编者按：第53届欧洲肝脏研究学会（EASL）年会召开期间，世界卫生组织（WHO）全球肝炎项目负责人Marc Bulterys教授在EASL-WHO联合论坛中就丙型肝炎的防治给出了最新WHO指南建议，并于会后就肝炎患者的饮酒问题及如何降低我国肝炎发病率和死亡率等问题接受了《国际肝病》记者的采访，相关内容整理如下。

 

戒酒对于病毒性肝炎患者意义重大

 

当前，全球范围内由乙型肝炎和丙型肝炎所引起的肝硬化和肝细胞癌占了很大比例。其中约45%是由乙型肝炎引起，约20%是由丙型肝炎引起，其余的多由摄入大量酒精所引起。值得注意的是，病毒感染和大量酒精摄入量之间的相互作用可导致肝细胞癌。因此，必须清醒认识到，酒精的摄入，特别是大量酒精的摄入会对肝脏造成极大危害。

 

对于乙型肝炎或丙型肝炎患者，减少酒精的摄入，甚至杜绝任何酒精摄入是非常重要的。如果持续摄入大量酒精，则发展为肝细胞癌的风险极高。肝癌是中国非常重要的癌症之一，它是男性第二大癌症和女性第三大癌症。如果感染了乙型肝炎或丙型肝炎病毒，摄入酒精会极大增加相应的风险。

 

Bulterys教授在采访中指出，患者一旦出现肝硬化，此时再停止饮酒已不再有助于缓解病情。本届EASL年会上交流的一项临床试验提供的数据显示，在肝硬化阶段再减少酒精的摄入量，对于减少肝细胞癌的机会影响并不大，难以从中获益。

 

中国病毒性肝炎：考虑谈判机制，提高治疗可及性

 

世界范围内，乙型肝炎和丙型肝炎的治疗方法在持续改进中，高效抗病毒药物不断涌现。这对拥有约1亿病毒性肝炎患者的中国而言非常重要，确保这些患者的治疗可及性是当下必须实现的目标。

 

Bulterys教授在采访中指出，使用WHO认可且被WHO指南推荐的替诺福韦或恩替卡韦来治疗乙型肝炎，可大大降低疾病进展。中国的一些公司已经正在生产替诺福韦，这对于大幅降低慢性乙型肝炎感染所引起的发病率和死亡率意义重大。

 

对于1000万的丙型肝炎患者，中国作为中高收入国家，应考虑与公司直接谈判，协商一个更好的价格来治疗所有已感染者和新增感染者。之前澳大利亚和英国就已经这样做了，澳大利亚基于五年治疗全部感染者（250000人）进行谈判。类似的，中国可以就所有感染者和每年治疗一百万人来谈判，以获得更好的价格。

 

点击“阅读原文”，查看中英文对照

 

Prof Bulterys: Hepatitis B and C contribute a large proportion of all the cirrhosis cases and hepatocellular carcinoma in the world. About 20% are due to hepatitis C, and about 45% due to hepatitis B. Of the remainder, many are due to a high intake of alcohol. The important point is that there is actually interaction between viral infection and high alcohol intake in causing hepatocellular carcinoma. It is important to realize that if someone is infected with either hepatitis B or hepatitis C, it is very important to reduce alcohol intake, and ideally to prevent any alcohol intake at all. If a patient continues with a very high alcohol intake, the risk of progression to hepatocellular carcinoma is much higher. Liver cancer is a very significant cancer in China. It is the second largest cancer for men, and third largest for women. It is essential to realize that alcohol intake, particularly if at a very high level, is very dangerous for the liver. It is even more dangerous if you have a chronic infection with one of the two main viral infections, hepatitis B or hepatitis C. Once someone has developed cirrhosis, stopping drinking is no longer to help the situation. There was data presented at this conference from a clinical trial showing that it is not really possible to reduce hepatocellular carcinoma by that stage. It is too late once someone has cirrhosis to be reducing alcohol intake to incur any benefit. People need to be very aware of this interaction.

 

Prof Bulterys: I work for the World Health Organization, so from my perspective, the treatments for hepatitis B and hepatitis C are still continually improving. Better and better treatments are becoming available. This is really important in China because around 90 million people there are chronically infected with hepatitis B and about 10 million with hepatitis C. Around 100 million people in total are infected with hepatitis viruses. As treatments improve, we have to make sure that those treatments also become available to this population. We can greatly reduce the progression of hepatitis B by treating with one of two drugs that are now WHO approved and part of our WHO Guidelines - tenofovir or entecavir. Tenofovir is becoming more readily available now in China at a much lower cost because it is now a generic drug. A number of companies in China are producing tenofovir. It is feasible to greatly reduce mortality and morbidity due to chronic hepatitis B infection. For the ten million people infected with hepatitis C, drugs are becoming more available with generic drugs through India, but now that China is considered an upper middle income country, China should consider negotiating directly with companies, similar to what Australia and England have done, to get a good price. What Australia has done has basically negotiated for five years of treatment for the entire population that is affected (250000 people). China could similarly negotiate a much better price by negotiating for all of the people who are infected and to treat one million people per year, for instance.