慢性乙型肝炎患者的他汀类药物使用和肝细胞癌的风险。

StephenW

Hepatology. 2019 Sep 25. doi: 10.1002/hep.30973. [Epub ahead of print]
Statin Use and the Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B.
Goh MJ1, Sinn DH1, Kim S2, Woo SY2, Cho H2, Kang W1, Gwak GY1, Paik YH1, Choi MS1, Lee JH1, Koh KC1, Paik SW1.
Author information

1
    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
    Statistics and Data Center, Samsung Medical Center, Seoul, Korea.

Abstract

Statins have pleiotropic effects which may include chemoprevention. Several observational studies have suggested that statins may prevent hepatocellular carcinoma (HCC) but they have not yet been fully studied in patients with chronic hepatitis B virus (HBV) infections. A hospital-based retrospective cohort of 7,713 chronic HBV-infected individuals between January 2008 and December 2012 were analyzed. The primary outcome was the development of HCC. Patients who used statins for at least 28 cumulative defined daily doses (cDDD) during the follow-up period were defined as statin users (n = 713). The association between the use of statin and the incidence of HCC was analyzed using the multivariable Cox regression model with time-dependent covariates. During a median follow-up of 7.2 years (min-max: 0.5-9.7), HCC newly developed in 702 patients (9.1%). Statin use was associated with a lower risk of HCC (adjusted hazard ratio (HR) = 0.36, 95% confidence interval (CI): 0.19-0.68, adjusted for age, sex, cirrhosis, diabetes, hypertension, serum alanine aminotransferase, cholesterol, HBV DNA level, antiviral treatment, and antiplatelet therapy). The observed benefit of the statin use was dose dependent (adjusted HR (95% CI), 0.63 (0.31-1.29); 0.51 (0.21-1.25); 0.32 (0.07,1.36); and 0.17 (0.06, 0.48) for patients with statin use of 28-365, 366-730, 731-1095, and more than 1095 cDDDs, respectively). In subgroup analysis, the association between statin use and reduced risk of HCC was observed in all pre-specified subgroups analyzed. CONCLUSIONS: Statin use was associated with a reduced risk of HCC development in chronic HBV-infected patients, suggesting that statin may have chemopreventive role in this population. These findings warrant a prospective evaluation.

© 2019 by the American Association for the Study of Liver Diseases.
KEYWORDS:

Antiviral therapy; Hepatocellular carcinoma; Liver cirrhosis; Statins

PMID:
    31556128
DOI:
    10.1002/hep.30973

StephenW

肝病。 2019年9月25日。doi：10.1002 / hep.30973。 [Epub提前发布]
慢性乙型肝炎患者的他汀类药物使用和肝细胞癌的风险。
Goh MJ1，Sinn DH1，Kim S2，Woo SY2，Cho H2，Kang W1，​​Gwak GY1，Paik YH1，Choi MS1，Lee JH1，Koh KC1，Paik SW1。
作者信息

1
成均馆大学医学院三星医学中心医学系，韩国首尔。
2
韩国首尔三星医疗中心统计和数据中心。

抽象

他汀类药物具有多效作用，可能包括化学预防。几项观察性研究表明，他汀类药物可以预防肝细胞癌（HCC），但尚未在患有慢性乙型肝炎病毒（HBV）的患者中进行研究。分析了2008年1月至2012年12月在医院的7,713例慢性HBV感染者的回顾性队列。主要结果是肝癌的发展。在随访期间使用他汀类药物至少28次累积定义剂量（cDDD）的患者被定义为他汀类药物使用者（n = 713）。使用具有时间依赖性协变量的多变量Cox回归模型分析了他汀类药物的使用与HCC发生率之间的关联。在7.2年的中位随访期间（最小-最大：0.5-9.7），702例患者中新发展了HCC（9.1％）。服用他汀类药物具有较低的HCC风险（调整后的危险比（HR）= 0.36，95％置信区间（CI）：0.19-0.68，针对年龄，性别，肝硬化，糖尿病，高血压，血清丙氨酸转氨酶，胆固醇的调整后） ，HBV DNA水平，抗病毒治疗和抗血小板治疗）。使用他汀类药物的观察到的益处是剂量依赖性的（对于患者），调整后的HR（95％CI），0.63（0.31-1.29），0.51（0.21-1.25），0.32（0.07、1.36）和0.17（0.06、0.48）他汀类药物使用28-365、366-730、731-1095和超过1095个cDDD，在亚组分析中，在所有预先指定的亚组中观察到他汀类药物使用与降低的HCC风险之间的相关性。与慢性HBV感染患者的HCC发生风险降低有关，这表明他汀可能在该人群中具有化学预防作用。

©2019美国肝病研究协会版权所有。
关键词：

抗病毒治疗；肝细胞癌；肝硬化；他汀类药物

结论：
31556128
DOI：
10.1002 / hep.30973