2026年欧洲肝病学会年会（EASL 2026）于西班牙巴塞罗那隆重召开，大会聚焦肝脏疾病诊疗前沿进展，分享领域内新理念、新技术与临床实践经验。本次盛会期间，《国际肝病》特邀专访英国诺丁汉大学Guruprasad P. Aithal教授。当前进展期慢性肝病的诊疗模式正持续迭代，精准医疗、靶向治疗的应用，推动传统诊疗体系不断革新，标准化诊疗路径的搭建与优化也成为业内关注的重点。Aithal教授结合临床一线经验，围绕行业现状与发展方向展开深度分享。

《国际肝病》

相较于传统诊疗模式，精准医疗理念应用于进展期慢性肝病，能够从哪些方面突破现有诊疗局限？目前该诊疗模式在临床中主要落地于哪些诊疗环节？

Aithal教授：以往临床多采用试错式诊疗思路，也就是先开展治疗、逐步调整用药剂量，同时监测不良反应，一旦患者出现副作用便停止用药。这种方式会引发不少问题：患者出现不适后需要反复就诊，增加了门诊频次；若不良反应较为严重，患者还可能因此住院。想要优化现有诊疗模式，可提前进行筛查评估：精准筛选出能够从对应治疗中获益的患者，同时甄别出易发生不良反应的人群，对这类高风险患者则避免使用该治疗方案。

Hepatology Digest: Compared with traditional management modes, in what aspects can precision medicine break the limitations of treatment for advanced chronic liver disease? Which clinical procedures have widely adopted this medical approach at present?

Prof. Aithal: In the past, clinical care mostly followed a trial-and-error approach. Clinicians would initiate treatment first, gradually adjust drug dosages, and monitor adverse reactions. Medication would be halted immediately once patients developed side effects. This model brings about many problems. Patients suffering from discomfort have to make repeated hospital visits, which increases the frequency of outpatient consultations. In severe cases of adverse reactions, patients may even need hospitalization.

To improve the current treatment model, we can conduct preliminary screening and assessment. We can accurately select patients who are likely to benefit from specific treatments, and identify those at high risk of adverse drug reactions, for whom the corresponding therapies will be avoided.

《国际肝病》

靶向治疗已是进展期慢性肝病重要干预手段，临床筛选适用患者时主要参考哪些依据？不同类型的进展期肝病，在靶向药物选用与治疗策略上存在哪些差异？

Aithal教授：本次会议重点探讨的进展期慢性肝病核心治疗药物为非选择性β受体阻滞剂，临床常用药物主要包括普萘洛尔与卡维地洛两种。现有临床数据证实，可通过检测门静脉压力评估患者用药应答：对于静脉应用普萘洛尔后应答良好的患者，可选用普萘洛尔开展治疗；而对普萘洛尔无应答的患者，则更换为卡维地洛治疗。长期随访结果显示，该个体化用药方案能够有效减少进展期慢性肝病患者的失代偿事件，尤其可显著降低腹水的发生风险。

目前临床为推动该个体化治疗方案落地普及，正探索更简便的联合筛查方式，依托瞬时弹性成像、肝脏硬度检测、脾脏硬度检测以及血小板计数等常规简易检查，筛选出适合接受β受体阻滞剂治疗、可获得临床获益的患者，同时精准排除无治疗获益、无需使用该类药物的人群。

但目前这套筛查评估体系仍存在明显短板，存在约40%的诊断空白区间。现有检测标准可明确判定：肝脏硬度数值＞25 kPa的患者，可确诊存在进展期肝硬化；肝脏硬度数值＜15 kPa的患者，可直接排除进展期肝硬化。而肝脏硬度处于15~25 kPa区间的患者，占比约40%，通过现有简易检测手段，无法准确判定其是否存在进展期硬化，无法明确用药指征。这也是目前简易筛查方案应用于临床实践中存在的局限。

Hepatology Digest: Targeted therapy plays a vital role in treating advanced chronic liver disease. What criteria are mainly used to screen eligible patients clinically? What differences exist in targeted drug selection and treatment strategies for various types of advanced liver diseases?

