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近日，2024年新加坡GIHep与肝病联合大会（Combined GlHep & SHC 2024）在新加坡举办。新加坡国立大学医院Daniel Huang Qingyao医生在会上作多项报告分享。《国际肝病》特邀Daniel Huang Qingyao医生就亚洲代谢相关性脂肪性肝病（MAFLD）的疾病特点、肝病检查手段等内容进行分享，以下为采访实录。
《国际肝病》
亚洲人群中脂肪肝的病因与欧美人群相比有何不同？亚洲脂肪肝人群与欧美脂肪肝人群之间有哪些差异？
Daniel Huang Qingyao医生：在病因方面，亚洲脂肪肝人群与欧美脂肪肝人群非常相似。在亚洲，我们观察到一个显著的特点，那就是较高比例的脂肪肝患者的体重指数（BMI）是正常的。这一现象给临床医生带来了新的挑战。通常，对于肥胖或超重的个体，我们会建议进行肝纤维化筛查，但对于这些体重正常的脂肪肝患者，我们还没有类似的筛查建议。
Hepatology Digest: Is the etiology of fatty liver disease different in Asian populations compared to European and American populations？What are the differences between the Asian fatty liver population and the European and American fatty liver populations?
Dr Huang: In terms of etiology, it's quite similar across populations. The main difference in Asia is the higher proportion of people with fatty liver who have a normal body mass index (BMI). This creates challenges for clinicians because, for obese and overweight individuals, there is a recommendation to screen for liver fibrosis. However, for those with a normal body weight, there isn't a similar recommendation to screen for advanced liver disease.
《国际肝病》
亚洲地区脂肪肝的流行病学特征有哪些独特性？与欧美地区相比有何异同？针对亚洲患者的具体情况，是否有特定的治疗或管理建议？
Daniel Huang Qingyao医生：正如我们所讨论的，亚洲地区脂肪肝的流行病学特征中，一个显著的特性就是瘦型脂肪肝病例占比较高。在治疗方面，虽然治疗指征大致相同，但亚洲面临的主要困境是缺乏有效的脂肪肝治疗方法。尽管美国已经批准了瑞美替罗（Resmetirome）等药物，但目前尚无将这些治疗引入亚洲的计划。因此，亚洲脂肪肝患者的治疗依赖于生活方式的改变。在严重情况下，如失代偿期肝病患者可能需要进行肝移植。当前亚洲在这方面的治疗处于空白阶段。
Hepatology Digest: What are the unique epidemiological characteristics of fatty liver in Asia, and how do they compare to those in European and American populations? Are there any specific treatment and management recommendations for Asian patients based on their conditions?
Dr Huang: As we've discussed, there's a higher proportion of lean fatty liver cases in Asia. In terms of treatment, the indications are generally the same. The major difficulty in Asia is the lack of available treatments for fatty liver. While resmetirome has been approved in the US, there are currently no plans to introduce this treatment in Asia. Therefore, individuals in Asia must rely on lifestyle modifications, or in severe cases, liver transplantation if they develop decompensated liver disease. This is a significant gap in treatment options in Asia.
《国际肝病》
肝病患者普遍对肝活检接受度不高，那非侵入性检测在MAFLD和肝细胞癌的诊断中起到什么作用？
Daniel Huang Qingyao医生：我们正逐渐走向一个肝活检变得罕见的世界。预计未来五年左右，非侵入性检测将会取代肝活检，成为诊断肝脏疾病的主要手段。这一转变有利于临床试验的开展和临床护理。
Hepatology Digest: Patients with liver disease generally have a low acceptance of liver biopsy. What role does non-invasive testing play in the diagnosis of NAFLD and HCC?
Dr Huang: We are gradually moving towards a world where liver biopsy is rare. In the next five years or so, I envision that non-invasive tests will replace liver biopsy for diagnosing liver conditions. This will be beneficial for both clinical trial development and the management of clinical care.
《国际肝病》
中国《慢性乙型肝炎防治指南（2022年版）》建议扩大抗病毒治疗适应证。您在报告中也提到了扩大慢性乙肝治疗适应证。请问扩大治疗适应证是目前国际间的普遍共识吗？这给慢性乙型肝炎患者带来了哪些好处？"
Daniel Huang Qingyao医生：目前，各个指南已经逐步扩展了治疗适应证的范围。世界卫生组织最近更新的指南明确指出，对于慢性乙型肝炎患者，如果其ALT水平异常且HBV DNA水平超过2000 IU/mL，可以考虑进行治疗。这是一个重要的进步。扩大治疗适应证可以使更多因未得到及时治疗而出现并发症的患者被纳入治疗范围。当然，由于各地区的指南仍在持续更新中，我们需要关注不同社会如何适应这些新的变化。
Hepatology Digest：China's Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022), which suggest expanding the conditions for antiviral treatment. You also mentioned expanding the treatment indications for chronic hepatitis B in your report. Is there a universal consensus internationally on this expansion, and what benefits does it bring to patients with chronic hepatitis B?
Dr Huang: Currently, treatment indications have been expanded depending on the guidelines. The World Health Organization recently updated its guidelines, stating that individuals with chronic hepatitis B, abnormal ALT levels, and hepatitis B DNA levels over 2000 IU/mL can be considered for treatment. This is a significant step forward, as it expands treatment criteria to include patients who might develop complications from chronic hepatitis B if left untreated. However, regional guidelines are still being updated, and we need to see how each society adapts to these changes.
