APASL 2009会议上 Kwang Hyub Han教授访谈

Hepatology Digest: When assessing the risk of HCC occurrence， what are the most important factors?

国际肝病：您能否谈下如何评估肝细胞癌的发生风险？

韩光协:  Cirrhosis is an end stage of the progress of liver disease causing many people’s illness especially in Asia. Inflammation of the liver progresses to necrosis and inflammation and then finally it progresses to cirrhosis. Then in the case of cirrhosis there is a high chance of HCC developing.

韩光协：肝硬化是肝病进展的终末阶段，特别在亚洲，很多人患有这种疾病。肝脏的炎性反应会导致坏死、炎症，最终发展为硬化。肝硬化患者发生肝细胞癌的风险非常高。

Hepatology Digest: As HCV and HBV are the most important risk factors involved in the development of HCC， what should we do to prevent this happening? 

国际肝病：HCV 和HBV 是导致肝细胞癌最主要的危险因素，对肝细胞癌的发生，我们应该如何防范？

韩光协:  To prevent HCC development from Hepatitis B and C we have two options. The first prevention of HBV – try to be vaccinated. For Hepatitis C， we have no vaccination yet so try to avoid risk of exposure such as needle sharing by drug addicts and unclean tattooing and something like that. The second prevention is try to control the patient’s inflammation by using effective drug therapy to reduce the development of HCC.

韩光协：防范乙肝和丙肝患者发生肝细胞癌，我们有两个办法。第一，预防乙肝，要尽可能注射疫苗。对HCV ，我们现在还没有疫苗，所以要尽量避免与吸毒者共用注射器，不卫生的纹身等可以丙肝传播的危险因素。第二，要尽量通过有效的药物控制炎症反应来减少肝细胞癌的发生风险。

Hepatology Digest: In your study you introduced at this conference， you have developed a model which predicts the risk of HCC in the HBV/HCV patient. What’s your view on the future of using this model in clinical studies?

国际肝病：在这次大会上，您对自己的研究做了介绍，谈到研发了一个可以预测乙肝/丙肝患者发生肝细胞癌发生风险的模型。您对这种模型未来的临床应用有什么展望？

韩光协:  This model has been established by our institute based on our database. So every country might be a little different but generally it can apply easily so the clinician can predict whether the patient is in a high-risk group or low-risk group and we can concentrate and we can be aware of the risk of development of HCC in the high-risk group in the clinic itself. So it’s very easy to apply. We can concentrate on the high-risk group and we can tell the patient “You are ok， you are not at high risk， so don’t worry too much”. But in the case where we may have a high risk， the clinician will need to consult with the patient regularly.

韩光协：这个模型的建立是依据我们的研究数据。每个国家的情况可能都会稍有差异，但总体来说应用会很容易。临床医生可以预测患者是在患肝细胞癌的高风险组还是低风险组，我们能意识到患者是否有患肝癌的高风险因素而把注意力集中在他们身上。因此，应用很容易。我们可以把注意力集中在高风险组身上，对低风险组患者，我们可以告诉他们：“你很好，患肝癌的风险不高，不用担心。”但对高风险组的患者，临床医生需要定期诊治患者，和患者交流病情。

Hepatology Digest: Could you talk about the advantages and disadvantages of newer methods of assessment of liver cirrhosis?

国际肝病：您能否谈一下关于新的肝硬化评估方法的利弊？

韩光协:  In the past we had no good method to predict fibrosis status in a liver patient except liver biopsy， but not every patient likes to do an invasive method. Alternatively recently we had several good tests or methods to measure and predict the degree of fibrosis. The first one is the Fibroscan， and the second is the Fibrotest. So we try to validate and fortunately find they are good to predict and measure， but the problem is still it has some false positivity and false negativity so we try to focus on how to improve the sensitivity and how to reduce the false positives.

韩光协：过去，除了肝活检，我们没有更好的方法来评估患者的纤维化程度。但不是每个患者都会接受这种侵入性检查。最近，我们有了其他几种很好的检测技术和方法来测量、预估纤维化程度。一种是Fibroscan，另一种是Fibrotest。我们尽可能的验证这些方法。幸运的是，这些方法确实能很好的测量和预估纤维化程度。但仍有一些问题存在，这些检测存在假阳性率和假阴性率，因此我们要尽可能提高它们的敏感性，降低假阳性率。

Hepatology Digest: The rise of HCC in high-risk conditions has proved to be cost effective， especially in high endemic areas. What’s your opinion about the current surveillance program for HCV and HBV?

国际肝病：经证实，高风险人群肝癌发生率的升高使花费显得更有效，特别是在疾病高发地区，您对目前的丙肝/乙肝监测计划有什么看法？

韩光协:  For example， in western countries they recommend less tests with less frequent intervals to screen high-risk groups to save money but in my opinion this will decrease the sensitivity. In the Japanese group they are concerned with sensitivity so they have more tests and the interval is shorter but it will be costly. So we need to adjust what is the best interval to test so our program may predict so we can focus on the high-risk group， we can give more tests and in the low- risk group we can escape more expensive tests and we can extend the interval and then we can be more cost effective.

韩光协：举个例子来说，在西方国家，他们推荐给高风险组的筛查频率较低、检查的间隔时间也比较长，这样可以为患者节省花费。但我认为，这样做会降低敏感性。在日本，他们更关心敏感性，以至于他们的检测频率较高，检测间隔时间较短，但花费很高。因此，我们需要调整间隔时间到最佳状态来监测患者，这样能预测患者发病风险的高低，并把注意力集中在高风险组患者，对这些患者的检查可以更频繁些。对于低风险组，我们可以放弃一些昂贵的检查，进行检查的间隔时间也可以长一些。这样就能使患者的钱花在刀刃上。