解读乙肝治疗指南，更新指南——APASL主席Omata教授现场采访

lifescript

Q: In this meeting, would change APASL hepatitis B guideline?
在这次的会议中，有关乙型肝炎的指南会被修改吗？

A: Yes. As we have the two day’s meeting all we finished and the experts, maybe 20 experts gathered yesterday and the day before yesterday, and we discussed the revising the new APASL guidelines. And we made many changes of the APASL 2005 guidelines, because this is 2007, after two years we will make the changes.
是的。在刚结束的这两天会议当中，大概有20位专家云集一起共同商讨对新ADASL指南的修改。我们对于2005年版的ASASL指南作了很多的修改，主要是因为今年已经是2007年，两年的时间很多东西都发生了变化，需要我们作进一步的更新。

Q：Then what are the main changes about the guideline?
那该指南主要的变化什么呢？

A: The main changes about the guideline is that we have several new drugs and their new data. So according to their new data of the new drugs, we will change the anti-viral drugs.
对指南最主要的修改是我们有了好几种新药以及这些新药的数据。根据这些新药的临床数据，我们将会修改抗病毒药物的指南内容。

Q: We know you participated the AASLD meeting in BOSTON，had any new content in the AASLD meeting?
我们知道你同时还参加了波士顿的AASLD会议，有什么新内容带给我们吗？

A: I know this new data on the new drug Tenofovir, it is presented, and also a new date on Entacavir, that is also presented. These are the drugs for HBV, but also there are some data presented for Hepatitis C virus.
我知道的内容是有关新药天诺福韦的最新数据，同时还报道了恩替卡韦新的临床数据。这两种是针对乙肝病毒的药物，另外针对丙肝病毒也有一些新的治疗数据的报道。

Q: As so , has hepatitis B guideline changed?
那乙肝治疗指南有更改吗？

A: APASL hepatitis B will change according to our new experts consensus meeting here in Pattaya. That is because the guideline of the APASL. APASL is Asian Pacific Association who study liver and we have members. So after getting the consensus the agreements among the members of  APASL in Korea sort of our meeting in March, then it will be published in Hepatology international in June Issue, 2008.
根据我们这些新专家在该次芭提亚会议中达成一致共识后的结论，来对APASL的乙型肝炎指南进行修改。APASL做亚太肝病研究联盟，该联盟有组成的成员。当明年三月在韩国举行的APASL会议来自各个国家的专家成员对于乙型肝炎的观点都达成一致后，有关的指南修改就会确定下来，同时在2008年的《国际肝脏病学》杂志上刊登。

Q: Professor Keeffe currently advanced the hepatitis B roadmap concept, in your opinion, is this roadmap suitable for the Asian people?
Keeffe教授最近提出了有关乙型肝炎路线图的概念，你对于该路线图看法如何？他是否适用于亚洲人群？

A: Well, it is not just for the Asian, but also suitable for many patients in any area. But I think it is suitable not because of the patients in different areas of the world, however it is a road map needed in some drugs but maybe not so much in other drugs. So it depends on the drugs. Especially if the drugs going to show the mutations resistance, then you have to monitor and maybe sometimes you need additional rescue treatment. So for those drugs are roadmap concept needed. But in some of the drugs, the mutation frequency is so low, so you don’t need necessary always check on the virus DNA. And not necessary to follow the roadmap concept. So depends on the drugs.
嗯，这个路线图并不是单纯针对亚洲人群的，还是用于任何地区的许多患者。但是我个人认为该路线图的实用性广，不是因为人群来自于全球各地不同地区，而是因为这个路线图指示对于某几种药物适用，并不是很多药物都适用。特别是如果药物将会出现病毒变异耐药的时候，你就要作检测，有时候可能你还需要进行附加的补救疗法。所以对于那些药物来说，路线图概念就需要。但是在某些药物，耐药变异的发生率很低，并不是很必要总是查病毒载量，所以这个时候路线图就并非十分必要去遵循。路线图概念的使用还是依据不同的药物情况来区分。

Q: Now the incidence of hepatocellular carcinoma increased, prevalence increasingly on young people, do you think what is the main reason?
现在，肝细胞肝癌在年轻人当中的发生率逐渐上升，你认为主要的原因是什么？

A: well, not necessary just in the younger generation, but also increasing in the old generation. Maybe it is more so in the older generation. Just like what we have in Japan, so, any generations. And the reason why it is increasing in any generation is because maybe one reason is, we became able to find the cancer we can make accurate diagnosis more often than we used to be, comparing to the old days sometimes hepatocellular carcinoma was misdiagnosed as cirrhosis. So now more accurate, image techniques can make diagnosis hepatocellular carcinoma. And also the life expectancy of the people in the individual countries are prolonged therefore you get older, the more you get cancers. So it is increasing in Japan, in the United States, and also in China.
嗯，并不是仅仅在年轻一代的人群中肝细胞肝癌的发生率高，在老年人群中也同样高。也许在老年人中这个普及率更高。就想我们在日本的情况一样，所以，任何年龄层次的人都会发生。原因为什么在任何年龄段的人群中都有上升趋势，有一个可能的原因是，我们现在发现肿瘤并且诊断明确的手段方法比以前更加多，回顾以前，我们很多时候会把肝细胞肝癌误诊为肝硬化。所以随着现在诊断正确性的上升，影像学水平的提高，对于肝细胞肝癌的诊断率也就随着上升。同时，也因为各地区的人群寿命在增加，所以年龄越大，罹患肿瘤的可能也就越大。这种情况在日本，美国甚至在中国也会是如此。

Q: We know you have thoroughly study liver cancer, so for pairs of small liver carcinoma patients, you prefer liver transplantation or liver resection? Why?
我们知道你对于肝癌的研究非常的透彻，对于小肝癌的患者你主张肝移植还是肝脏部分切除？为什么？

A: first of all, you have to make some kind of the very effective strategies to find the cancer very small, and if you could do it, there are so many options of the treatment. But if you are only able to find the cancer very big, then not many options left. So the fast strategy now you have to think about is who will get the cancer on these patients.
首先，你一定要采取有效的手段来发现小肝癌。如果你能这样做的话，就有很多治疗的方案可以选择。但是如果你只能发现大肝癌的的话，就不是很多方案可以提供选择。所以你现在必须需要考虑的最快的方案是，如何发现那些病人有可能罹患肿瘤。

And then that strategy would be taken place in many Asian countries so unfortunately, when the patient came with the cancer it is too big, but in Japanese strategy we knew we would get the cancers, so we will do the frequent screening of the Ultrasound, the tumor . so average size, we could find the tumor about 2.4 cm. But in many Asian countries maybe average size cancer maybe sometimes 5-10 cm. So first of all, I think because now in Asian countries the treatment in hepatitis is so much widespread, so much more generalized, so I think now the next step, you got to have the ability to find the cancer small, then you have many options, like radiation frequency of population, liver resection and transplantation.  
虽然这个方案在很多亚洲国家都已经普及，但是……>>浏览全文