他汀类药物降低乙肝病毒的患者肝癌的风险

StephenW

Statin use decreases HCC risk in HBV patients

Hsiang JC, et al. J Hepatol. 2015;doi:10.1016/j.jhep.2015.07.009.
August 13, 2015

   
In a retrospective cohort study, statin use was found to be associated with a reduced risk of hepatocellular carcinoma among patients with hepatitis B virus infection, according to study data.

“We investigated the effect of statin in the primary prevention of HCC in a hospital-based population of HBV patients, by correcting for any potential confounders and biases,” the researchers wrote. “We also examined the effect of statin among other high-risk subgroups to evaluate the potential clinical use and impact of statin.”

Researchers extracted and analyzed data of 73,499 patients with HBV from the Hospital Authority registry database, which contained data of patients from 43 hospitals and 120 clinics in Hong Kong territory, between January 2000 and December 2012. This data was retrieved after researchers searched the database looking for specific ICD-9 codes and hepatitis B surface antigen (HBsAg) positivity. Of these patients, 53,513 were included in the final analysis. Researchers found that 1,176 of these patients were statin users and 52,337 patients were not.

Over a median follow-up of 4.6 years, 6,883 cases of HCC developed in 393,154 patient-years, according to the research. The crude incidence rate of HCC was 1.75 per 100 patient-years (95% CI, 1.71-1.79). After a 2-year landmark analysis, the median follow-up after the landmark date was 1.6 years for statin users and 4.9 years for nonusers. The unadjusted crude incidence rate of HCC was 0.52 per 100 patient-years for all the patients in this analysis. When assessed alone, the statin group had a higher crude HCC incidence rate compared with the non-users (1.24 vs. 0.51; P < .001).

In an outcome analysis after propensity score weighting, statin users were found to have a 32% reduced risk of HCC (weighted subdistribution hazard ratio [SHR] = 0.68; 95% CI, 0.48-0.97) in the 2-year landmark cohort. However, overall mortality risk was similar between statin users and non-users (weighted SHR = 0.92; 95% CI, 0.76-1.11).

In a sensitivity analysis, patients who used nucleotide analogues (NA) with statins had an “additional 59% HCC risk reduction compared to NA users alone,” according to the research. When assessing other high-risk groups, researchers found that age greater than 50 years and male gender had a “lesser degree of HCC reduction benefit.” In addition, researchers saw a trend toward a reduced risk for HCC among patients with diabetes mellitus (weighted SHR = 0.63; 95% CI, 0.38-1.04).

The researchers concluded: “We have shown statin can provide 33 [to] 34% risk reduction in HCC development, but did not reduce mortality in HBV-infection population. The additive HCC risk reduction among the synergistic use of NA and statin merits further investigation in prospective trials.” – by Melinda Stevens

Disclosures: Hsiang reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

StephenW

他汀类药物降低乙肝病毒的患者肝癌的风险

襄JC，等人。肝脏病学杂志。 2015年，DOI：10.1016 / j.jhep.2015.07.009。
2015年8月13日

   
在一项回顾性队列研究中，他汀类药物的使用被发现与患者之间的乙肝病毒感染肝细胞肝癌的风险降低有关，根据研究数据。

“我们研究了他汀类药物的效果在肝癌的乙肝患者的医院为基础的人群一级预防，通过纠正任何潜在的混杂因素和偏见，”研究人员写道。 “我们还研究了除其他高风险亚群以评价潜在临床用途和他汀类药物的他汀类药物的影响的效果。”

研究人员提取并分析了73499例患者数据与医院管理局注册表数据库，其中包含了患者的数据来自43家医院和诊所120在香港境内，2000年1月和2012年12月之间的这种数据被检索后，研究人员检索数据库寻找HBV对于特定的ICD-9代码和B型肝炎表面抗原（HBsAg）阳性。在这些患者中，53513人纳入最后的分析。研究人员发现，这些患者均1176他汀类用户和52337例患者并非如此。

在中位随访4.6年中，6883例肝癌开发的393154人年，根据研究。肝癌的粗发病率为1.75每100人年（95％CI，1.71-1.79）。经过2年的具有里程碑意义的分析，中位随访具有里程碑意义的日期后为1.6岁，他汀类用户和4.9岁，不上网。肝癌的未经调整的粗发病率为0.52每100病人年为所有患者在这种分析中。当单独评估，他汀组与非使用者相比更高粗肝癌发病率（1.24与0.51; P <0.001）。

在倾向评分加权后的结果分析，他汀类药物使用者中发现有肝癌的32％降低风险（加权subdistribution危险比[SHR] = 0.68; 95％CI，0.48-0.97）在2年具有里程碑意义的队列。然而，整体死亡风险是他汀类药物使用者和非使用者之间的相似（加权SHR = 0.92; 95％CI，0.76-1.11）。

在敏感性分析中，谁使用核苷类似物（NA）与他汀类药物的患者有一个“额外降低59％的风险肝癌较单独的NA用户，”根据研究。在评估等高危人群，研究人员发现，年龄大于50岁，男性有“肝癌减少利益程度较轻。”此外，研究人员发现了对肝癌患者中有糖尿病的风险降低的趋势（加权SHR = 0.63; 95％CI，0.38-1.04）。

研究人员得出结论：“我们已经表明他汀类药物可提供33至] 34减少％的风险在肝癌的发展，但并没有降低死亡率在HBV感染人群。该添加剂肝癌的风险降低的协同使用NA和他汀类药物值得进一步调查的前瞻性研究之中。“ - 由梅琳达·史蒂文斯

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