Patrick S. Kamath教授：再谈NAFLD

2023 年7 月14-16日，由西安国际医学中心医院主办的首届国际医学高峰论坛暨慢性进展期肝病（cACLD）终南论坛于西安胜利召开。肝胆相照平台特邀美国妙佑医疗国际(Mayo Clinic)肝病及胃肠病学杰出人物Patrick S. Kamath 教授围绕本次大会和肝病领域学术进展进行经验分享，并将采访内容整理成文，以飨读者。

Part1、肝胆相照：“首届国际医学高峰论坛暨慢性进展期肝病（cACLD）终南论坛”的召开意义重大，能否分享一下您与本次大会的故事，以及参加本次大会的感受？

IGandan:“International Medical Summit Forum and  compensated advanced chronic liver disease (cACLD) Zhongnan Forum " is of great significance. Could you share your story with this conference and your feelings about attending this conference?

Patrick S. Kamath教授：我非常开心有机会参加这次会议。这次会议为东西方医生和研究人员提供了一个交流经验的平台，对我而言也是一个很好的学习机会。我从东方学者的身上学习到了很多，这为以后更好地合作奠定了基础，对患者来说也是非常有利的。

I'm very grateful for this opportunity of coming to this conference. It's a very good opportunity for us in the west to share our experience with physicians and researchers from the east. But for me, more important is it's an opportunity for me to learn.

From researchers in the east, so I have really learn a lot at this meeting and I think ultimately when we share our thoughts in the east and west and when we collaborate better, I think it's better for patience.

Part2、肝胆相照：近年来国际交流和创新越来越受到关注，您作为肝病领域的顶级专家，拥有大量学术成就，能否请您分享一下您对于国际交流合作和学术创新价值的见解和经验，给中国医生一点建议。

IGandan: In recent years, international exchanges and innovation have attracted more and more attention. As a top expert in the field of liver disease, you have made a lot of academic achievements. Could you please share your insights and experience on the value of international exchanges and cooperation , and give some advice to Chinese doctors.

Patrick S. Kamath教授：作为医生，最重要的工作是让我们的患者康复，所以通常医生在照顾病人。但是除了看病以外，找到让患者更容易康复的方法也十分重要，因此我们需要做研究，去找到更好的治疗方法。最后，我们还要教别人如何做得更好。总的来说，我们的工作是照顾患者，做研究和把经验传授给年轻医生。我总是告诉年轻医生，医学研究十分必要，但这并不容易。这需要耗费很多时间且没有捷径，我们不能很快到达山顶。到达山顶的路很艰难，你必须靠自己攀爬才能爬上山顶，甚至路上可能会摔倒，但你必须坚持努力的走下去。所以，只有持之以恒的努力，你才会达到顶峰。

The most important part of job as doctors is to make our patients better. So typically a doctor works on looking after the patient, but I think it's really important that every day we find ways of making things easier and better for the patient, so in addition to seeing patients, we required to do research, find ways of doing things better, and once you find doing things better, that's better for the patients. And so that goes to the third aspect of our job. And the third aspect of our job is to teach others how to do things better so we should look after patients, do research and educate others. I always tell my younger colleagues, research is very rewarding, but it's not easy. It takes time. There is no elevator. We cannot reach the top very quickly. The way to the top is slow. You have to climb stairs to go to the top. The stairs are not even their slippery, you might fall, but you have to get back and try and continue. So if you work hard enough you'll reach the top and that is very rewarding.

Part3、肝胆相照：您在会上分享了《非酒精性脂肪性肝病的研究》，讲得非常精彩。目前，脂肪肝正在严重威胁人们的健康，成为仅次于病毒性肝炎的第二大肝病。请您谈谈脂肪肝的危害。

IGanDan: You shared the study on non-alcoholic fatty liver disease at the meeting, which was very wonderful. At present, fatty liver is posing a serious threat to people's health, becoming the second largest liver disease after viral hepatitis. Please talk about the harm of fatty liver disease.

