Through long-term planning to immunize against hepatitis B vaccination, Guangdong and even China will have an outstanding effect on the control of new hepatitis B cases. But to solve the incremental problem, what about the original huge stock of infected people and patients? How to further strengthen the detection and treatment of existing chronic hepatitis B patients? How to manage them well and not let the disease progress to the stage of liver cancer?
On December 11, the first International Summit Forum on Liver Disease in the Greater Bay Area and the 2021 International Conference on the Elimination of Viral Hepatitis, sponsored by the Guangdong Society for The Application of Precision Medicine and co-hosted by Southern Hospital of Southern Medical University, Zhuhai People's Hospital, Guangdong Institute of Liver Diseases and Shenzhen Hospital of Southern Medical University, opened in Zhuhai. At the meeting, Professor Hou Jinlin, a well-known liver disease expert, director of the Liver Disease Center of The Southern Hospital of Southern Medical University and director of the Institute of Liver Diseases, said that the stock of China's high-risk population of liver cancer is extremely high, and if there is no early screening of high-risk groups of hepatitis B, 40% of the population will eventually develop liver cancer. To this end, he led the launch of a large-scale liver cancer early screening intervention project "Rainbow Plan" is being piloted in Yudu County, Ganzhou City, Jiangxi Province, Liaobu Community in Dongguan City, Guangdong Province, and Zhuhai People's Hospital in Guangdong Province, planning to manage 1 million high-risk groups of liver cancer in 1,000 medical institutions across the country to help early screening and early diagnosis of liver cancer.
Professor Hou Jinlin, a well-known liver disease expert, director of the Liver Disease Center of Nanfang Hospital of Southern Medical University, and director of the Institute of Liver Diseases.
It is reported that the conference invited Academician Li Lanjuan of the Chinese Academy of Engineering, Academician Wang Fusheng of the Chinese Academy of Sciences and other leaders in the field of liver disease and infectious diseases to share the frontiers and progress of international academic research online. More than 100 well-known experts from all over the world have made joint efforts on the triple elimination of "hepatitis B, AIDS and syphilis", and actively responded to the world's liver disease problems by reducing new hepatitis, promoting the promotion of hepatitis B maternal and infant blockade work, promoting early screening and early diagnosis of liver cancer and improving the level of accurate diagnosis and treatment.
Academician Wang Fusheng of the Chinese Academy of Sciences shared the frontiers and progress of international academic research online.
Academician Li Lanjuan of the Chinese Academy of Engineering is sharing a video.
The new hepatitis B population was controlled
It is even more important to manage existing hepatitis B patients
Professor Hou Jinlin said that since the implementation of the hepatitis B immunization program in China, the number of new chronic hepatitis B patients every year has been greatly reduced by vaccinating newborns free of hepatitis B vaccine. However, there are many existing hepatitis B patients in China, "At present, there are 7 million people with cirrhosis in China, and there are 90 million people carrying hepatitis B virus." These patients are all at high risk for liver cancer. ”
According to the latest global cancer burden data released by the World Health Organization's International Agency for Research on Cancer (IARC) in 2020, more than 410,000 people in China will have new liver cancer in 2020, accounting for 45% of new cases worldwide; more than 390,000 people will die of liver cancer, accounting for 46% of global deaths.
"Guangdong is a province with a high incidence of liver cancer, and about 10% of the population in the economically underdeveloped areas of guangdong' east and west are infected with chronic hepatitis B, and hepatitis B patients account for about one-tenth of the country. Moreover, more than 90% of liver cancer in the province is related to hepatitis B; 80% of liver cancer patients are already advanced liver cancer when they are diagnosed; 80% of liver cancer patients have not received formal treatment when they are diagnosed. "It is precisely because the early liver cancer screening rate is extremely low, the early diagnosis rate of liver cancer in China does not exceed 20%, and the five-year survival rate of liver cancer patients in China is only 14.1%, far lower than that of countries such as Japan and South Korea in Asia, which have exceeded 30%.
The vast majority of liver cancers are related to viral hepatitis, and it is particularly significant to do a good job in the management of hepatitis B patients.
Use the system to identify people at high risk of liver cancer
Two places in Guangdong have launched early screening projects
Just in June this year, the World Health Organization WHO updated the 2030 elimination of hepatitis B target, the newly released target in addition to mentioning to reduce the incidence of hepatitis B by 95%, mortality rate by 65%, but also refine the absolute specific indicators of chronic hepatitis B, such as the incidence of mother-to-child transmission ≤2%, hepatitis B annual mortality rate of ≤ 4/100,000, to achieve this goal is not easy.
Zhang Wenhong, an infectious disease expert, also sent video courseware to the conference.
