APASL 2009大会主席廖家杰教授专访

Hepatology Digest: It’s a great honor. This is only the second time， since 1982， that Hong Kong has hosted the annual meeting for APASL. Can you tell us some of the important progress that we’ve made in the field since the last meeting?

国际肝病：非常荣幸。这是自1982年后，在香港主办的第二次APASL年会。您能不能谈谈那次年会后，这个领域有什么重要进展？

Prof. Lau: There has been a tremendous growth in terms of participation and also the scientific content of this conference. This year， say for instance， we are anticipating around 4000 delegates coming to Hong Kong to join this annual meeting of the Asia Pacific Association for the Study of the Liver， and we have more than 150 faculty members flying in from all parts of the world. They are all well-renown experts in the field of hepatitis， liver cancer and other fields of hepatology， who will come to join the meeting to share their views and the latest information and knowledge in the clinical management of liver diseases in the Asia-Pacific region.

廖家杰教授：这次大会的参加人数和科学含量都有极大的增加。例如，今年我们预期有超过4000名代表、150名教授来香港参加这次APASL年会。他们都是肝炎、肝癌以及肝病其他领域的知名专家，将在大会上展示他们的观点和关于亚太地区最新的资讯及在肝病临床治疗方面的知识。

Hepatology Digest: The theme of the conference this year will be the multi-disciplinary approach to clinical hepatology. As the president of the 18th APASL meeting， can you further elaborate on the chosen theme， and also perhaps some highlights you’re expecting from this annual meeting?

国际肝病：今年大会的主题是临床肝病的多学科治疗方法。作为第18界APASL的主席，您能不能详细介绍下选择的主题和在今年大会上，您所期待的亮点是什么？

Prof. Lau: The participants attending the meeting are mostly clinicians with more than 98% of them being clinical hepatologists. They are doctors taking care of patients with liver diseases and therefore， we decided to have the theme focused on clinical hepatology. Nowadays， because of the rapid developments in the various disciplines， people really need to come together and work as a team to take care of patients. For instance， we have radiologists; we have people who are very good at interventions， radiology， surgery， transplant surgeons， molecular biologists， physicians， hepatologists， and viralologist. They will all come together as a team to share their knowledge and to treat the patients so that we can deliver the best service for our liver disease patients. Therefore， we decided the theme of our conference to be the multi-disciplinary approach to clinical hepatology.

廖家杰教授：参加大会的绝大多数是临床医生，而他们中超过98%的人是肝病临床学家。他们是治疗肝病患者的医生，因此，我们决定把主题定在临床肝病学上。如今，由于各学科的飞速发展，各学科专家需要作为一个协调的小组来共同治疗患者。例如，我们有放射学专家，有在介入治疗、外科、移植外科、分子生物学、内科学、肝病学、病毒学等方面很出色的专家。他们会共同协作，互相交流专业知识，以便在治疗同时为患者提供更好的服务。因此，我们确定了我们这次大会的主题是临床肝病的多学科治疗。

Hepatology Digest: Obviously， you will be an important speaker at this year’s meeting and one topic you’ll be speaking about is the management of chronic hepatitis B in the Asia-Pacific region. What are your views on that topic?

国际肝病：作为这次大会重要的发言人，您的一个讲演主题是亚太地区慢乙肝的治疗。在这个问题上您的观点是什么？

Prof. Lau: Hepatitis B is still the most important cause of liver diseases in the Asia-Pacific region.  Each year we have more than half a million people dying in the region because of hepatitis B related complications， that is liver cirrhosis and liver cancer. Now in 2009， we have a lot of Asians registering for the treatment of hepatitis B but we still do not have a perfect answer yet， and in fact， apart from the treatments available， we also have to face the community. There are a lot of activities， I believe， in the community that needs to be activated so that our patients will no longer suffer from hepatitis B related liver diseases， that is liver cirrhosis and liver cancer. My talk will be focused on the latest developments in the clinical management of patients with chronic hepatitis B and how to prevent these patients from developing liver cancer and liver cirrhosis.  