Prof. Aithal: Non-selective beta-blockers are the core therapeutic agents for advanced chronic liver diseases, which were thoroughly discussed at this conference. Propranolol and carvedilol are the two most commonly used drugs in this category. Existing clinical data have proven that portal venous pressure testing can be used to evaluate patients’ response to medication. Patients who respond well to intravenous propranolol can continue treatment with this drug, while those who show no response to propranolol will be switched to carvedilol.

Long-term follow-up data indicate that this individualized medication regimen can effectively reduce decompensation events in patients with advanced chronic liver diseases, and particularly cut down the risk of ascites significantly.

To promote the popularization and implementation of this individualized treatment regimen in clinical settings, researchers are now exploring simpler combined screening methods. Routine and convenient examinations including transient elastography, liver stiffness measurement, spleen stiffness measurement and platelet count are used to screen patients suitable for beta-blocker therapy who can gain clinical benefits, and precisely rule out those who will obtain no therapeutic benefits and do not require such medications.

However, this screening and assessment system still has obvious shortcomings, leaving a diagnostic gap of approximately 40%. According to the current testing standards: patients with liver stiffness higher than 25 kPa are diagnosed with advanced liver cirrhosis, and those with liver stiffness lower than 15 kPa can be excluded from a diagnosis of advanced liver cirrhosis.

Patients with liver stiffness between 15 kPa and 25 kPa account for around 40% of the total cases. Conventional simple examinations cannot accurately confirm whether these patients have advanced liver cirrhosis, nor can we define their medication indications. This is the main limitation restricting the clinical application of the simplified screening protocols.

《国际肝病》

完善标准化诊疗路径是提升进展期肝病救治质量的关键，结合精准医疗与靶向治疗技术，该如何搭建科学连贯的临床诊疗体系？未来还将从哪些方面优化这条诊疗路径？

Aithal教授：正如前文提及的诊断灰区，标准化诊疗路径的核心，是精准筛查出存在临床显著性门静脉高压的患者，优先选用卡维地洛这类非选择性β受体阻滞剂开展治疗，同时规避用药不良反应。

目前临床存在明显局限：部分患者处于诊断灰区，通过瞬时弹性成像、血小板计数等常规简易检查，无法明确判定是否合并慢性进展期肝病及显著性门静脉高压。针对这部分人群，可借助MRI检测技术进一步明确病情，同时通过更多临床研究，将该技术纳入标准化诊疗体系，弥补现有筛查短板。

此外，基因检测是优化诊疗路径、实现个体化安全用药的重要方向。临床可通过检测患者CYP2D6基因表型，筛查出卡维地洛代谢不良、易发生药物不良反应的人群，对此类患者更换普萘洛尔治疗。该方式可精准匹配适配药物、筛选获益患者，有效规避用药风险。

Hepatology Digest: Establishing standardized care pathways is critical to improving treatment outcomes of advanced liver disease. How to build a systematic and coherent clinical management system combining precision medicine and targeted therapy? In what ways can these care pathways be further optimized in the future?

Prof. Aithal: As mentioned earlier regarding the diagnostic grey zone, the core of standardized diagnosis and treatment pathways is to accurately screen patients with clinically significant portal hypertension. For these patients, we should prioritize the use of non-selective beta-blockers such as carvedilol, while taking precautions against adverse drug reactions.

Current clinical practice faces prominent challenges. For patients within this diagnostic grey zone, routine simple tests like transient elastography and platelet count cannot confirm whether chronic advanced liver disease is associated with significant portal hypertension or not. For such patients, MRI can be adopted to further clarify their conditions. More clinical studies are also underway to incorporate MRI into the standardized diagnosis and treatment system to offset the deficiencies of existing screening tools.

Furthermore, genetic testing is an important direction to optimize clinical pathways and realize individualized and safe medication. Clinicians can test patients’ CYP2D6 genetic phenotypes to identify people with poor carvedilol metabolism who are prone to adverse drug reactions, and switch these patients to propranolol instead. This approach enables accurate matching of appropriate drugs, selection of patients who can benefit from treatment, and effective prevention of medication-related risks.

（来源：《国际肝病》编辑部）

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