阿司匹林降低乙肝患者的HCC风险

StephenW

Aspirin Lowers HCC Risk in Hep B Patients
Retrospective analysis shows benefit, but expert considers practice changes premature

Daily aspirin is significantly associated with a reduced risk for liver cancer in patients with hepatitis B virus (HBV), according to an analysis of data from a nationwide cohort study.

The findings, presented at the 2017 Liver Meeting (abstract 223), showed that aspirin cut the incidence of liver cancer from 5.59% to 2.86% in patients with HBV.

Investigator Teng-Yu Lee, MD, PhD, MBA, a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital, in Taiwan, said the information may help prevent HBV-related liver cancer in “patients with chronic HBV infection, particularly … those who are not indicated for antiviral therapy.”
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Multiple clinical studies have demonstrated a link between long-term use of aspirin and a reduction in the incidence and mortality of several cancer types, including colorectal, stomach, esophageal, breast, lung, prostate and liver cancer (Lancet 2011;377:31-41). Research also has demonstrated that aspirin can reduce cancer risk, particularly in the presentation of colorectal cancer (Clin Cancer Res 2014;20:1087-1094).

In the new study, Dr. Lee and his colleagues retrieved medical records from the National Health Insurance Research Database in Taiwan between 1998 and 2012 and screened the records of 204,507 patients with chronic HBV infection. They excluded patients who had other forms of infectious hepatitis and who already had been diagnosed with hepatocellular carcinoma (HCC). A cohort of 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched on a 1:4 basis with 6,212 patients who had never received antiplatelet therapy using propensity scores consisting of baseline characteristics, the index date and use of nucleos(t)ide analog during follow-up.

The patients who received aspirin had a lower incidence of HCC than the nonaspirin group at five years (2.86% vs. 5.59%; P<0.01). In a multivariable regression analysis, aspirin therapy was independently associated with a reduced HCC risk (hazard ratio, 0.63; P=0.002). Sensitivity subgroup analyses also verified this association. Use of nucleos(t)ide analogs or statins also was associated with a decreased HCC risk. Older age, male sex, cirrhosis and diabetes were independently associated with an increased risk.

Dr. Lee said the research team was pursuing prospective investigations to further confirm the findings.

Timothy R. Morgan, MD, the chief of hepatology at VA Long Beach Healthcare System, in California, and a professor of medicine in the Division of Gastroenterology at the University of California, Irvine, said more evidence is needed about the benefits of aspirin before he would make any practice changes. “Based on the abstract,” he said, “I would not recommend that patients with HBV start taking aspirin to reduce their risk of liver cancer.”

—Kate O’Rourke

StephenW

阿司匹林降低乙肝患者的HCC风险
回顾性分析显示收益，但专家认为实践变化为时过早

根据全国队列研究数据分析，每日阿司匹林与乙肝病毒（HBV）患者肝癌风险降低显着相关。

在2017年肝脏会议上发表的研究结果（摘要223）显示，阿司匹林将乙肝患者的肝癌发病率从5.59％降至2.86％。

台湾退伍军人总医院消化内科研究员，研究员Teng-Yu Lee医学博士表示，这些信息可能有助于预防“慢性HBV感染患者的HBV相关肝癌，特别是那些...谁没有被指示为抗病毒治疗。“
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多项临床研究表明长期使用阿司匹林与降低几种癌症类型（包括结肠直肠癌，胃癌，食管癌，乳腺癌，肺癌，前列腺癌和肝癌）的发病率和死亡率之间存在联系（Lancet 2011; 377：31- 41）。研究还表明，阿司匹林可以降低癌症风险，特别是在结肠直肠癌的报告中（Clin Cancer Res 2014; 20：1087-1094）。

在这项新研究中，李博士及其同事在1998年至2012年期间从台湾国家健康保险研究数据库中检索了病历，并筛选了204,507名慢性HBV感染患者的记录。他们排除了患有其他形式的传染性肝炎并且已经被诊断患有肝细胞癌（HCC）的患者。一组1,553名持续接受每日阿司匹林至少90天的患者随机接受1：4的随机匹配，其中6,212名患者从未接受抗血小板治疗，使用倾向评分包括基线特征，指标日期和核苷酸使用情况t）ide模拟在随访期间。

接受阿司匹林治疗的患者在5年时发生HCC的发生率低于非阿司匹林组（2.86％比5.59％; P <0.01）。在多变量回归分析中，阿司匹林治疗与HCC风险降低独立相关（风险比为0.63; P = 0.002）。敏感性亚组分析也验证了这种关联。核苷（t）ide类似物或他汀类药物的使用也与HCC风险降低有关。年龄较大，男性，肝硬化和糖尿病与风险增加独立相关。

李博士说，研究团队正在进行前瞻性调查，以进一步确认调查结果。

加利福尼亚州弗吉尼亚州长滩医疗保健系统肝病学主任医师Timothy R. Morgan博士和加州大学欧文分校消化内科教授表示，需要更多关于阿司匹林治疗益处的证据他会做出任何修改。 “根据摘要，”他说，“我不会建议患有HBV的患者开始服用阿司匹林来降低他们患肝癌的风险。”

-Kate O'Rourke

jsmscym

阿司匹林时间用长了会胃出血的。

StephenW

回复 jsmscym 的帖子

是的，阿司匹林有很多好处，但正确的用量非常重要.
每日阿司匹林应该由医生开处方.

tacolynn

阿司匹林可真是慎用！我没有乙肝，看欧美都是一天一片低剂量的阿司匹林可以预防心脑血管病，我就也开始吃，一天一片80mg的，结果。。。刚吃了三天，半夜牙出血，满嘴血腥味的醒来。。。。好吧，我本身有牙周炎。

StephenW

回复 tacolynn 的帖子

80mg是一个低剂量, 但阿司匹林是一种血液稀释剂.