阿司匹林减少接受口服核苷类似物的慢性乙型肝炎患者的肝

StephenW

Aspirin Reduces the Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Receiving Oral Nucleos(t)ide Analog
Vicki Wing-Ki Hui  1   2   3 , Terry Cheuk-Fung Yip  1   2   3 , Vincent Wai-Sun Wong  1   2   3 , Yee-Kit Tse  1   2   3 , Henry Lik-Yuen Chan  1   2   3 , Grace Chung-Yan Lui  1   2   4 , Grace Lai-Hung Wong  1   2   3
Affiliations
Affiliations

    1
    Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China.
    2
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    3
    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
    4
    Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.

    PMID: 33750746 DOI: 10.14309/ctg.0000000000000324

Abstract

Introduction: Aspirin may reduce the risk of chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) in patients receiving antiviral treatment. We aimed to investigate the impact of aspirin on reducing HCC risk in patients treated with first-line oral nucleos(t)ide analogs (NAs; entecavir and/or tenofovir disoproxil fumarate).

Methods: We conducted a territorywide, retrospective cohort study in NA-treated CHB patients between 2000 and 2018 from the electronic healthcare data repository in Hong Kong. Subjects were classified into aspirin users for at least 90 days during NA treatment (aspirin group) or no aspirin or any other antiplatelet use during follow-up period (no aspirin group). Incidence rates of HCC and gastrointestinal bleeding (GIB) in 2 groups with propensity score matching with 1:3 ratio.

Results: Of 35,111 NA-treated CHB patients of mean age of 53.0 years and 61.6% men, sixty-nine (4.0%) and 1,488 (4.5%) developed HCC at a median (interquartile range) of 2.7 (1.4-4.8) years and 3.2 (1.8-6.0) years in the aspirin group and no aspirin group, respectively. A duration-dependent association between aspirin and the risk of HCC was observed (subhazard ratio [sHR] 3 months-2 years: 0.65; 95% confidence interval [CI] 0.47-0.92; sHR 2-5 years: 0.63; 95% CI 0.43-0.94; sHR from ≥5 years: 0.41; 95% CI 0.18-0.91). Patients who took aspirin for ≤2 years had significantly higher risk of GIB (sHR: 1.73, 95% CI 1.07-2.79) than those not receiving aspirin. The risk of GIB started declining with the longer use of aspirin and becoming insignificant for ≥5 years' use (sHR: 0.79, 95% CI 0.19-3.21).

Discussion: Long-term aspirin use is associated with a lower risk of HCC in a duration-dependent manner in NA-treated CHB patients without a significant increase in the risk of gastrointestinal adverse effects.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

StephenW

阿司匹林减少接受口服核苷类似物的慢性乙型肝炎患者的肝细胞癌发病率
许永基1 2 3，叶德丰1 2 3，黄伟顺1 2 3，谢洁洁1 2 3，陈力源1 2 3，，正恩1 2 4，黄丽红1 2 3
隶属关系
隶属关系

    1个
    香港中文大学医学数据分析中心，中国香港。
    2个
    香港中文大学医学与治疗学系，香港，中国。
    3
    香港中文大学消化系统疾病研究所，香港，中国。
    4
    香港中文大学赛马会公共卫生与初级保健学院何鸿tan新兴传染病中心，中国香港。

    PMID：33750746 DOI：10.14309 / ctg.0000000000000324

抽象的

简介：阿司匹林可降低接受抗病毒治疗的患者患慢性乙型肝炎（CHB）相关的肝细胞癌（HCC）的风险。我们旨在研究阿司匹林对一线口服核苷酸类似物（NAs；恩替卡韦和/或替诺福韦富马酸替诺福韦酯）治疗的患者降低HCC风险的影响。

方法：我们在2000年至2018年之间从香港的电子医疗数据存储库中对接受NA治疗的CHB患者进行了一项回顾性队列研究。在NA治疗期间（阿斯匹林组），受试者至少90天被分类为阿司匹林使用者（在阿司匹林组中），或在随访期间未使用阿司匹林或使用任何其他抗血小板药物（在阿司匹林组中）。两组肝癌和胃肠道出血（GIB）的发生率倾向得分与1：3比例匹配。

结果：35,111名接受NA治疗的CHB患者平均年龄为53.0岁，男性为61.6％，其中69岁（4.0％）和1,488（4.5％）发生了HCC，中位（四分位间距）为2.7（1.4-4.8）岁阿司匹林组和无阿司匹林组分别为3.2和1.8（6.0-6.0）岁。观察到阿司匹林与HCC风险之间存在持续时间相关性（亚危险比[sHR] 3个月至2年：0.65； 95％置信区间[CI] 0.47-0.92； sHR 2-5年：0.63； 95％CI 0.43-0.94;≥5年的sHR：0.41; 95％CI 0.18-0.91）。服用阿司匹林≤2年的患者比未接受阿司匹林的患者发生GIB的风险显着更高（sHR：1.73，95％CI 1.07-2.79）。随着阿司匹林使用时间的延长，GIB的风险开始下降，并且≥5年使用才变得微不足道（sHR：0.79，95％CI 0.19-3.21）。

讨论：在NA治疗的CHB患者中，长期使用阿司匹林与HCC的风险呈持续依赖关系，而不会显着增加胃肠道不良反应的风险。

版权所有©2021作者。由Wolters Kluwer Health，Inc.代表美国胃肠病学院出版。

StephenW

https://journals.lww.com/ctg/Ful ... patocellular.9.aspx