD7 CAR T 細胞組成，這些細胞在異體幹細胞移植前輸注，以期對頑固性 T 細胞急性淋巴母細胞白血病達到深度分子緩解。

The investigators now report results of the completed phase one study.

研究人員現報告已完成的第一期試驗結果。

Universal base edited anti CD7 car T cells were administered to nine children as well as to two adults who were treated under compassionate use access arrangements.

通用鹼基編輯的抗 CD7 CAR T 細胞被施用於九名兒童以及兩名在恩慈治療管道下接受治療的成人。

The investigators found that the investigational therapy induced anti leukemic responses in all the patients with relapsed or refractory CD7T cell all who received treatment.

研究人員發現，該實驗性療法對所有接受治療的復發或頑固性 CD7 T 細胞白血病患者都誘導了抗白血病反應。

Nine patients underwent allogeneic hematopoietic stem cell transplantation while in deep remission.

九名患者在深度緩解期間接受了異體造血幹細胞移植。

Two patients with quantifiable minimal residual disease in bone marrow received palliative care.

兩名骨髓中可量化微量殘留疾病的患者接受了姑息治療。

Limitations of this therapy included CD7 antigen loss and risks of viral related complications.

這項療法的限制包括 CD7 抗原缺失以及病毒相關併發症的風險。

I'm Darin Taichman, a deputy editor at the New England Journal of Medicine.

我是 Darin Taichman，NEJM 的副編輯。

I've been a full time medical journal editor for over 15 years, but I've never stopped seeing patients.

我當了 15 年的全職醫學期刊編輯，但我從沒停止看診。

Just like the other full time physician editors on our team, I continue to practice medicine for a couple of reasons.

就像我們團隊裡其他全職醫師編輯一樣，我繼續看診有幾個原因。

最重要的是，我熱愛這份工作。

I've known many of my patients for over 20 years and I don't want to lose those connections.

我認識我的許多病患超過 20 年了，我不想失去這些連結。

I also think seeing patients makes me a better editor.

我也認為看診讓我成為更好的編輯。

When we sit around the table and discuss papers, my colleagues and I can understand why the questions asked by the research studies we're considering are important or not to pract clinicians because we see patients ourselves.

當我們圍坐討論論文時，我和我的同事們能理解為什麼我們要考慮的研究問題對臨床醫師來說重要或不重要，因為我們自己也看診。

I love this work because I always learn a lot and the goal is simple to help our authors clearly, honestly and concisely communicate their findings to our readers so they in turn can use what they read to help their patients.

我熱愛這份工作，因為我總能學到很多，而目標很簡單，就是幫助我們的作者清楚、誠實、簡潔地向我們的讀者傳達他們的發現，這樣他們就能運用所學來幫助他們的病患。

It certainly helps me take better care of my patients.

這確實能幫助我更好地照顧我的病患。

We're published by the Massachusetts Medical Society, a not for profit publisher, and

我們是由麻州醫學會出版的，這是一個非營利出版機構，

we rely on subscriptions from individual readers, medical schools, and libraries to fund what we do.

我們仰賴個人讀者、醫學院和圖書館的訂閱來支持我們的運作。

Functional Dyspepsia A review article by Pankaj Pashrika from the Mayo Clinic, Scottsdale, Arizona and Nicholas Talley from the University of Newcastle, New South Wales, Australia.

功能性消化不良 由來自亞利桑那州斯科茲代爾梅約診所的 Pankaj Pashrika 和來自澳洲新南威爾斯大學的 Nicholas Talley 撰寫的評論文章。

Functional dyspepsia is a common but serious medical syndrome that can induce weight loss and food aversion and may be associated with increased risks of hospitalization and death.

功能性消化不良是一種常見但嚴重的醫學症候群，可能導致體重減輕和厭食，並可能與住院和死亡風險增加有關。

Functional dyspepsia probably comprises several different and yet incompletely characterized disorders.

功能性消化不良可能包含幾種不同的、尚未完全闡明的疾病。

Patients with local mucosal microinflammation driven by an aberrant TH2 response may represent an important subgroup.

由異常的 TH2 反應驅動的局部黏膜微發炎患者可能代表一個重要的亞群。

There is overlap with other gastrointestinal syndromes, particularly irritable bowel syndrome and gastroesophageal reflux disease, and

與其他腸胃道症候群，特別是腸躁症和胃食道逆流疾病有重疊，

patients with overlap have more severe symptoms.

症狀重疊的患者有更嚴重的症狀。

There is no approved drug for functional dyspepsia.

目前沒有核準用於治療功能性消化不良的藥物。

Treatment is empirical and directed at symptoms and consists of acid suppressants and low dose tricyclic antidepressants and other neuromodulators along with appropriate nutritional and psychological support.

治療是經驗性的，以症狀為導向，包含使用制酸劑、低劑量三環抗憂鬱藥物及其他神經調節劑，並輔以適當的營養和心理支持。

A 50 year old woman with fever and abdominal pain.

一位50歲女性，出現發燒和腹痛。

A case record of the Massachusetts General Hospital by Stephen Threlkeld and colleagues.

這是由Stephen Threlkeld及其同事提供的麻省總醫院病例記錄。

A 50 year old woman was admitted to the hospital because of fatigue, diarrhea, leg pain, headache and chills after returning from a trip to remote northeastern Brazil.

一位50歲女性，在從巴西東北部偏遠地區旅行回來後，因疲勞、腹瀉、腿痛、頭痛和發冷而入院。

The patient had acquired schistosomiasis as a child in Brazil.

這位病患小時候在巴西感染了血吸蟲病。

The infection had been complicated by portal hypertension and and hypersplenism.

