他汀类药物与慢性肝病肝硬化风险降低有关

StephenW

Statins linked to lower risk for cirrhosis in chronic liver diseases

Kim RG, et al. Clin Gastroenterol Hepatol. 2017;doi:10.1016/j.cgh.2017.04.039.
May 16, 2017

Results of a systematic review and meta-analysis showed a probable association between statin use and a lower risk for hepatic decompensation and mortality in patients with chronic liver disease. Further, statin use may reduce portal hypertension in these patients.

“Statins are one class of medications being studied to determine their effect on progression and decompensation of [chronic liver diseases],” Rebecca G. Kim, MD, MS, from the University of California at San Diego, and colleagues wrote. “Epidemiological studies have observed a protective association between statin use and hepatocellular cancer. Recent studies have also suggested an association between statin use and risk of fibrosis progression and hepatic decompensation in patients with [chronic liver diseases], although the effects have been variable.”

To determine the association between statin use and the risk for fibrosis progression or cirrhosis development, risk for developing decompensated cirrhosis, mortality and progression of portal hypertension, researchers reviewed the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database and Systematic Reviews, Scopus, Web of Science and PubMed databases.

Thirteen studies totaling 121,058 patients initially met the researchers’ criteria, including three randomized control trials and 10 observational studies. Two studies were later excluded due to similar population and insufficient information, respectively.

Five studies reported statin use was associated with a 58% lower risk for development of cirrhosis or progression of fibrosis in patients with non-cirrhotic chronic liver diseases (RR = 0.42; 95% CI, 0.16-1.11). Excluding one of these studies that relied solely on administrative claims codes, the researchers found a 35% lower risk (RR = 0.65; 95% CI, 0.48-0.87). Three of these studies reported specifically on the risk for fibrosis progression, resulting in a 27% lower risk (RR = 0.73; 95% CI, 0.54-1).

Four studies reported a 46% lower risk for progression to decompensated cirrhosis in both patients with baseline compensated cirrhosis and non-cirrhotic chronic liver diseases (RR = 0.54; 95% CI, 0.46-0.62). In patients with baseline compensation only, there was a similar protective association between statin use and risk for hepatic decompensation (RR = 0.54; 95% CI, 0.44-0.66).

Six studies reported statin use was associated with a 39% lower risk for mortality (RR = 0.61; 95% CI, 0.48-0.78). Out of four studies that reported on the risk for re-bleeding or clinically significant improvement in portal hypertension in patients with baseline cirrhosis, three randomized control trials reported a 27% lower risk (RR = 0.73; 95% CI, 0.59-0.91) and one observational study reported a 61% lower risk (RR = 0.39; 95% CI, 0.19-0.79).

“Moderate quality evidence suggests beneficial effect of statins on risk of hepatic decompensation and mortality, and variceal bleeding, especially in patients with known compensated cirrhosis, and low quality evidence suggests a mortality benefit in patients with [chronic liver diseases],” the researchers concluded. “Large, pragmatic [randomized control trials] in patients with compensated cirrhosis, are required to confirm these observations.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.

StephenW

他汀类药物与慢性肝病肝硬化风险降低有关

Kim RG，et al。胃肠激素肝素2017; DOI：10.1016 / j.cgh.2017.04.039。
2017年5月16日

系统评价和荟萃分析结果显示，他汀类药物使用与慢性肝病患者肝功能失代偿和死亡风险相关性较低。此外，他汀类药物使用可能会降低这些患者的门静脉高压。

“他汀类药物是一类正在研究的药物，以确定其对慢性肝脏疾病进展和代偿失调的影响，”加利福尼亚大学圣地亚哥分校的Rebecca G. Kim，医学博士和同事们写道。 “流行病学研究观察到他汀类药物使用与肝细胞癌之间的保护性关联。最近的研究也表明，他汀类药物使用与[慢性肝病]患者纤维化进展与肝功能衰竭的风险有关，尽管效果是可变的。“

为了确定他汀类药物使用与纤维化进展或肝硬化发展风险之间的联系，发展失代偿性肝硬化的风险，门静脉高压的死亡率和进展，研究人员回顾了MEDLINE，EMBASE，Cochrane对照试验中心登记册，Cochrane数据库和系统评价， Scopus，Web of Science和PubMed数据库。

总共有121,058名患者的13项研究最初符合研究人员的标准，其中包括3项随机对照试验和10项观察性研究。由于类似的人口和信息不足，两项研究后来被排除在外。

五项研究报道他汀类药物使用与非肝硬化慢性肝病患者肝硬化发展风险降低58％或纤维化进展相关（RR = 0.42; 95％CI，0.16-1.11）。研究人员排除其中一项完全依赖行政索赔代码的研究，发现风险降低了35％（RR = 0.65; 95％CI，0.48-0.87）。其中三项研究报道了纤维化进展的风险，导致风险降低27％（RR = 0.73; 95％CI，0.54-1）。

4项研究报道，基线补偿性肝硬化和非肝硬化慢性肝病患者进展失代偿性肝硬化风险降低46％（RR = 0.54; 95％CI，0.46-0.62）。在仅有基线补偿的患者中，他汀类药物使用与肝功能失代偿风险之间存在类似的保护性关联（RR = 0.54; 95％CI，0.44-0.66）。

六项研究报告他汀类药物使用与死亡风险降低39％（RR = 0.61; 95％CI，0.48-0.78）。在报告基线肝硬化患者门静脉高压重新出血风险或临床显着改善的四项研究中，三项随机对照试验报告风险降低27％（RR = 0.73; 95％CI，0.59-0.91），一项观察性研究报告降低了61％的风险（RR = 0.39; 95％CI，0.19-0.79）。

研究人员得出结论：“质量证据表明，他汀类药物对肝功能失代偿和死亡风险的有益作用，以及静脉曲张出血，特别是已知补偿性肝硬化患者，低质量证据表明患有慢性肝病患者的死亡率有益。 。补偿性肝硬化患者的大型实用[随机对照试验]需要确认这些观察结果。“ - 由Talitha Bennett

披露：研究人员报告没有相关的财务披露。