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在刚刚闭幕的肝病学领域国际年度压轴盛会——美国肝病研究学会年会（AASLD2023）上，美国加利福尼亚大学圣地亚哥分校Monica A. Tincopa教授应邀在“Patient-centered Management of Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD)”专题中，介绍了MASLD的管理现状，并于会后接受《国际肝病》专访时提出了新时期MASLD管理的四点新见解，访谈视频和中英文对照访谈原稿分享如下。

 

一、发挥患者的主观能动性，自我感知并主动管理MASLD

 

《国际肝病》

患者如何自身感知并主动管理MASLD，以减轻病情和避免进一步恶化？

 

Monica A. Tincopa教授

 

从以患者为中心的代谢相关脂肪性肝病（MASLD）管理专题讲座中我们可以总结出，患者和照护者主要需要做的一件事是去了解疾病相关知识，例如为什么我们需要重视MASLD？很多时候患者得到的诊断结果仅仅是他们有慢性肝病并且需要减重。为了能够使患者更好地理解并接受减重治疗建议，我们需要让患者明白确诊MASLD意味着什么，从长远来看会产生什么影响，应该注意哪些迹象和症状。

 

具体哪些食物和生活方式可能会帮助或影响患者的病情呢？我认为，一旦他们能够更好地了解这些事情，患者就可以成为他们自己最好的支持者，知道他们什么时候需要额外的运动，在遇到困难时仍应关注的事情，以及在可支配时间内可以做什么类型的事情。

 

英文原文：

 

: How can patients perceive and actively manage MASLD on their own to alleviate the condition and avoid further deterioration?

 

Dr. Monica A. Tincopa: I think the main thing that we heard from today's session from the patients and the caregivers really has to do about empowering themselves with knowledge. So why should we care about, you know, MASLD? A lot of times patients are told that they have a chronic liver disease and they have to lose weight, but nothing really beyond that. So, to be able to better understand like what are the implications, what in the long term can come from this, what signs and symptoms should I be looking for and then to get a better understanding of, ok, I should lose weight.

 

What are the foods and the different associated kind of lifestyle behaviors that could potentially help or maybe hurt? I think once they are able to have a better understanding of those things and they can be their best advocate in terms of knowing when they need additional work up, if they have questions, things they should be concerned about and on their own time in between visits, what types of things they can be working on.

 

二、照护者需了解疾病阶段，营造良好生活方式氛围

 

《国际肝病》

照护人员如何针对MASLD患者的特殊需求，提供个性化的护理和支持？

 

Monica A. Tincopa教授

 

我认为从照护者的角度来看，这在很大程度上也取决于疾病的阶段。会上，我们听到了一位重症患者的看护者的分享。一旦患者出现肝硬化和并发症，看护就会变得很困难。患者经常需要频繁地入院和出院，进行肝移植评估，以及需要忍受等待肝移植的焦虑。

 

我认为了解患者的病情处于哪个阶段，并帮助他们改善生活方式会对患者有很大的帮助。数据表明，如果周围的人也在做同样的事情，人们就能更好地改变饮食，保持体育锻炼。所以，我认为这是看护人需要做的关键事项，至少在病程前期是这样。当患者的病情继续发展，会有更多的事情需要去做，比如确保他们按照预约去看医生、按医嘱服药，以及跟进后续治疗。

 

英文原文：

 

: How can caregivers provide personalized care and support to meet the specific needs of patients with MASLD?

 

Dr. Monica A. Tincopa: Again, I think from a caregiver perspective, a lot of it also depends on kind of the stage of disease.

 

So today we heard from somebody who is a caregiver with somebody with fairly advanced disease, so once they have cirrhosis with complications, it can be extremely challenging. Patients are often in and out of the hospital, they have to do evaluation for liver transplant, with all of the anxiety related to be waiting for liver transplant kind of in earlier stages.

 

Again, I think a lot of it is advocacy knowing kind of what is your stage of disease, helping them implement these lifestyle changes. There is really good data to show that, you know, people are better able to implement dietary changes, maintain physical activity, if the people around them are also doing the same thing. So, I think that that is a key thing for caregivers. At least as it relates to early stage and then obviously once people are into kind of more advanced stages, a lot of it has to do with just making sure that they are getting through their appointments, taking their medications, and getting appropriate follow up.