廖家杰教授：在亚太地区，HBV仍然是导致肝病的主要原因。每年这个地区都会有超过50万人死于乙肝相关并发症，例如肝硬化、肝癌。本次会议上注册的亚洲人中，有很多从事慢乙肝的治疗，但我们对治疗还没有一个理想的答案。实际上，除了可用的治疗外，我们还要面对社区。我相信，在社区有很多机构能被充分利用，使患者免受乙肝相关疾病的折磨，如肝硬化、肝癌等。我的演讲主题将会集中在慢乙肝患者临床治疗的最新进展以及如何预防患者出现肝癌、肝硬化等方面。

Hepatology Digest: Moving on to more about the treatments. The big topic is， if and when nucleoside analogs can be stopped in HBV treatment. Can you give some of your views on when or if nucleoside analogs can be stopped?

国际肝病：谈到治疗，一个重要话题是，在乙肝的治疗中是否可以停用核苷类似物和何时停用。对这个话题您的观点是什么？

Prof. Lau: Well， from an immunology point of view， nucleoside analogs can only be stopped when the host immune response to the virus has been restored. Unfortunately we do not have very good clinical markers， apart from seroconversions to indicate that the host has already recovered. From an immunology point-of-view， that is fully against the virus and therefore we need new markers to guide our therapies. Say for instance， I think that one of the hot topics in the field right now is how the quantification of surface antigen can help to guide the therapy. Now， if for the current therapies seroconversion is still very low， I think the most significant difference that has an impact on treatments is related to interferon-based therapy and that is PEG interferon alfa-2a and 2b. Now， I think that research has to be focused so that we can further improve our seroconversion rate in these patients to practically induce a cure to patients with chronic hepatitis B infection.

Lau教授：从免疫学角度来说，核苷类似物只有在针对病毒的宿主免疫反应已经恢复时才能停用。然而目前除了血清转换，确实还没有更好的临床标记物检测宿主的免疫反应是否恢复。从免疫学角度来说，就是病毒被完全抑制。因此，我们需要新的标志物来指导治疗。例如，我认为现在这个领域一个比较热点的话题是如何通过HBsAg定量来指导治疗。如果目前患者血清转化率还是很低，我认为，对治疗最有意义的是以干扰素为基础的治疗方案，即PEG-IFN-α。现在，我认为应该集中这方面的研究，以提高慢性肝患者的血清转换率来达到治愈。

Hepatology Digest: You’ve just mentioned pegylated interferon treatment. Specifically for patients in the Asia-Pacific or China， how does that fit into the treatment plan of hepatitis B specifically for this region?

国际肝病：您提到PEG-IFN治疗，那么针对亚太地区和中国的患者，治疗上有无特殊之处？

Prof. Lau: First of all， I think it is a misnomer that the Chinese， because most of the infections are vertically transmitted or maternal-fetal transmitted， that they do not respond well to the interferon based therapies. Based on the phase 3 registration trials with the PEG interferon alfa， it has clearly been shown to be an effective agent in terms of inductions of full e-seroconversion and disease remission in a substantial proportion of patients with chronic hepatitis B infections. Now the question is， how are we going to further select patients who will benefit more from the course of therapy， which is sometimes expensive and also at risk of certain side effects. A lot of pharmagenetics and immunogenetics activities need to come into place so we can predict which patients will benefit more. Also， parameters for monitoring the viral response as antigen quantitations might help us to determine whether we should continue the form of therapies of certain patients before we decide it is fruitless or fruitful.

廖家杰教授：首先，有观点认为由于大部分中国感染者都是垂直感染或母婴感染的，所以他们对以干扰素为基础的疗法应答不好，我认为这种观点是不恰当的。PEG-IFNα的3期临床试验清楚地表明，对广大慢乙肝患者来说，它在诱导血清转换和在一定程度上减轻慢乙肝患者病情方面非常有效。由于这种治疗比较昂贵且存在某些副作用，现在的问题是如何才能进一步选择出更能受益于这种治疗方法的患者。我们需要从药物基因学以及免疫遗传学角度来考察，以便预测哪种患者更得益于这种治疗。一些监测病毒学应答的参数例如抗原定量也能帮我们判定治疗是否有效，以便决定对这类患者是否应该继续应用这种治疗。

Hepatology Digest: What about combination treatment in hepatitis B patients? Can you give an introduction into the present situation as far as combination therapy is concerned?

国际肝病：您能否给我们一些介绍目前关于乙肝患者的联合治疗方面的情况？

Prof.Lau: Personally， I believe in combination therapy...

国际肝病：APASL与其他会议的区别？