感染已併發門脈高壓和脾功能亢進。

On current arrival in the emergency department, the patient was hypotensive, febrile and tachypneic with hepatosplenomegaly and petechiae.

抵達急診室時，病患血壓低、發燒且呼吸急促，並有肝脾腫大和瘀點。

Imaging revealed cirrhotic liver changes, esophageal varices, pulmonary infiltrates and a large uterine fibroid.

影像學檢查顯示肝臟硬化變化、食道靜脈曲張、肺部浸潤和一個大的子宮肌瘤。

She rapidly deteriorated into refractory septic shock with disseminated intravascular coagulation and multiorgan dysfunction.

她迅速惡化成難治性敗血性休克，伴隨瀰漫性血管內凝血和多器官功能障礙。

The bacteria on initial gram staining of her blood appear to be gram positive cocci in clusters.

她血液初步革蘭氏染色顯示為革蘭氏陽性球菌，呈簇狀排列。

Organism identification performed with matrix assisted laser desorption ionization, time of flight Malditoff mass spectrometry showed findings consistent with Neisseria meningitidis.

使用基質輔助雷射脫附遊離飛行時間質譜儀進行的微生物鑑定，結果顯示與 Neisseria meningitidis 一致。

Re examination of the initial gram staining and repeat staining identified N. Meningitidis.

初步革蘭氏染色複檢及重複染色確認為 N. Meningitidis。

The patient was treated with broad spectrum antibiotics, vasopressors, steroids and supportive measures, but refractory shock developed.

病患接受廣效抗生素、昇壓藥、類固醇及支持性療法，但出現頑固性休克。

Invasive meningococcal disease is associated with a substantial public health burden worldwide.

侵襲性腦膜炎雙球菌疾病在全球造成相當大的公共衛生負擔。

In the United States, the incidence of invasive meningococcal disease is highest among infants and young children.

在美國，侵襲性腦膜炎雙球菌疾病的發生率在嬰幼兒中最高。

However, a growing proportion of cases are occurring in older age groups.

然而，越來越多的病例發生在較年長的年齡層。

Because clinical manifestations of invasive meningococcal disease vary, a high index of suspicion is required.

由於侵襲性腦膜炎雙球菌疾病的臨床表現多樣，需要高度警覺。

Insurance coverage and pricing of weight loss drugs in the United States A perspective by Stacy Ducetzina from Vanderbilt University Medical Center, Nashville and Rachel Sachs from Washington University in St.

美國減重藥物的保險給付與定價：來自納許維爾範德堡大學醫學中心 Stacy Ducetzina 和聖路易華盛頓大學 Rachel Sachs 的觀點。

Louis on November 6, the Trump administration announced agreements with Eli Lilly and Novo Nordisk regarding pricing and coverage of their glucagon like peptide 1 GLP1 receptor agonists including Tirzepatide and Semaglutide.

11 月 6 日，川普政府宣佈與 Eli Lilly 和 Novo Nordisk 達成協議，針對其胰高血糖素樣肽-1 GLP1 受體促效劑（包括 Tirzepatide 和 Semaglutide）的定價與給付。

The wide ranging agreements include provisions relating to various segments of the market.

這些廣泛的協議包含與市場各個區塊相關的條款。

Beginning in January 2026, patients purchasing injectable forms of GLP1 agents without insurance cash pay using direct to patient sales platforms are expected to be able to obtain these drugs for an average of $350 per month rather than the current $500 or so per month depending on the drug and dose.

從 2026 年 1 月開始，沒有保險、透過直銷平臺購買可注射型 GLP1 藥物的患者，預計每月平均只需支付 350 美元，而非目前約 500 美元（視藥物和劑量而定）。

The lower prices are available only for starting doses.

較低的價格僅適用於起始劑量。

According to a November 6 fact sheet issued by the White House, the companies have agreed to a Medicare price of $245 per month for all injectable GLP1 agents for currently covered indications including diabetes, chronic kidney disease and sleep apnea, and

根據白宮 11 月 6 日發布的事實說明，這些公司已同意為所有可注射型 GLP1 藥物設定聯邦醫療保險（Medicare）的每月價格為 245 美元，涵蓋目前已獲準的適應症，包括糖尿病、慢性腎臟病和睡眠呼吸中止症，以及

for newly expanded use for obesity and related coexisting conditions.

新擴大的用於肥胖症及相關共病症的用途。

Medicare beneficiaries would have their copayments set at $50 per month for all indications.

聯邦醫療保險受益人所有適應症的自付額將設定為每月 50 美元。

The announcement also states that Medicaid programs will be able to opt into this price for all GLP1 agents.

該聲明還指出，醫療補助計畫（Medicaid）將能夠選擇加入所有 GLP1 藥物的此價格。

In comments to the press, Eli Lilly's chief executive officer, indicated that the lower CO payments and expanded coverage for obesity indications could take effect in 2026.

Eli Lilly 的執行長在對媒體發表評論時表示，較低的自付額和擴大的肥胖症適應症給付可能在 2026 年生效。

The new agreements for GLP1 drugs could reduce prices and improve access for some patients, but

這些針對 GLP1 藥物的新協議可能會降低價格並改善部分患者的取得管道，但

will probably also mean that there will be substantial additional spending on these drugs soon.

也可能意味著這些藥物的額外支出將很快大幅增加。

Generic Liraglutide Overlooked but not Forgotten A perspective by Suhas Gandhi from Massachusetts General Hospital Boston and CO authors Total US spending on GLP1 drugs increased by more than 500% since 2018, exceeding $71 billion in 2023.

學名藥 Liraglutide 被忽略但未被遺忘 由麻州總醫院的 Suhas Gandhi 和其他共同作者提供的觀點 2018 年以來，美國在 GLP1 藥物上的總支出增加了 500% 以上，2023 年超過 710 億美元。