他汀类药物在慢性肝病患者中预防肝细胞癌的疗效和安全性

StephenW

Efficacy and Safety of Statin for Hepatocellular Carcinoma Prevention Among Chronic Liver Disease Patients: A Systematic Review and Meta-analysis
Yu-Jun Wong  1 , Tian-Yu Qiu, Gin-Kee Ng, Qishi Zheng, Eng Kiong Teo
Affiliations
Affiliation

    1
    Department of Gastroenterology and Hepatology, Changi General Hospital Yong Loo Lin School of Medicine, National University of Singapore Lee Kong Chian School of Medicine Cochrane Singapore, Singapore.

    PMID: 33606427 DOI: 10.1097/MCG.0000000000001478

Abstract

Introduction and aim: Hepatocellular carcinoma (HCC) is a deadly complication among patients with chronic liver disease (CLD). Controversies on the efficacy and safety of statin to prevent HCC among patients with CLD remain despite the growing evidences. We aim to investigate the efficacy and safety of using statin for HCC prevention among adult with CLD.

Methods: We performed a systematic search of 4 electronic databases (PubMed/MEDLINE, EMBASE, Cochrane library, and ClinicalTrial.gov) up to April 15, 2020. We selected all types of studies evaluating the statin use and the risk of HCC among CLD patients, regardless of language, region, publication date, or status. The primary endpoint was the pooled risk of HCC. The secondary endpoint was the risk of statin-associated myopathy.

Result: From 583 citations, we included a total of 13 studies (1,742,260 subjects, 7 types of statins), fulfilling the inclusion criteria, evaluating efficacy and safety of statin in CLD patients for HCC prevention. All studies were observational (2 nested case-control studies, 11 cohort studies), and no randomised trial was identified. We found that statin user has a lower pooled risk of HCC development (hazard ratio=0.57, 95% confidence interval: 0.52-0.62, I2=42%). HCC reduction was consistent among statin users in cirrhosis, hepatitis B virus, and hepatitis C virus infections. The risk of statin-associated myopathy was similar between statin user and nonuser (hazard ratio=1.07, 95% confidence interval=0.91-1.27).

Conclusion: Statin use was safe and associated with a lower pooled risk of HCC development among adults with CLD. Given the bias with observation studies, prospective randomised trial is needed to confirm this finding.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

StephenW

他汀类药物在慢性肝病患者中预防肝细胞癌的疗效和安全性：系统评价和荟萃分析
黄玉军1，邱天宇，吴健基，郑其石，永强德
隶属关系
联系

    1个
    新加坡国立大学樟宜总医院雍禄林医学院消化内科和肝病科，新加坡新加坡科克伦李光前医学院。

    PMID：33606427 DOI：10.1097 / MCG.0000000000001478

抽象的

简介和目的：肝细胞癌（HCC）是慢性肝病（CLD）患者中的致命并发症。尽管有越来越多的证据表明，他汀类药物在CLD患者预防HCC的功效和安全性方面仍存在争议。我们的目的是调查在CLD成人中使用他汀类药物预防HCC的有效性和安全性。

方法：截至2020年4月15日，我们对4个电子数据库（PubMed / MEDLINE，EMBASE，Cochrane库和ClinicalTrial.gov）进行了系统搜索。我们选择了所有评估他汀类药物使用和CLD中HCC风险的研究类型患者，无论语言，地区，出版日期或状态如何。主要终点是肝癌的合并风险。次要终点是他汀类药物相关肌病的风险。

结果：从583篇文献中，我们纳入了13项研究（1,742,260名受试者，他汀类药物7种），符合纳入标准，评估了他汀类药物在预防HCC的CLD患者中的疗效和安全性。所有研究均为观察性研究（2项嵌套病例对照研究，11项队列研究），且未确定随机试验。我们发现他汀类药物使用者的肝癌发展风险较低（危险比= 0.57，95％置信区间：0.52-0.62，I2 = 42％）。在肝硬化，乙型肝炎病毒和丙型肝炎病毒感染的他汀类药物使用者中，HCC降低是一致的。他汀类药物使用者和非他汀类药物与他汀类药物相关的肌病风险相似（危险比= 1.07，95％置信区间= 0.91-1.27）。

结论：他汀类药物的使用是安全的，并能降低CLD成人的HCC发生风险。考虑到观察研究的偏倚，需要进行前瞻性随机试验以证实这一发现。

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