Tom Hemming Karlsen教授

EASL秘书长、挪威奥斯陆大学医院

 

第54届欧洲肝脏研究学会年会（EASL2019）暨国际肝病大会（ILC 2019）于4月10日～14日在奥地利维也纳隆重举行。这是一次在欧洲召开，但聚焦全球的国际盛会。会议对全球肝脏疾病的流行及应对策略等公共健康问题进行了讨论。EASL现任秘书长、挪威奥斯陆大学医院Tom Hemming Karlsen教授在接受《国际肝病》采访时着重介绍了欧洲的情况。

 

1、肝病严重威胁着西欧年轻人的健康

 

Tom Hemming Karlsen教授认为，东西方的肝病流行病学模式有差异。就西欧而言，普遍认为肝病的流行率和死亡率的增加主要体现在年龄组的变化上。来自英国“柳叶刀肝病常设委员会”的数据清楚地表明，肝病正在成为年轻人群死亡的主要原因。对于在65岁之前死亡的患者，肝病是目前的主要致死病因，这是需要关注的重点。“在许多地区，肝脏疾病不仅是发病率在上升，而且也是死亡的重要原因，并且正在导致年轻患者的死亡。”

 

2、酒精对肝病的影响需引起重视

 

在全球范围内，可以清楚地观察到代谢性肝病（如NAFLD）和肝癌发病率的增加。肝癌不仅与代谢疾病有关，病毒性肝炎仍然是其主要致癌因素。但在这些背后，无论是在东方还是西方，酒精暴露都是一个日益增长的致病因素，会影响肝病的进展，“这需要引起大家的广泛关注”。

 

3、亚洲肝病学拥有巨大的发展机遇

 

“亚洲肝病学家有一个在肝脏研究中发挥主导作用的独特且令人惊叹的机会”，Karlsen教授在采访中表示，这源自亚洲的巨大肝病患者人群，特别是在病毒性肝炎和肝癌方面。

 

但随着病毒性肝炎防治的进展，丙型肝炎可以获得治愈、乙型肝炎可通过疫苗进行预防，以及火热研发中的免疫肿瘤学药物，亚洲同时也肩负着将这些创新成果惠及全球肝病患者的重大临床责任，“当然这是一项艰巨的任务”。

 

因此，无论是在研究方面，还是在临床方面，亚洲肝病学都有着巨大的机会和良好的发展势头。“我认为在许多方面，亚洲肝病学的发展都比西方肝病学强。”

 

4、消除病毒性肝炎，各国策略有所不同

 

2016年，世界卫生组织（WHO）提出了至2030年消除病毒性肝炎作为公共威胁的目标。面对这一全球战略，Karlsen教授认为，不同地区需要采取的策略可能略有不同。

 

他表示，在西方人群中，确定患者同时鉴别以匹配合适的治疗是一项重大挑战，专项的亚组人群计划或微观消除计划适用于这种情况；流行率更高的其他地区，则需要考虑全球消除计划，采取大规模的筛查和合适治疗的对接，例如蒙古和格鲁吉亚就采取的这一策略。

 

此外，EASL国际肝脏基金会（EILF）的成立为消除病毒性肝炎提供了很大的助力，以承担起消除病毒性肝炎的广泛社会责任为初衷，建立公众意识、加强科学研究等，旨在将EASL从传统的学术活动，拓展到更为复杂的项目和新领域。

 

: Could you talk about the prevalence and mortality of chronic liver disease worldwide, and how it appears to be growing in recent years?

 

Prof. Karlsen: I think there are different considerations to be made for the Western world versus other areas like Asia where there are differences in the epidemiological patterns. The general observation and the important note to make regarding Western Europe, for instance, where there is data showing an increasing mortality associated with liver disease, is the age group being affected by these changes. Data from the Lancet Standing Commission on Liver Disease in the UK clearly shows that liver disease is taking over as the major cause of death in the younger population. For patients dying before the age of 65, liver disease is currently taking the lead. This is an important part of the message. Not only is liver disease on the rise in many areas, but is also a significant cause of death and is killing younger patients. In the global landscape, we are clearly observing an increase in metabolic liver disease such as NAFLD, and also liver cancer, which is not only related to metabolic disease but viral hepatitis is still a major contributor worldwide. Behind all of that, both in the East and the West, alcohol is a growing etiology. So when talking about epidemiology, metabolic factors, diet, nutrition, and viral hepatitis are all being driven by alcohol exposure. It has to be a broad consideration.

 

: This is truly an international meeting. It is being held in Europe, but there are people from all over the world here. China is very well represented. Do you have any message for the Asian cohort of hepatologists?

 

Prof. Karlsen: The message I would share is that Asia has a unique opportunity to take a leading role in liver research. There are huge patient populations, particularly related to viral hepatitis and liver cancer. The research opportunities are amazing. But also, now that there are drugs for viral hepatitis, a hepatitis C cure, hepatitis B vaccination, and ongoing drug development with immuno-oncology becoming available, there is also a huge clinical responsibility in Asia to bring these innovations to the people. That is, of course, an enormous undertaking. So both on the research side and the clinical side, I see huge opportunities. I think hepatology in Asia, in many ways, is stronger than hepatology in the West.

 

: In 2016, the World Health Assembly approved a global strategy to achieve elimination of viral hepatitis by 2030. What is the biggest challenge to achieving that goal?

 

Prof. Karlsen: I think that also varies between Western regions and elsewhere. In Western populations, clearly there is a major challenge in identifying patients, and having identified them, linking them up with proper therapy. Of course, this moves into specialized sub-population programs or micro-elimination programs, which have a utility in this setting. In other areas where prevalence is higher, we need to consider global elimination programs, with mass screening and linking to appropriate therapy, as has been seen in Mongolia and Georgia, for example. So there are slightly different approaches needed in these different regions.

 

: Could you give us a brief introduction to the EASL International Liver Foundation (EILF)? 

 

Prof. Karlsen: The concept of the International Liver Foundation evolved around taking a broader societal responsibility for viral hepatitis elimination, as well as building public awareness, enhancing research and so on. The aim of forming the EILF was to go beyond the classical programming where EASL was a medical association running conferences and events, to more complex projects and new territories where EASL saw a need. That is the brief version.