 

三、对相关科室医师进行培训，并推广实施非侵入性评估手段

 

《国际肝病》

医疗保健专业人员如何综合运用现有诊断工具和治疗方法，有效管理和治疗MASLD患者？

 

Monica A. Tincopa教授

 

这个领域一直不断有新的研究和突破。正如此次在会议上谈到的，在今年之前，并没有针对MASLD进行筛查的建议。之前我们并没有研发出合适的算法，但是现在有了。我认为一个很大的挑战是对初级保健提供者和为这些患者看病的其他相关专家的教育推广，例如心脏病学、内分泌学医生等，需要对其进行相关培训，给他们提供工具，让他们知道应该关注哪些患者。

 

我认为教育和实施非侵入性检测是相对容易的，但还是有很多工作要做。例如，我们如何让临床更容易地使用现有工具，以确定需要转诊接受针对MASLD治疗的患者。从转诊的角度来看，让患者接受适合的治疗是很有挑战性的。目前，基于电子健康记录，我们已经开发了一种可自动计算的算法。

 

英文原文：

 

: How can healthcare professionals utilize existing diagnostic tools and treatment modalities in an integrated approach to effectively manage and treat patients with MASLD?

 

Dr. Monica A. Tincopa: So there is been a lot of movement in this space. So, prior to this year, as we talked about today's session, there was no recommendation to screen. We did not really have well defined algorithms, so now we do and I think a big barrier has to do with kind of education outreach to the primary care providers and other associated specialists that are seeing these patients.

 

So, things like cardiology, endocrinology, so educating them and providing them tools to know which patients should I be worried about. There is a lot of work going into teaching and implementation of FIB-4. So, how can we make it easier for people to use those to then identify who needs to be sent to us. So, in a lot of electronic health records now we have developed an algorithm that will automatically calculate it. So, I think education, implementing, you know, fairly easy to administer, non-invasive testing and then to help them better understand based on that initial data who are the patients that they need to then try and send to us. Because from a referral standpoint, access can be pretty challenging.

 

四、积极应对更名带来的挑战，不断优化管理流程

 

《国际肝病》

目前MASLD的管理指南和治疗策略在实践中是否得到充分应用，还存在哪些挑战和争议？

 

Monica A. Tincopa教授

 

正如我所说，我们在这个领域的目标是不断发展的。我认为仍然有相当多的工作需要去完成。在某种程度上，我们面临的挑战不仅是要了解和掌握所有的筛查和风险分层方法，而且包括“非酒精性脂肪性肝病（NAFLD）”更名为“代谢相关脂肪性肝病（MASLD）”之后所面临的全新患者分类。

 

向初级保健和转诊提供者宣教NAFLD和非酒精性脂肪肝炎（NASH）已经够困难的了，现在又更名为MASLD和代谢相关脂肪性肝炎（MASH），进一步增加了普及相关知识的难度。尽管如此，但我认为这是非常有必要的工作。因为在不了解MASLD的情况下，很多时候他们会提出，“我该关注谁”、“我应该安排什么检查”、“我该如何向患者说明这项检查” 等问题。

 

所以，我认为，在我们目前的指南下，患者、医生和看护人均能得到更多的建议和帮助。但就临床管理流程而言，仍需要不断优化。

 

英文原文：

 

: Are current guidelines and treatment strategies for managing MASLD being fully implemented in practice, and what challenges and controversies still exist?

 

Dr. Monica A. Tincopa: So these guidelines are all kind of new for this year. And as I said, it is a moving target. I still think there are tons of work to be done. In part, some of the challenging things have to do is not only knowing how many screening guidelines and risk stratification guidelines, but we now change the entire kind of nomenclature of everything and we have a whole new category of patients.

 

So, it was already hard enough to get the word out to primary care and referring providers about NAFLD and NASH and now we have gone and changed it to MASLD and MASH. We have to teach them about that. So, but I do think it is very helpful because a lot of times it was very frustrating for them to know: “OK, well. Who do I have to worry about? If I am worried about them, what test should I be doing, how do I interpret that test and who do I then send on?

 

And I think with our current guidelines, there is a lot more guidance, but I think getting the word out in terms of how to think about it and workflow, it is very much a work in progress.

 

 

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