Janicko Martin, Drazilova Sylvia, Pella Daniel, Fedacko Jan, Jarcuska Peter
Martin Janicko, Daniel Pella, Jan Fedacko, Peter Jarcuska, 1 Department of Internal medicine, Pavol Jozef Safarik University in Kosice, Louis Pasteur University hospital, 04001 Kosice, Slovakia.
World J Gastroenterol. 2016 Jul 21;22(27):6201-13. doi: 10.3748/wjg.v22.i27.6201.
Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic sinusoidal microthrombosis. Two randomized controlled trials confirmed that statins decrease hepatic vein pressure gradient in patients with portal hypertension and improve the survival of patients after variceal bleeding. Lower rates of infections were observed in patients with cirrhosis who received statin treatment. Statins decrease the risk of hepatocellular carcinoma (HCC) in patients with advanced liver disease in general but particularly in patients with chronic hepatitis B and C. Statins in patients with chronic hepatitis C likely increase the virological response to the treatment with pegylated interferon and ribavirin and have the potential to decrease the rate of fibrosis. Finally, data from randomized controlled trials also confirmed that the addition of statin prolongs the survival of patients with advanced HCC even more than sorafenib. Statins are a very promising group of drugs especially in patients with liver disease, where therapeutic options can often be limited. Some indications, such as the prevention of re-bleeding from esophageal varices and the palliative treatment of HCC have been proven through randomized controlled trials, while additional indications still need to be confirmed through prospective studies.
他汀类药物是一类抑制HMG CoA还原酶的分子。它们通常被开作降血脂药物。然而，越来越多的证据表明，他汀类药物具有多种与降脂作用相关或不相关的次要作用。这篇文献综述旨在为读者提供来自临床研究的信息，这些研究涉及他汀类药物的作用及其在肝病患者中的潜在用途。在任何病因导致的晚期肝病患者中，他汀类药物可能通过预防肝窦微血栓形成发挥抗纤维化作用。两项随机对照试验证实，他汀类药物可降低门静脉高压患者的肝静脉压力梯度，并提高静脉曲张出血后患者的生存率。接受他汀类药物治疗的肝硬化患者感染率较低。一般来说，他汀类药物可降低晚期肝病患者患肝细胞癌（HCC）的风险，尤其是慢性乙型和丙型肝炎患者。慢性丙型肝炎患者使用他汀类药物可能会增加对聚乙二醇干扰素和利巴韦林治疗的病毒学反应，并有可能降低纤维化发生率。最后，随机对照试验的数据也证实，添加他汀类药物比索拉非尼更能延长晚期HCC患者的生存期。他汀类药物是非常有前景的一类药物，尤其是在肝病患者中，因为这些患者的治疗选择往往有限。一些适应证，如预防食管静脉曲张再出血和HCC的姑息治疗，已通过随机对照试验得到证实，而其他适应证仍需通过前瞻性研究来确认。
