第四章血液內(nèi)科答案DialogueInterpretingDoctor:早上好，史密斯先生，請進(jìn)。Patient:Goodmorning,doctor.Doctor:那么，我能為你做些什么？Patient:Ioftenfeeltiredanddizzy.Doctor:你這種感覺持續(xù)多久了？Patient:Formorethanhalfamonth.Doctor:有發(fā)燒嗎？Patient:Yes,andIoftenfeellightheadedandweakallover.Doctor:來，量下體溫。Patient:Doctor,doIhaveafeverrightnow?IfeellikeI’mrunningatemperature.Doctor:是的，低燒，37.4℃。流鼻血嗎？Patient:Ioncehadanosebleed.Itwasn’tmuch,soIdidn’tpaymuchattentiontoit.Doctor:你的四肢上經(jīng)常有淤青嗎？Patient:Yes,thereareoftenbruisesonmyarmsandlegs,somepurpleandblueincolor.Doctor:這些淤青是自己出現(xiàn)的，還是受傷后才有的？Patient:Theyappearsuddenly,withoutanyinjury.Doctor:感到骨頭疼嗎？Patient:WhenIpressfirmlyonmychest,itfeelspainful.Doctor:你需要做個血液檢查，實(shí)驗(yàn)室在三樓，我的助理會帶你過去。Patient:Doctor,howarethetestresults?Doctor:不太好。顯示白細(xì)胞增多、血小板減少和貧血。外周血中出現(xiàn)原始細(xì)胞尤其值得關(guān)注。我認(rèn)為你需要做骨髓檢查來確診。Patient:Doesthistesthaveanysideeffects?Isitdangerous?Doctor:一般來說是安全的，只有極少數(shù)并發(fā)癥。它有助于疾病的診斷。Patient:Doctor,here’sthetestreport.Ismyillnessserious?Doctor:不要擔(dān)心。貧血或血小板減少可能由多種疾病引起，比如再生障礙性貧血、急性白血病、大細(xì)胞性貧血等。確診后你應(yīng)盡快接受治療。Patient:Doctor,pleasetellmehonestly—whatexactlyiswrongwithme?Doctor:根據(jù)癥狀和化驗(yàn)結(jié)果，你被診斷為急性白血病。Patient:OhmyGod,Ihaveleukemia!Doctor:你應(yīng)該立即住院治療。Patient:Doctor,canmyillnessbecured?Doctor:我們一定會盡最大努力治好你。Patient:Please,doctor,doeverythingyoucan.I’monly34yearsold—Idon’twanttodie.Canyouexplainthetreatmentprocesstome?Doctor:主要治療是化療。同時支持性治療也很重要，包括使用抗生素和輸血。Patient:WhatshouldIpayattentionto?Doctor:我建議你好好休息。我相信你很快就會康復(fù)。你明天早上可以到住院部，護(hù)士會幫你安排好。Patient:Thankyouverymuch,doctor.I’llcometobeadmittedtomorrow.Goodbye.Consecutive/SimultaneousInterpretingPassageOne人類免疫缺陷病毒今天，我想談一個具有深遠(yuǎn)意義的話題——人類免疫缺陷病毒（HIV）。它對全球健康產(chǎn)生了重大影響，而了解這種病毒對于我們預(yù)防和治療感染至關(guān)重要。HIV主要分為兩種類型：HIV-1和HIV-2，它們都屬于反轉(zhuǎn)錄病毒科慢病毒屬。隨著時間推移，HIV可導(dǎo)致一種被稱為獲得性免疫缺陷綜合征（AIDS）的疾病。AIDS的特征是免疫系統(tǒng)逐漸衰退，使患者極易受到威脅生命的感染和癌癥的侵襲。如果不進(jìn)行治療，感染HIV者的平均生存期估計約為9至11年，具體取決于病毒的亞型。在大多數(shù)情況下，HIV通過性接觸傳播。此外，非性傳播途徑包括接觸被感染的血液或血制品（例如被污染的針具），以及感染母親在妊娠期、分娩時或通過母乳喂養(yǎng)將病毒傳染給嬰兒。在這些體液中，HIV既以自由病毒顆粒的形式存在，也存在于被感染的免疫細(xì)胞中。HIV感染人體免疫系統(tǒng)中的關(guān)鍵細(xì)胞，如輔助性T細(xì)胞（特別是CD4?T細(xì)胞）、巨噬細(xì)胞和樹突狀細(xì)胞。HIV感染會通過多種機(jī)制導(dǎo)致CD4?T細(xì)胞數(shù)量下降，包括：被“無效感染”的T細(xì)胞發(fā)生細(xì)胞焦亡，未感染的旁觀細(xì)胞發(fā)生細(xì)胞凋亡，病毒直接殺死被感染細(xì)胞以及CD8?細(xì)胞毒性淋巴細(xì)胞識別并殺死被感染的CD4?T細(xì)胞。當(dāng)CD4?T細(xì)胞數(shù)量下降到臨界水平以下時，細(xì)胞介導(dǎo)的免疫功能喪失，人體對機(jī)會性感染的抵抗力逐漸減弱，最終發(fā)展為AIDS。雖然目前HIV尚無法治愈，但抗病毒治療（ART）的發(fā)展極大地改變了患者的生活前景。通過規(guī)范治療，感染者可以實(shí)現(xiàn)病毒載量檢測不到，從而阻止病毒傳播并顯著提高生活質(zhì)量。提高公眾認(rèn)知、消除社會歧視、并推廣早期檢測與及時治療，是全球抗擊HIV和AIDS的重要舉措。感謝大家的聆聽，讓我們攜手努力，共同創(chuàng)造一個更加健康的未來。PassageTwoDeepVeinThrombosisoftheLowerLimbsToday,Iwouldliketotalkaboutahealthissuethatisoftenoverlookedbutcanbeextremelydangerous—deepveinthrombosisofthelowerlimbs.Deepveinthrombosisofthelowerlimbsreferstotheabnormalclottingofbloodwithinthedeepvenoussystemofthelegs,whichcausesblockageoftheveinsandimpairsbloodflow.Itcanleadtosymptomssuchasswelling,pain,andlimitedmobilityoftheaffectedlimb.Insomecases,thesymptomsaremildorevenabsent;however,ifabloodclotdislodgesandtravelstothelungs,itcancauseapulmonaryembolism,leadingtoserioussymptomssuchaschesttightness,chestpain,anddifficultybreathing.Clinically,whenpeoplesuddenlyexperienceswellingorpaininoneleg,mostofthemdon’ttakeitseriously.Theymaythinkthatapplyingawarmcompress,gettingsomephysiotherapy,orhavingamassagewillmakeitbetter.Butisitreallythatsimple?Infact,thesecouldbetypicalsignsofdeepveinthrombosis.Withouttimelyandeffectivetreatment,severeswellingcanoccurinashorttime,andinextremecases,mayevenleadtotissuenecrosis.What’smoredangerousisthatonceathrombusdetachesandtravelsthroughthebloodstreamtothepulmonaryartery,itcancausepulmonaryembolism,whichmaypresentassuddenshortnessofbreath,palpitations,and,inseverecases,respiratoryfailureanddeathwithinminutes.Evenforpatientswhosurvivetheacutestage,long-termcomplicationssuchasvenousobstructionorvalvularinsufficiencymaydevelop,leadingtorecurrentlegswellingandchronicvenousulcers,whichcanseverelyaffectworkandqualityoflife.Ladiesandgentlemen,deepveinthrombosisofthelow