Patrick S. Kamath教授：我认为这是一个全球性的问题。全世界有30%的人患有脂肪肝，现在这被称为代谢功能障碍相关脂肪性肝病。目前的焦点问题是患有脂肪肝的患者人群正在大幅增长，且亚洲人群的增长速度更快。如果将目光聚焦到儿童上，我们发现超重儿童数量最多的是美国，其次是印度，第三个是中国。今天我与来自西安和中国其他地区的同事交谈，我了解到中国至少30%-50%的人口患有脂肪肝。在糖尿病患者人群中，几乎70%的患者合并脂肪肝，且与心血管疾病的发生相关。大约3％-4%的脂肪肝患者会死于肝病。

I think the problem is worldwide. 30% of people worldwide have fatty liver disease. Now it's called metabolic dysfunction. But it just means that the liver cells have fat and 30% of the population have that. So it's increasing. So the problem is, I think, increasing more rapidly in Asia. So if you look at children, the highest number of overweight children are in the United States, but next is India and third is China. And talking to colleagues from Xian and other parts of China today, we know that at least 30% of the population in China has fatty liver disease, and probably 50%. If you have diabetes, it is almost 70%. So metabolic liver disease related to fat and the liver is only going to increase.It's going to be associated with cardiovascular disease. And about 3-4% of all patients with fatty liver disease will die of liver disease.

Part4、肝胆相照：2020年，有专家提出了将非酒精性脂肪性肝病（NAFLD）更名为代谢相关脂肪性肝病（MAFLD），时隔三年，又有专家建议将NAFLD更名为代谢相关脂肪变性肝病（MASLD）。NAFLD两度更名引发了业内专家的热烈讨论，也吸引了众多临床医生的广泛关注。对此，您怎么看？

IGanDan：In 2020, some experts proposed to change the name of non-alcoholic fatty liver disease (NAFLD) to metabolic-related fatty liver disease (MAFLD), and three years later, some experts proposed to name NAFLD to metabolic-related steatosis liver disease (MASLD). The NAFLD renaming has sparked discussion among experts and attracted wide attention from many clinicians. What do you think about this?

Patrick S. Kamath教授：因此，我们试图改变原术语非酒精性脂肪肝（NAFLD）有两个原因。一是它没有给出肝病的病因。它说，这不是由于酒精导致的，而且肝脏里有脂肪，但是这并不能解释病因。第二，研究者们认为患者可能不喜欢脂肪肝这个称呼。因此新术语是代谢相关脂肪变性肝病。当我们说与代谢障碍相关时，我认为这就解决了第一个问题。它告诉我们病人是因为代谢功能障碍而患有肝病。第二患者可能不喜欢肥胖这个词。我认为这对患者来说有点复杂，代谢障碍相关的脂肪肝不等于肥胖，因此用一个不同的术语来形容脂肪，患者可能会更好地理解这一点。我们也知道，新的术语的确认主要是西方的研究者，来自亚洲的研究者很少。不知道亚洲的国家是不是有更好的词语可以形容这个概念。

So the original term non alcoholic fatty liver disease was tried to be changed for two reasons. One is it did not give the cause of the liver disease. It said it was not due to alcohol. And there was fat in the liver, so it did not explain the cause. The second it was thought that if you say fatty liver disease, patients might not like it. So the new terminology is metabolic dysfunction related liver disease. So when we say metabolic dysfunction related, I think that takes care of the first point. And now it tells us why the patient has liver disease because of metabolic dysfunction.The second part is when we say fatty liver disease, that was not good for the patient, that still we don't know whether the patients were like this term or not.I think it's a little complicated for patients, metabolic dysfunction related fatty liver disease means fat, but you're using a different term for fat, whether the patients will understand this better. Whether they will relate to this better, I don't know. We also know that the new terminology was predominantly western investigators. There were very few from Asia. So is this a good term for the rest of the world or is it a good term only for the west? We still don't know as yet.

