Editor’s Note: Under long-term and repeated stimulation from various causes, a normal liver can develop into cirrhosis. Histologically, cirrhosis is characterized by diffuse liver fibrosis accompanied by collapse of the lobular structure (including microvascular structures) and the formation of pseudolobules, leading to portal hypertension and even liver function decompensation. Professor Hong You’s team at Beijing Friendship Hospital, Capital Medical University, was the first in the world to propose a new pathological standard for evaluating the reversal of hepatitis B-induced cirrhosis. This new standard, known internationally as the “Beijing Standard,” not only increases the recognition rate of cirrhosis reversal but also changes the clinical practice of requiring two liver biopsies for evaluation. Recently, at the “25th National Academic Conference on Traditional Chinese Medicine for Hepatobiliary Diseases,” Hepatology Digest conducted an exclusive interview with Professor Hong You to discuss the diagnosis of cirrhosis reversal and other related issues. Here are the highlights of the interview.
Hepatology Digest: Cirrhosis is not an independent disease but a pathophysiological process. You have created a new pathological standard for cirrhosis reversal. How effective is this diagnostic standard and the treatment of cirrhosis reversal in clinical application? What challenges remain?
Professor Hong You: Cirrhosis is a common liver disease in China, mainly caused by viral hepatitis, though the prevalence of fatty liver disease is gradually increasing, which can also lead to liver fibrosis and cirrhosis.
The new pathological diagnostic standard (R-I-P classification) we proposed has been referred to by international experts as the “Beijing Standard.” It allows observation of collagen fiber dynamics with a single liver biopsy, determining whether the patient’s disease is progressing or reversing based on the state of the collagen fibers. “R” stands for regressive, indicating thin, dense collagen septa with no significant inflammation; “P” stands for progressive, indicating large, wide septa with loose collagen structures and significant inflammation; “I” stands for indeterminate, indicating characteristics between the two.
Currently, the “Beijing Standard” is still being promoted and popularized. Further research is needed to link the “Beijing Standard” with endpoints such as reduced incidences of liver cancer and decompensation.
Hepatology Digest: What are the advantages of combining traditional Chinese and Western medicine in treating cirrhosis?
Professor Hong You: Currently, there are no specific drugs for treating liver fibrosis and cirrhosis. Clinical treatments are mostly aimed at the underlying causes. Even with treatments such as alcohol cessation, weight loss, and antiviral therapy, only half of the patients with cirrhosis see their condition controlled or reversed. For the remaining patients whose condition is not effectively controlled, the combination of traditional Chinese and Western medicine can offer unique advantages.
First, TCM provides individualized treatment for patients with liver fibrosis and cirrhosis through syndrome differentiation and treatment. Second, different diseases have different pathogenesis. For example, if cirrhosis is of the blood stasis and qi stagnation type, promoting blood circulation and removing blood stasis is necessary. If there are hardened nodules due to tumors, softening and resolving nodules is required. Large-scale clinical RCT studies in China have confirmed that combining Chinese medicine formulas with antiviral therapy is more effective than antiviral therapy alone. This excellent treatment method should be promoted further to benefit more patients.
Hepatology Digest: What new breakthroughs have you and your team made in the field of cirrhosis reversal so far? What research directions will you focus on in the future?
Professor Hong You: Our team has contributed clinical evidence to China and the world in reducing the incidence and mortality of cirrhosis complications. More people now recognize that cirrhosis can be reversible.
However, reversing cirrhosis to a normal state requires long-term treatment and further exploration of the pathogenesis. This means there are many research opportunities. First, innovation in both Western and Chinese medicine is necessary to benefit patients. By studying key targets, we can develop drugs for treating liver fibrosis and cirrhosis and combine these with the advantages of Chinese medicine for individualized treatment, further reducing the proportion of patients with liver fibrosis and cirrhosis. Second, with improved living standards, the disease spectrum of liver diseases has changed. The number of patients with fatty liver disease far exceeds those with viral hepatitis, and a significant proportion of fatty liver disease progresses to liver fibrosis and cirrhosis. Current pathological diagnosis mainly relies on liver biopsy, so we must strive to shift from invasive to non-invasive diagnostic methods.
In summary, our research aims to deepen our understanding of the disease mechanisms and develop innovative treatment methods that can be effectively integrated with TCM, ultimately improving patient outcomes and quality of life.
