[FRLF2012]FibroScan在日本获得广泛应用——日本东京大学Masao Omat

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                        [FRLF2012]FibroScan在日本获得广泛应用——日本东京大学Masao Omata教授访谈                    

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                        来源： 作者：M.Omata 发布时间：2012-7-9 15:35:32   阅读：6

                    
                                                                我对于鉴别高风险组有着浓厚的兴趣。关于生物学标志物参数的研究非常多，但是在日常临床工作中对于此类患者的分类非常困难。我一直强调血小板计数的重要性：如果高于200000/mL，风险就非常小；但是如果下降至100000/mL，那么患癌的概率可能为3000～5000/年。我坚持这一观点已经超过25年。
                    
                                                                                       

　　Hepatology Digest: You have reported that liver stiffness is strongly associated with the risk of HCC. Would you like to tell us the significance of evaluating the risk of HCC and how to evaluate the risk of HCC by FibroScan?
　　《国际肝病》：您曾报告肝硬度值与HCC风险强相关。您能告诉我们评估HCC的意义以及如何使用FibroScan评估HCC吗？
　　Professor Omata: I was very interested in identifying the high risk groups. There are many studies on the biochemical parameters but in daily clinical practice it is very difficult to categorize those people. I kept saying that platelet counting was very important and if it is beyond 200000/ml then you are at less risk and if it goes down to 100000/ml platelet count， your chances of getting cancer are maybe 3000-5000 per year. That is what I have kept saying for the last 25 years. Then FibroScan came. Actually I was trained as a pathologist. The concept of fibrosis is very familiar to a pathologist as we take biopsies and other liver samples. I was trained initially as a pathologist here at New Haven in 1973. Then for six years I read the liver biopsies and I also did the liver biopsies on my own when I went back to Japan in 1979. Sometimes I would take twenty liver biopsies in two hours but accidents happen like bleeding so sometimes it was very scary. Liver biopsy is not a treatment; it is a diagnosis. If something happens during the diagnosis process the patient gets very upset and nowadays you might be sued for malpractice. So I knew the importance of liver biopsy but I also knew that I wanted to avoid the procedure. When FibroScan came to Japan， I was very eager to do it because instead of sticking in a needle I could use a probe and I could check the liver stiffness. Therefore we did the first stiffness studies on hepatitis C patients and these were the first of their kind. Many studies were comparing histology and FibroScan but our study was utilizing FibroScan readings as the baseline for four years with over 870 patients. We clearly showed that where the FibroScan reading was below 10kPa， only two out of 511 were liver cancers. In contrast， 14.4% of those above 15kPa developed cancer. So we proved that in patients by prospective randomized clinical studies with HCC. That is my story about Fibroscan.
　　Omata教授：我对于鉴别高风险组有着浓厚的兴趣。关于生物学标志物参数的研究非常多，但是在日常临床工作中对于此类患者的分类非常困难。我一直强调血小板计数的重要性：如果高于200000/mL，风险就非常小；但是如果下降至100000/mL，那么患癌的概率可能为3000～5000/年。我坚持这一观点已经超过25年。随着FibroScan的到来，情况出现变化。其实，我最初是一位病理学医生，纤维化的概念对于病理学医生而言是非常熟悉的。我最早是在1973年在NEW HAVEN大学接受病理学培训的，在其后的6年时间内，我都是独立读片。1979年返回日本后，我也自己进行肝脏穿刺检查。我曾在2小时内进行过20例左右的肝穿刺，但是有时会出现出血等并发症，因此非常紧张。肝脏穿刺并不是一种治疗方法，而是诊断的手段。但是如果在诊断的过程中患者出现并发症，病情变得非常糟糕，这将令人非常难过。因此，我非常清楚肝脏穿刺的意义，但是我更希望能避免进行这样的操作。当FibroScan进入日本后，我非常渴望去开展，因为你只需要一个探头，就可以检测肝脏硬度。因此，我们开展了丙型肝炎患者肝脏硬度的研究，这是在此类人群的第一个研究。有许多关于组织学和FibroScan相关性的研究，但是我们的研究在基线时就应用FibroScan检测，目前已经进行了4年，有超过870例的患者入组。我们的研究显示，当FibroScan读数低于10 kPa时，511例患者中仅有2例患者发生肝癌。对照组中，FibroScan读数超过15 kPa时有14.4%的患者发生肝癌。因此我们通过前瞻性随机研究验证了这些结论。这就是我和Fibroscan的故事。
　　Hepatology Digest: In Japan， what aspects of FibroScan have been used for reasons other than evaluating the risk of HCC?
　　《国际肝病》：在日本，FibroScan除被用于评估HCC风险外，还被用于哪些方面？
　　Professor Omata: Japan has seen a fast advancement of the procedure since its approval last year and there have been many areas， not just liver disease， where people are interested in checking stiffness. Of course， hepatitis C is a major one and also hepatitis B but now also NASH is increasing because twenty years ago， 10% hepatitis B-related hepatocellular carcinoma， 80% was hepatitis C. Now instead of hepatitis B， NASH non-viral cancers are 12%-15%， so more people are interested in checking liver stiffness for that growing number of NASH patients and metabolic cancers. I think there are three major indications to check for hepatocellular carcinoma: HBV， HCV and now NASH metabolic syndromes.
　　Omata教授：2011年，日本批准了FibroScan的临床应用，因此发展较为迅速，目前FibroScan的应用已经拓展到其他一些领域，不仅限于肝脏疾病，只要在检测硬度方面有兴趣时均可开展。当然，HCV、HBV感染是其中重要的一部分，目前针对NASH患者的检测发展也非常迅猛。因为在过去20年，10%患者为HBV相关性肝细胞肝癌，80%为HCV相关性肝细胞肝癌。而现在，除了乙型肝炎和丙型肝炎外，NASH等非病毒性肝癌占到12%～15%，因此人们越来越倾向于检测肝脏硬度，而且NASH和代谢性疾病相关肝癌患者的数量也在不断增加。我认为有三类人群需要进行肝细胞肝癌的监测：乙型肝炎、丙型肝炎、NASH代谢综合征患者。
　　Hepatology Digest: Can you talk about the Asia-Pacific consensus about non-invasive diagnosis of liver fibrosis?
　　《国际肝病》：亚太地区关于肝纤维化非侵入性诊断方面有哪些共识？
　　Professor Omata: In the APASL Guidelines， we have HBV， HCV and hepatocellular carcinoma but we do not have NASH guidelines. We did at one time put together liver fibrosis guidelines. At that time FibroScan was not available anyway so maybe pretty soon we have to set up new guidelines for fibrosis and for NASH. I think it is time that this was done as the last guidelines were written six or seven years ago so it is time to revise those.
　　Omata教授：在APASL系列指南中，我们已经制定了乙型肝炎、丙型肝炎以及肝细胞肝癌的指南，但是目前尚无NASH指南。我们将和肝纤维化指南同步推出。因为FibroScan并未完全普及，因此在适当的时机我们会推出NASH和肝纤维化的新指南。我认为，目前时机已经成熟，因为距离上次推出指南已经过去了6～7年的时间了，是时候更新了。