英国皇家自由医院Massimo Pinzani教授
Hepatology Digest: We have learned the importance of liver fibrosis detection. What is the benefit of liver fibrosis detection and monitoring on clinical practice?
Prof Pinzani: The benefit of detecting liver fibrosis is already in your question because the detection of liver fibrosis is important in monitoring disease progression from initial stages of necrosis and inflammation to cirrhosis. The benefits are first of all, to follow the patient in the right way to see if they are approaching stages of the disease that are characterized by clinical manifestations which may eventually lead to death or the need for liver transplantation.
Prof Pinzani: In current times, it is also true that there are treatments such as antiviral treatments for viral hepatitis which can stop the disease, so we need also to be able to see how the disease regresses from a high stage to a lower stage. The benefit in classifying disease is so that the patient and doctor can communicate in clear terms.
Hepatology Digest: In your lecture, you introduced a route for rapid patient allocation using transient elastography (TE). Can you summarize the application principles about this route? Do you think the route can be disseminated and applied in clinical practice?
Prof Pinzani: The protocol that I described in my presentation is the protocol that we use in our hospital. Right now there are three possibilities to monitor fibrosis. One is to do biopsies on everybody. Every patient with a chronic liver disease theoretically needs to have a liver biopsy every two to five years to monitor progression. With the introduction of non-invasive measures, namely serum markers and more importantly the introduction of transient elastography, the need to have a liver biopsy in every patient is greatly reduced.
Prof Pinzani: The protocol or algorithm I am presenting in my talk shows that in our hospital, every patient who comes in with a suspect chronic liver disease undergoes clinical examination, ultrasound and blood tests to understand the possible etiology whether it is viral, alcohol or metabolic, and then undergoes transient elastography with a careful interpretation. You can’t just do transient elastography without knowing the patient and without knowing the background. You can divide patients basically into three groups: patients who have little or no fibrosis; patients who have advanced fibrosis and even cirrhosis; and patients in between in what we call the grey area. These people have fibrosis but they have no cirrhosis but you cannot really grade these patients.
Prof Pinzani: In the end, the immediate need to do a biopsy is limited to the patients in the grey area who don’t have either no or early fibrosis or advanced fibrosis. With this approach we have reduced the number of liver biopsies by at least 50%. We still do liver biopsies because it is also important to know that liver biopsies are not just relevant for measuring fibrosis; what the liver looks like gives you information about the cause of liver disease.
Hepatology Digest: We have made much progress in non-invasive liver fibrosis detection. What is the current focus of study in non-invasive liver fibrosis detection for the future?
Prof Pinzani: This is an important question because we cannot expect that in ten to fifteen years we will still rely on physical methods like transient elastography. There will very likely be advances. An advance would be a method that allows you to not only measure fibrosis but other parameters like angiogenesis or liver function. The most likely technology that would allow us to do this is probably bio-imaging.
Prof Pinzani: It would be a methodology like PET scan using a biomarker as a tracer. It is important to say that the introduction of the initial non-invasive methods have opened a new avenue because before this, physicians and hepatologists1lo were not even thinking that first of all fibrosis was important and secondly, that you could measure fibrosis with non-invasive methods.
Hepatology Digest: Would you suggest that a combination of liver biopsy and non-invasive techniques like Fibroscan be used?
Dr Pinzani: As I said before, transient elastography, for example, reduced the number of biopsies by 50% which effectively means that in clinical practice you have to use both non-invasive methods and liver biopsies. Such a combination allows you to make good choices with fewer mistakes.
