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2023美国肝病研究学会年会（AASLD 2023）刚刚于美国波士顿闭幕。代谢相关脂肪性肝病（MASLD）是本届大会的重点议题，在“Healthy Liver, Healthy Lives”专题中，与会专家们就如何逆转全球MASLD趋势，以及采取何种行动措施以应对MASLD管理挑战展开了讨论。西班牙巴塞罗那全球卫生研究所（ISGlobal）卫生系统研究小组负责人、巴塞罗那大学教授Jeffrey V. Lazarus博士出席了会议，并于会后就相关热点问题接受了《国际肝病》的专访。访谈视频和中英文对照访谈原稿整理如下。

 

一、MASLD在全球范围内的流行趋势

 

《国际肝病》

MASLD在全球范围内的流行趋势是怎样的？是否有特定的地区或人群受到了更大的影响？原因有哪些？

 

Jeffrey V. Lazarus教授：当下，代谢相关脂肪性肝病的患病率预计达到了惊人的38%。全世界超过三分之一的成年人和超过十三分之一的儿童受到这种疾病的影响。代谢相关脂肪性肝病的发病率在国家之间和国家内部不同地区之间的差异性很大。受影响最严重的人群之一是Ⅱ型糖尿病患者。据估计，Ⅱ型糖尿病患者中代谢相关脂肪性肝病的患病率是全球患病率的两倍多，远高于60%。

 

英文原文

 

: What is the prevalence trend of MASLD globally? Are there specific regions or populations that are more affected and why?

 

Dr. Jeffrey Lazarus: Right now, the prevalence of MASLD is estimated to be a staggering 38%. More than one in three adults around the world and more than one in 13 children are affected by MASLD. There is great variation among countries, between countries and within countries. One of the most affected populations is those living with diabetes type 2, where it is estimated that the prevalence of MASLD is more than double the global prevalence. So far more than 60% among people living with type 2 diabetes.

 

二、MASLD当前的治疗和管理策略

 

《国际肝病》

在解决MASLD的问题上，我们已经采取了哪些行动？现有的治疗和管理手段是否有效？

 

Jeffrey V. Lazarus教授：我希望将这个问题分解成两个部分。总体来说，在世界范围内，我们针对代谢相关脂肪性肝病所做的工作并不多。这种疾病并没有被认为对公共健康产生威胁，因此它不在全球卫生议程上。事实上，世界卫生组织从没有提及过针对代谢相关脂肪性肝病和肝炎。但这并不意味着当临床有患者被确诊时我们没有做出任何的行动。

 

患有代谢相关脂肪性肝病的病患通常在肝病学或胃肠病学科室进行诊断，但也在内分泌学科室和初级保健机构中进行诊断。然后他们目前可获得的治疗，往往是生活方式改变，通过更多的体育活动，更合理的饮食和更低的热量摄入来进行治疗。这是目前可以为患者提供的建议，同时还可以治疗常见的合并症，如糖尿病、肥胖、高血压等。

 

英文原文

 

: What actions have been taken to address MASLD? Are the current treatment and management approaches effective?

 

Dr. Jeffrey Lazarus: Well, I would break this question into two parts. So overall, globally, not much has been done to address MASLD. It is not recognized as a public health threat. It is not on the global health agenda. In fact, the World Health Organization does not mention MASLD or MASH at all. That does not mean that nothing's being done in hospitals and clinics and where people are diagnosed. So where people are diagnosed typically is in hepatology or gastroenterology, but also in endocrinology clinics and in primary care. Then they are getting the treatment and care they need, which is typically focused on lifestyle changes, more physical activity, better diet, lower caloric intake. That is what can be offered right now, along with treating common comorbidities that could be diabetes, obesity, hypertension and so on.

 

三、MASLD领域科学研究的关注重点

 

《国际肝病》

目前针对 MASLD的研究主要集中在哪些方面？有哪些关键的科学问题需要进一步探讨？

 

Jeffrey V. Lazarus教授：当下研究的重点在于研发非侵入性检测。我们希望能用血清检测或影像学检查来代替像肝脏活检这样的侵入性检测。因为没有针对代谢相关脂肪性肝炎的特定药物，在治疗领域也有很大的投入。还有一些研究关注的是公共健康问题，不同的照护模式，如何计划最好的分层管理。一项令人兴奋的新研究将重点放在经济负担上，这将了解直接医疗保健成本以及生产力的间接成本。

 

英文原文

 

: What are the current research focuses on metabolic-associated fatty liver disease? What are the key scientific questions that need further exploration?

 

Dr. Jeffrey Lazarus: Right now there is a lot of focus on investigating and researching non invasive tests. We want to replace the liver biopsy with serum tests or imaging so that we can avoid such an invasive test. There is also great research being done on treatment as there is no specific drug for MASH. And then there is some research that is looking at public health issues, different models of care, how best do you plan to stratify. And an exciting new study coming is focused on the economic burden, which will be an investment framework to understand the direct healthcare costs as well as the indirect costs on productivity.

 

四、应对MASLD挑战的未来行动计划

 

《国际肝病》

为了更好地应对MASLD的挑战，我们需要怎样的研究和行动路线图？应该如何实施和监测？

 

Jeffrey V. Lazarus教授：在过去的几个月里，我们在EASL官方期刊Journal of Hepatology和AASLD的官方期刊Hepatology杂志上发表了一份全球研究和行动议程。来自100多个国家的350多名专家，不仅是肝脏专家，还有卫生系统专家、糖尿病专家和其他专家，聚集在一起进行了多轮Delphi研究，希望就我们需要关注的紧迫研究和行动议程问题达成一致。这些问题包括治疗和照护模式，还包括教育、意识、领导力和其他相关问题。我们首次在代谢相关脂肪性肝病和肝炎领域制定了全面的研究和行动议程。

 

英文原文：

 

: What kind of research and action roadmap is needed to better address the challenges of MASLD? How should these roadmaps be implemented and monitored?

 

Dr. Jeffrey Lazarus: Over the last few months, we have published in the Journal of Hepatology from EASL as well as Hepatology from AASLD, a global research and action agenda. More than 350 experts, not just liver specialists, but health systems experts, diabetes experts and others from over 100 countries, came together in multiple rounds of a Delphi study to get agreement on what are the pressing research and action agenda issues that we need to focus on. They included treatment and care, of course, and models of care, but also education, awareness, leadership, and other related issues that we have a comprehensive for the first time research and action agenda in the field of MASLD de MASH.

 

 

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