拉丁美洲的肝病:现状、未满足的需求和改进的机会。

Luis Antonio Díaz, Gustavo Ayares, Jorge Arnold, Francisco Idalsoaga, Oscar Corsi, Marco Arrese, Juan Pablo Arab
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摘要

综述目的评估拉丁美洲目前在肝脏疾病方面面临的挑战,包括疾病负担、获得护理的机会、筛查和治疗需求:拉丁美洲是一个有着丰富的多元文化传统和重要的社会经济差异的地区。该地区肝病负担沉重,主要原因是酒精摄入量高以及与非酒精性脂肪肝相关的风险因素(即久坐不动的生活方式、更广泛地接触高度加工食品、肥胖和 2 型糖尿病)激增。致肝病毒也在慢性肝病的发病过程中起着一定的作用,尽管在过去几十年中,致肝病毒的出现频率在不断降低。拉丁美洲在接受肝病筛查和治疗方面存在重大差距,这反映在获得直接作用抗病毒药物和治疗肝细胞癌药物等关键治疗的机会较少。此外,多个国家在肝脏移植方面存在重大障碍,包括死者捐献率低,以及一些国家(尤其是中美洲国家)缺乏肝脏移植手术。我们地区在肝病研究和教育方面也处于劣势,这限制了地区学术发展和肝病治疗质量的提高。总结:为了应对肝病带来的日益沉重的健康负担,拉丁美洲迫切需要有针对性的干预措施,通过制定有效的公共卫生政策来控制这些疾病的主要风险因素。此外,发展肝脏移植项目、提高医学教育和研究能力以及所有利益相关者之间的广泛合作也是解决该地区肝病问题的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement.

Purpose of review: To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America.

Recent findings: Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low access to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors' rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases.

Summary: In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region.

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