Hou Jinlin believes that the first thing is to improve the early diagnosis rate of liver cancer, and the realization of early diagnosis of liver cancer depends on the screening and management of high-risk groups. Regular screening of people at high risk of liver cancer is the most cost-effective way to increase early diagnosis rates and reduce mortality. However, due to the huge base of patients with chronic liver disease in China and the uneven distribution of health and medical resources in various places, liver cancer screening has not yet been fully popularized. It is reported that in order to make liver cancer screening feasible, since 2008, Professor Hou Jinlin's team has created and verified a cross-etiological (hepatitis B, hepatitis C, non-viral) and cross-racial (Asian, Western) liver cancer risk estimation model by constructing a global prospective follow-up population of 17374 patients with chronic liver disease. The prediction model can accurately predict the risk of liver cancer by entering the patient's age, sex, platelets, albumin and total bilirubin, so that most low-risk populations (the annual incidence of liver cancer is less than 0.2%) are exempt from frequent liver cancer screening, saving medical resources.
"Because many people don't do screening, they don't know they are infected with hepatitis B, and even if they are infected with hepatitis B, they don't have standardized treatment." Guo Yabing, director of the Liver Cancer Center of Nanfang Hospital of Southern Medical University, said, "By screening in the community, looking for high-risk groups of liver cancer, follow-up treatment and management of them, thereby reducing the incidence of liver cancer." This large-scale liver cancer early screening intervention project, led by Professor Hou Jinlin, is called the Rainbow Project. ”
Guo Yabing introduced to reporters that the "Rainbow Plan" has established a pilot base in Yudu County, Ganzhou City, Jiangxi Province, and formed the Yudu experience. "We have trained the backbone doctors of 33 community health service centers in Dongguan to standardize their diagnosis and treatment of hepatitis; secondly, by using the liver cancer risk estimation model, to find out the high-risk population of liver cancer, this method only needs to draw a little blood for examination, and input platelets, albumin and total bilirubin and other 5 indicators, can predict the risk of liver cancer in patients." Therefore, this scoring mini program can be used as a simple tool for hepatocellular carcinoma screening and management in primary hospitals; third, at present, we have found that 1% of the population in the community is a high-risk group of liver cancer, and the high-risk population is followed up, standardized treatment, and regular ultrasound examination is carried out, thereby improving the early diagnosis rate of hepatocellular carcinoma and reducing mortality. ”
At present, the "Rainbow Plan" project has been carried out in three pilot projects in Yudu County, Ganzhou City, Liaobu Community in Dongguan city and Zhuhai People's Hospital. Li Yong, assistant to the president of Zhuhai People's Hospital, introduced to reporters that it is expected that in 2022, Zhuhai People's Hospital will include 2,000 people in the hepatology department into the plan, and follow up and manage patients through risk stratification. Among them, it is worth mentioning that the patient's initial examination and follow-up are paid for by the project (about 1080 yuan). It is expected that after the project matures, it will be promoted to various communities in Zhuhai. At present, the antiviral drugs for hepatitis B are very cheap, and the cost of a month's medicine is only more than a dozen yuan. Li Yong also revealed, "At present, the Zhuhai Municipal Medical Insurance Bureau is ready to decentralize 36 million yuan of medical insurance funds to the community for the prevention and control of chronic diseases. ”
Except for viral hepatitis
Alcoholic liver and cirrhosis are also on the rise
In addition to being vigilant against liver damage caused by viral hepatitis, some non-viral hepatitis such as alcoholic liver and cirrhosis caused by obesity are also worthy of vigilance. The prevalence of non-alcoholic fatty liver disease (NAFLD) has grown rapidly, surpassing chronic viral hepatitis B to become the first chronic liver disease in China. For every 10 Chinese, about 3 may be diagnosed with fatty liver. Poor eating habits, irrational dietary structure, sedentary lifestyle and long-term heavy drinking have "spawned" fatty liver.
Sun Jian, vice president of Nanfang Hospital of Southern Medical University and an expert in liver disease, said that fatty liver is reversible in the initial stage, and if ignored, it can also develop into steatohepatitis, liver fibrosis, cirrhosis or direct progression to liver cancer. Older age, obesity, and diabetes are independent risk factors for progressive liver fibrosis or cirrhosis and liver cancer in patients with fatty liver disease. "Although they (alcoholic liver, fatty liver) have a lower risk of turning into liver cancer than hepatitis B, the risk is much higher than that of the general population." To prevent liver cancer, patients with these two types of liver disease may be well followed up. ”
Sun Jian said that in the United States, non-alcoholic fatty liver disease is gradually becoming the main cause of liver cancer. The annual increase rate of liver cancer in patients with fatty liver disease is about 9%, and the survival period is lower than that of patients with hepatitis B and C. This is related to the fact that patients with fatty liver liver neglect to screen and diagnose liver cancer at an early stage, and the tumor is found to be advanced. Therefore, pay attention to the prevention and treatment of fatty liver, in addition to the need to control intake, improve diet structure, increase exercise, maintain a reasonable weight, regular work and rest, if necessary, the use of drug treatment, but also need to pay attention to regular liver cancer screening. For patients with steatohepatitis-related liver fibrosis or cirrhosis, experts recommend that liver cancer screening should be performed every 6 months.
Written by: Nandu reporter Wang Daobin Correspondent Yang Fang