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肝病学领域正以前所未有的速度蓬勃发展，全球的科研人员与临床医师正携手并肩，共同应对日益沉重的肝病负担。2024年11月15日至19日，全球肝病学术界的璀璨盛事——美国肝病研究学会（AASLD）年会（The Liver Meeting®）在美国加利福尼亚州风景秀丽的圣迭哥市召开。会上，我们有幸与AASLD主席W. Ray Kim教授展开深度对话，就肝病预防、精准诊断及创新治疗等核心议题，聆听他独到的见解与前瞻性的思考。
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科研新突破，未来新篇章01
《国际肝病》
作为2024年AASLD的领航者，您认为本次大会中哪项研究成果最为振奋人心？这些突破将如何引领肝病领域的未来走向？
W. Ray Kim主席：正如在大会尾声压轴出场的“TLM Debrief”环节中所提到的，代谢相关脂肪性肝病（MAFLD）治疗领域的崭新成果令人眼前一亮。特别是关于司美格鲁肽在合并肝纤维化（2/3期）的代谢相关脂肪性肝炎（MASH）患者中的Ⅲ期临床研究（ESSENCE研究），其积极结果无疑为MAFLD患者带来了福音。我们有望见证继Resmetirom之后，第二种用于MASH治疗的新药的诞生，除此之外，后续更有诸多创新药物正蓄势待发。
此外，肝癌治疗领域的进步同样令人瞩目。大会展示的研究揭示，多种治疗策略的有机结合能显著提升肝癌患者的治疗效果。这无疑标志着我们在多种肝病治疗领域取得了实质性的跨越。
There are very exciting data presented during the late-breaking abstract sessions, and that includes MAFLD treatment. There is a Phase III study on semaglutide with positive results. This is a very exciting development. It is likely that we will have a second liver-directed treatment for MAFLD. After resmetirom, it’s likely that semaglutide will also be approved, and there are other subsequent products being developed.
Finally, we have some really meaningful solutions for MAFLD. Also interesting is the liver cancer treatment development. A study presented here shows that the combination of different cancer treatments really makes a difference. So, we are making progress in many different liver diseases at this meeting.
脂肪性肝病挑战重重，破局之道何在？02
《国际肝病》
面对MAFLD全球流行的现状，您在预防、诊断及治疗方面看到了哪些核心挑战？有何良策应对？
W. Ray Kim主席：个人认为其核心挑战是如何早期精准诊断肝病，这要求我们在卫生政策、医疗服务与数据挖掘协同作用。要切实改善广大肝病患者的健康状况，仅凭高端治疗技术是远远不够的，还需政策与医疗服务之间的紧密配合，以实现肝病的早期精准诊断。
例如，我们团队的研究工作着重于深入探索电子健康记录（EHR）这一丰富的信息资源，借助数据挖掘技术，以期从中识别出潜在的肝病患者群体。既往传统的诊断模式大多局限于寻找特定的生物学标志物，但这种方法不仅效率低下，且覆盖范围有限。因此，我们需将关注重点放在那些处于早期肝纤维化阶段的患者身上，他们正是未来可能发展为严重肝病的高风险人群。所以，构建一种既全面又系统的筛查策略显得至关重要。
另外，要想真正破解肝病防治的难题，还需将这一筛查策略有效地融入到初级保健与家庭医学体系之中。作为一名肝病专科医生，我深刻认识到，单凭个人的力量难以覆盖到庞大的肝病患者群体。因此，如何强化初级保健层面对肝病的识别与管理能力，是我们当前亟待解决的重要课题。
To really impact liver disease in the population, what needs to happen is not so much fancy treatment but having a policy and healthcare delivery coordinated together so we can diagnose early liver disease patients.
My personal research is to utilize health records—electronic health records—and use existing data to find out who has liver disease. The traditional model is to look for, for example, fat in the liver, hepatitis viral markers, or specific liver disease diagnoses, but that is inefficient, in my opinion.
What we need to do is look for people with liver fibrosis in early stages. Those are the people set up to develop serious liver disease in the future. That systematic effort to find those individuals—regardless of whether they have fatty liver or some other markers—is important.
Once we have that kind of policy and knowledge, implementing that in primary care and family medicine is crucial. As a liver doctor, I can’t go out into the community and deal with millions or hundreds of millions of patients with liver disease. That needs to come from primary care. That’s the challenge. We need to do more work on how to deliver liver care more efficiently.
构建医疗综合体系，共绘肝病未来蓝图03
《国际肝病》
展望未来，您对肝病领域的研究与发展有何期许？研究人员、临床医生、患者及政策制定者应如何携手并进，共同推动肝病防治事业的进步？
W. Ray Kim主席：要从根本上应对肝病这一公共卫生挑战，我们亟需的不仅限于治疗技术的革新，更是一个将政策引导、医疗服务优化、早期系统诊断以及患者教育紧密结合在一起的医疗综合体系。
这一体系的建立，需要多方力量的深度协作与共同努力。政策制定者应当致力于构建一个全面且完善的制度框架，确保早期肝病筛查能够成为初级保健服务中的标准配置，为肝病的早期发现与治疗奠定坚实基础。研究人员则需不断探索并优化预测算法，充分挖掘EHR等大数据资源的潜力，以提升肝病诊断的准确性与效率。同时，临床医生与初级保健医师也需不断提升自身的专业素养与敏锐洞察力，以便能够及时识别并干预患者的早期肝纤维化迹象，有效阻止病情的进一步恶化。
此外，患者教育同样是这一综合体系中不可或缺的一环。通过加强肝脏健康知识的普及与传播，提高患者对肝病的认知水平与自我管理能力，从而构建起一道坚实的健康防线，共同促进肝脏健康，降低肝病的发生率与死亡率。
To truly address liver disease, it’s not just about developing treatments. We need a coordinated approach where policies, healthcare delivery, and systematic early diagnosis come together.
This involves a collective effort. Policymakers need to provide frameworks that allow for better integration of early liver disease screening in primary care. Researchers should continue developing tools like predictive algorithms and refining our ability to use electronic health records. Clinicians and primary care physicians must be equipped to identify early-stage fibrosis in their patients. And, of course, patient education plays an essential role in promoting liver health and preventing progression.
总结W. Ray Kim主席的深刻洞察，不仅揭示了肝病管理领域协同作战的重要性，更为我们描绘了一幅充满希望的未来图景。从MAFLD与肝癌治疗的突破性进展，到早期纤维化筛查的系统性布局，每一步都凝聚着科研人员、临床医生、患者与政策制定者的共同努力。随着这些前沿进展与战略举措的落地实施，肝病学领域正以前所未有的姿态，为人类健康的改善贡献着智慧与力量。