专家介绍

●Patrick S. Kamath教授

●美国妙佑医疗国际肝病及胃肠病学专家，长期致力于肝硬化及相关并发症、非酒精性脂肪性肝病、酒精性肝病、肝脏血管性疾病、Fontan相关性肝病等肝脏疾病的临床诊疗及科学研究。此外，Kamath教授活跃于教育领域，长期为住院医师和专科研究员提供指导，其讲座在世界范围内受到广泛欢迎。在妙佑医疗国际工作期间，曾12次被选为“年度教师”，这在世界肝病学领域都是前所未有的记录。他还获得了美国胃肠病学协会(AGA)和美国肝病研究协会（AASLD）颁发的“杰出教育家/导师奖”，被美国expertscape网站评价为“全球十大肝硬化专家”之一，并在2022年获得欧洲肝病学年会（EASL）颁发的“国际成就奖”。

●Kamath教授在肝病学的科学研究方面取得了非凡的成就，是当今该领域最杰出的人物之一。Kamath教授最重大的研究成果为2000年首创的MELD终末期肝病评分模型(Model for End-stage Liver Disease)，这是一种旨在量化肝硬化患者短期死亡风险的预测工具，深刻改变了终末期肝病的诊疗规范，成为全球重症肝炎、肝硬化、门脉高压、肝癌等终末期肝病诊治评价标准的基石，并自2002年起成为全美肝移植分配肝源的依据。

●目前，Kamath教授在New England Journal of Medicine、Gastroenterology、Hepatology、Gut、Journal of Hepatology等国际顶尖期刊发表同行评议文章400余篇。他曾担任国际权威期刊Clinical Gastroenterology and Hepatology、Hepatology、Journal of Hepatology等杂志副主编，并在包括Internal Medicine、Gastroenterology、Liver Transplantation等众多国际知名期刊编辑委员会任职，长期担任New England Journal of Medicine，Lancet，Nature Medicine等顶级期刊评审专家，在临床研究论文的撰写、投稿方面具有丰富的经验。

●Dr. Patrick S. Kamath

●Dr. Kamath is an expert in hepatology and gastroenterology at Mayo Clinic. He has been dedicated to clinical diagnosis and treatment, as well as scientific research, of liver diseases such as cirrhosis and related complications, non-alcoholic fatty liver disease, alcoholic liver disease, liver vascular diseases, Fontan-associated liver disease, etc. In addition, Professor Kamath is active in the education field, providing guidance to residents and specialty researchers, and his lectures are widely welcomed worldwide. he was selected 12 times as "Teacher of the Year" at Mayo Clinic, a record unprecedented in the field of hepatology worldwide. He also received the "Outstanding Educator/Mentor Award" from the American Gastroenterological Association (AGA) and the American Association for the Study of Liver Diseases (AASLD), was recognized as one of the "Top 10 Global Experts in Hepatic Fibrosis" by the Expertscape, and was awarded the "International Achievement Award" by the European Association for the Study of the Liver (EASL) in 2022. 

●Currently, Dr. Kamath has achieved remarkable accomplishments in scientific research in the field of liver disease and is one of the most outstanding figures in the field. His most significant research achievement is the Model for End-stage Liver Disease (MELD) scoring system, which he pioneered in 2000. This is a predictive tool designed to quantify the short-term mortality risk of patients with liver cirrhosis and has profoundly changed the diagnostic and treatment standards of end-stage liver disease. It has become the cornerstone of the evaluation standards for end-stage liver diseases such as severe viral hepatitis, liver cirrhosis, portal hypertension, liver cancer, etc. worldwide and has been the basis for liver transplantation allocation in the United States since 2002.

●Currently, Professor Kamath has published over 400 peer-reviewed articles in top international journals such as the New England Journal of Medicine, Gastroenterology, Hepatology, Gut, and the Journal of Hepatology. He has served as associate editor for prestigious international journals including Clinical Gastroenterology and Hepatology, Hepatology, and the Journal of Hepatology, and has been a member of the editorial board for numerous renowned international journals including Internal Medicine, Gastroenterology, and Liver Transplantation. He has also served as a reviewer for top-tier journals such as the New England Journal of Medicine, Lancet, and Nature Medicine, and has extensive experience in clinical research papers.  

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*本文仅供医疗卫生专业人士为了解资讯使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议。如该等信息被用于了解资讯以外的目的，平台及作者不承担相关责任。

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