FDA批准用于其他目的二甲双胍和他汀类药物可能预防肝癌可

StephenW

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更多关于二甲双胍和他汀类药物被FDA批准用于其他目的，可能预防肝癌

From HBF’s expert Guest Blogger, Dr. Thomas London…
In an earlier blog, I pointed out that the available drugs to treat or prevent primary liver cancer (hepatocellular carcinoma, HCC) have been disappointing.  I noted that there may be drugs used for other purposes that may work against HCC.  The most promising of these was an old drug called metformin that has been used to treat type II diabetes for 17 years.  Now a new study on metformin provides the most intriguing results yet.

At the 2012 Digestive Disease Week meeting in San Diego, an enormous study from Taiwan was reported that encompassed almost all of Taiwan’s 23 million people. (I am indebted to Christine Frangou for her excellent report in Gastroenterology and Endoscopy News and have quoted from it extensively.) The investigators used the Taiwan National Insurance Database to identify all cases of HCC diagnosed from 1997 to 2008. There were 97,430 patients with HCC (most of whom would have had chronic hepatitis B). They were compared with 200,000 controls matched to the HCC cases by age, gender, and date of first physician visit.  Using the same database they linked all patients with diabetes and their treatment methods to patients with and without HCC.

From this they were able to show that patients with diabetes had a 2.3-fold increased risk of developing HCC.  In those patients who were taking metformin, however, HCC occurred about 20% less often than in those who were not treated with metformin. Furthermore, the longer patients took metformin, the lower their risk of HCC; about 7% lower for each year that they took the drug.

This study is not the final answer.  We don’t know why some diabetic patients were treated with metformin and some were not.  It is possible that the patients who did not take metformin had some unknown liver abnormality and were deliberately not treated with metformin.  Nevertheless, anti-tumor effects of metformin in experimental animals and in cell culture systems continue to be reported.  I will keep my eye out for more research on metformin and HCC and report it as it hits the medical press.

Statins are another group of drugs that are in common use. They were first approved by the FDA in 1987 to lower serum cholesterol levels and thereby prevent heart disease.  Statins inhibit an enzyme in the liver used to make cholesterol.  Several isolated reports suggested that statins might also help prevent HCC.  This month investigators at the Mayo Clinic in Rochester, Minnesota reported a meta-analysis (a statistical method to combine results from different studies) of all the reports in the medical literature of new cases (incidence) of HCC and exposure to statin therapy.  Ten studies reporting a total of 4,928 HCC cases in 1,459,417 patients were analyzed.  Overall, patients who were treated with statins had a 40% lower risk of developing HCC than those who were untreated.  The results varied from population to population. Asian populations which were more likely to also have chronic hepatitis B, had a 50% lower risk of developing HCC, while western populations had about a 30% lower risk.

At this time we do not know what the mechanism of a preventative effect of statins on HCC might be.  Nor do we know whether statins might have been withheld from patients with high cholesterol levels because they had a liver abnormality. It is likely, however, that more information on these issues will become available in the near future.  When that happens I will report it to you.

StephenW

HBF的专家访客的Blogger，伦敦托马斯博士...
在之前的博客中，我曾指出，可用药物来治疗或预防原发性肝癌（肝细胞癌，HCC）是令人失望的。我注意到，有可能是药物用于其他的目的，可能对HCC
有效的。最有前途的是一个叫做二甲双胍的老药，已被用于治疗II型糖尿病17年。现在，一项新的研究二甲双胍提供了最有意思的结果。

在2012年消化疾病周会议在圣地亚哥，一个巨大的来自台湾的研究报告，涵盖几乎所有的台湾两千三百万人民。我要感谢恭Frangou，她出色的报告，胃肠病学和内镜新闻和，广泛引自。研究者使用台湾的国家保险数据库，以确定1997年至2008例原发性肝癌诊断。有97,430原发性肝癌患者（其中大部分有慢性B型肝炎）。他们比较了20万的肝癌病例对照按年龄，性别和日期的第一个医生，请访问。使用相同的数据库，他们与所有的病人和无肝癌患者与糖尿病及其治疗方法。

从这个，他们能够证明，糖尿病患者发展为HCC的危险性增加2.3倍。在这些患者服用二甲双胍，但是，肝癌的发生往往比那些没有谁与二甲双胍治疗约20％。此外，较长的患者采取二甲双胍，低风险的HCC低约7％，每年他们
服

药物。

这项研究是不是最终的答案。我们不知道为什么有些糖尿病患者用二甲双胍治疗，有些则没有。这是谁没有采取二甲双胍的病人可能有一些未知的肝脏异常，故意不与二甲双胍治疗。然而，二甲双胍的抗肿瘤作用的动物实验和细胞培养系统继续予以报道。我会继续我的眼睛二甲双胍和HCC进行更多的研究和报告，因为它击中了医疗新闻。

他汀类药物是普遍使用的药物，另一组。他们首先于1987年由FDA批准，降低血清胆固醇水平，从而预防心脏疾病。他汀类药物抑制的酶，在肝脏中用于使胆固醇。几个孤立的报告表明，他汀类药物可能有助于预防肝癌。这个月，美国明尼苏达州罗切斯特的梅奥诊所的研究人员在报告的荟萃分析（一种统计方法，从不同的研究结果相结合）的所有报告在医学文献中HCC和曝光他汀类药物治疗的新发病例（发病率）。在1459417例患者共4928例肝癌十项研究报告进行了分析。总体而言，与他汀类药物治疗的患者比那些未接受治疗的人的发展为HCC的风险低40％。从人口到人口变化的结果。亚洲人群中也可能有慢性B型肝炎，发展为HCC的风险降低了50％，而西方人群中有大约30％的低风险。

在这个时候，我们不知道是什么的机制可能是他汀类药物对肝癌的预防效果。我们也不知道他汀类药物是否有可能被隐瞒胆固醇水平高的患者，因为他们的肝脏异常。这是有可能的，但是在这些问题上，更多的信息将成为在不久的将来。当这一切发生的时候，我会报告给你。