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1、肝硬化血清标志物的研究进展肝硬化血清标志物的研究进展首先，诊断肝纤维化有很多血清标记物，也就是说还没有金指标。有很多血清标记物意味着还没有真正的标记物，实际上这些血清标记物是用于将严重纤维化、肝硬化与其他疾病区分开来的。 Hans Van Vlierberghe 比利时根特大学医院 Hepatology Digest: Liver biopsy is an invasive test. Therefore, the use of non-invasive serum biomarkers has been developed for diagnosis of liver fibrosis. W
2、hat are some things we need to be mindful of when we use these biomarkers in a clinical setting? Prof. Van Vlieberghe: First of all, there are a lot of biomarkers for establishing liver fibrosis, which means the Holy Grail is not there yet. There are a lot of seromarkers so the real one is not there
3、. What those seromarkers are actually doing is distinguishing severe fibrosis and cirrhosis versus the rest. If you use them in these conditions then it is ok. If you want them to distinguish, for example, between an F2 and an F3 on the METAVIR score, then it wont work very well. So, if you expect t
4、his from a biomarker you will lose. I think that biomarkers can be implemented in clinics in a way where we combine, for example two biomarkers. If the two biomarkers are concordant, if they say there is the same degree of fibrosis, if there is less fibrosis then you can wait and not perform a biops
5、y, if the biomarkers say there is cirrhosis, you dont need the biopsy and you have to follow-up for HCC and variceal bleeding, and in the gray zone between F0 and F4, then you can decide on what to do. You can perform a liver biopsy regarding if there is an indication for management changes implicat
6、ed by the biopsy. So, by using two biomarkers, you can avoid a lot of biopsies, but you still can not avoid every biopsy. In my personal point of view, and this is what we do in our hospital, we perform in every patient where we will manage and where we think it is important. For example, patients o
7、ver 80 where treatment is not available or not necessary, of course we do not biopsy, but were it is clinically relevant, we perform a biopsy and we perform a one or two biomarkers depending on the situation. If the biopsy and the biomarkers are concordant, and we are not treating the patient for wh
8、atever reason, we can follow-up the patient with a biomarker without the need for a repeat liver biopsy after 34 years. We know that the concordance between the liver biopsy and the biomarkers is approximately 80%, so we perform a biopsy in everyone but follow-up biopsies can be reduced by 80% using
9、 this protocol. There are different ways of working, using two biomarkers, using liver biopsy; with them also the Holy Grail is not there so we need to go on with research regarding these biomarkers. 问：肝活检是一种有创检查。而非侵入性血清标志物已用于诊断肝纤维化。那么我们临床应用这些标记物是有什么注意事项吗？Van Vlieberghe教授：首先，诊断肝纤维化有很多血清标记物，也就是说还没有“金
10、指标”。有很多血清标记物意味着还没有真正的标记物，实际上这些血清标记物是用于将严重纤维化、肝硬化与其他疾病区分开来的。如果将它们用于这些情况，那没有问题，但如果您想将它们用于区分F2和F3的METAVIR评分，那它们并没有用，也就是说，如果您期望凭借一个生物标志物区分二者您会失望。我认为，临床上可以联合应用两种生物标志物，若两种标志物一致，提示无纤维化，则继续观察，不行活检。如果标记物提示有肝硬化，则不需要活检，而要追踪观察是否罹患肝癌及静脉曲张破裂出血。若提示为F0-F4之间的纤维化，那么您来决定该怎么做。您可以进行肝活检，通过活检了解是否存在需要治疗的病理改变。因此，应用两个标志物，就可以
11、避免一些活检，但仍无法避免所有活检。我个人认为，对每个需要治疗的患者都要做活检，我们医院现在也是这么做的。比如，对于超过80岁的患者，治疗不可行或不必要的，我们当然不需要做活检。但临床上，如果有指征时，我们可以进行活检，同时做一个或两个标志物。如果活检和生物标志物结果一致，对于不论出于什么原因我们并不准备给予治疗的患者，可以应用生物标记物追踪患者，而不需要34年后重复肝活检。我们知道肝活检与生物标记物之间的一致性可达到80%。所以我们虽然给每位患者行肝穿刺活检，但肝穿复查则可以减少80%。工作中我们可以选择不同方法，如联合测试两种标记物、或肝活检，但标记物目前尚无金标准，所以我们需要继续深入研
12、究。 Hepatology Digest: This past April you published an article entitled “Outcome of Patients with Hepatocellular Carcinoma Listed for Liver Transplantation within the Eurotransplant Allocation System” in Liver Transplantation. You pointed out that allocation rules for HCC should consider not only tu
13、mor characteristics, but also the degree of liver impairment. Furthermore, patients older than 50, with a stage above the Milan criteria at transplantation, have a poorer prognosis after transplantation. In a clinical setting, should HCC patients with a good prognosis be given priority for liver tra
14、nsplant rather than those who are sicker and with a poorer prognosis? Prof. Van Vlierberghe: First, the age is an important thing because the average age of transplant patients in Belgium and Western Europe is 55. This means that the majority of our patients are above the age of 50, which was published in the a
