伴有或不伴有肝硬化的慢性乙型肝炎患者使用阿司匹林和患

StephenW

伴有或不伴有肝硬化的慢性乙型肝炎患者使用阿司匹林和患肝细胞癌的风险

肝病学（马里兰州巴尔的摩）

带回家的信息

    这项有趣的研究着眼于阿司匹林对合并或不合并肝硬化的慢性乙型肝炎 (CHB) 患者各种结局的影响。对超过 300,000 名慢性乙型肝炎患者和至少连续使用阿司匹林 90 天的患者进行了评估。在没有肝硬化的患者中，使用阿司匹林对肝细胞癌 (HCC) 的发展具有保护作用，并降低了与肝脏相关的死亡风险。在肝硬化患者中没有注意到这种影响。使用阿司匹林未发现出血风险增加。

    在无肝硬化的 CHB 患者中，长期服用阿司匹林可能会降低 HCC 发展和肝脏相关死亡率的风险。

– Natasha von Roenn，医学博士
抽象的

该摘要可在出版商的网站上找到。
背景和目的

缺乏关于阿司匹林治疗对各种肝病 HCC 风险的不同影响的研究。我们调查了阿司匹林的使用与合并或不合并肝硬化的慢性乙型肝炎 (CHB) 患者的 HCC、肝脏相关死亡和大出血风险之间的关系。
方法和结果

我们使用韩国国民健康保险服务数据库从 2007 年到 2017 年确定了 329,635 名符合条件的 CHB 成人，包括连续服用阿司匹林≥90 天的患者（n = 20,200）和从未接受过抗血小板治疗的患者（n = 309,435）。在倾向评分匹配的队列（19,003 对）中估计了 HCC、肝脏相关死亡率和大出血的风险，考虑了竞争风险。中位随访时间为 6.7 年，阿司匹林治疗组 10 年 HCC 累积发生率为 9.5%，未治疗组为 11.3%（调整后的子分布风险比 [aSHR]，0.85；95% CI，0.78- 0.92)。然而，在肝硬化患者（2479 对）中，阿司匹林使用与 HCC 风险的关联并不明显（aSHR，1.00；95% CI，0.85-1.18）。肝硬化状态对阿司匹林使用与 HCC 风险之间的关联有显着影响（相互作用，n = 0.04）。阿司匹林的使用还与较低的肝脏相关死亡率相关（aSHR，0.80；95% CI，0.71-0.90）。此外，阿司匹林的使用与大出血风险无关（aSHR，1.09；95% CI，0.99-1.21）。
结论

使用阿司匹林可降低成年慢性乙型肝炎患者的 HCC 风险和肝脏相关死亡率。肝硬化状态对阿司匹林的使用与 HCC 风险之间的关联有显着影响。

StephenW

Aspirin Use and Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B With or Without Cirrhosis

Hepatology (Baltimore, Md.)

TAKE-HOME MESSAGE

    This interesting study looked at the impact of aspirin use on various outcomes in patients with chronic hepatitis B (CHB) with or without cirrhosis. Over 300,000 patients with CHB and at least 90 days of consecutive aspirin use were evaluated. In patients without cirrhosis, aspirin use had a protective effect on the development of hepatocellular carcinoma (HCC) and caused a reduction in the risk of liver-associated mortality. This effect was not noted in patients with cirrhosis. No increased risk of bleeding was noted with aspirin use.

    In patients with CHB without cirrhosis, there may be a benefit to long-term aspirin use in terms of reduced risk of HCC development and liver-associated mortality.

–  Natasha von Roenn, MD
abstract

This abstract is available on the publisher's site.
BACKGROUND AND AIMS

Studies on differential effect of aspirin therapy on HCC risk across the spectrum of liver diseases are lacking. We investigated the association between aspirin use and risks of HCC, liver-associated death, and major bleeding in chronic hepatitis B (CHB) patients with or without cirrhosis.
APPROACH AND RESULTS

We identified 329,635 eligible adults with CHB from 2007 through 2017, using the Korean National Health Insurance Service database, including patients who received aspirin for ≥90 consecutive days (n = 20,200) and patients who never received antiplatelet therapy (n = 309,435). Risks of HCC, liver-associated mortality, and major bleeding were estimated in a propensity-score-matched cohort (19,003 pairs), accounting for competing risks. With a median follow-up of 6.7 years, 10-year cumulative incidence of HCC was 9.5% in the aspirin-treated group and 11.3% in the untreated group (adjusted subdistribution hazard ratio [aSHR], 0.85; 95% CI, 0.78-0.92). However, among patients with cirrhosis (2479 pairs), an association of aspirin use with HCC risk was not evident (aSHR, 1.00; 95% CI, 0.85-1.18). Cirrhosis status had a significant effect on the association between aspirin use and HCC risk (pinteraction , n = 0.04). Aspirin use was also associated with lower liver-associated mortality (aSHR, 0.80; 95% CI, 0.71-0.90). Moreover, aspirin use was not associated with major bleeding risk (aSHR, 1.09; 95% CI, 0.99-1.21).
CONCLUSIONS

Aspirin use was associated with reduced risks of HCC and liver-associated mortality in adults with CHB. Cirrhosis status had a substantial effect on the association between aspirin use and HCC risk.

StephenW

长期服用阿司匹林前必须咨询医生