Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan.
Yuanshan Branch, Taipei Veterans General Hospital, I-Lan, Taiwan.
Hepatology. 2017 Sep;66(3):896-907. doi: 10.1002/hep.29172. Epub 2017 May 8.
Statin use decreases the risk of decompensation and mortality in patients with cirrhosis due to hepatitis C virus (HCV). Whether this beneficial effect can be extended to cirrhosis in the general population or cirrhosis due to other causes, such as hepatitis B virus (HBV) infection or alcohol, remains unknown. Statin use also decreases the risk of hepatocellular carcinoma (HCC) in patients with chronic HBV and HCV infection. It is unclear whether the effect can be observed in patients with pre-existing cirrhosis. The goal of this study was to determine the effect of statin use on rates of decompensation, mortality, and HCC in HBV-, HCV-, and alcohol-related cirrhosis. Patients with cirrhosis were identified from a representative cohort of Taiwan National Health Insurance beneficiaries from 2000 to 2013. Statin users, defined as having a cumulative defined daily dose (cDDD) ≥28, were selected and served as the case cohort. Statin nonusers (<28 cDDD) were matched through propensity scores. The association between statin use and risk of decompensation, mortality, and HCC were estimated. A total of 1350 patients with cirrhosis were enrolled. Among patients with cirrhosis, statin use decreased the risk of decompensation, mortality, and HCC in a dose-dependent manner (P for trend <0.0001, <0.0001, and 0.009, respectively). Regression analysis revealed a lower risk of decompensation among statin users with cirrhosis due to chronic HBV (adjusted hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.25-0.62) or HCV infection (HR, 0.51; 95% CI, 0.29-0.93). The lowered risk of decompensation was of borderline significance among statin users with alcohol-related cirrhosis (HR, 0.69; 95% CI, 0.45-1.07).
Statin use decreases the decompensation rate in both HBV- and HCV-related cirrhosis. Of borderline significance is a decreased decompensation rate in alcohol-related cirrhosis. (Hepatology 2017;66:896-907).
本研究旨在确定他汀类药物的使用对乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和酒精相关肝硬化患者肝失代偿、死亡率和肝细胞癌（HCC）发生率的影响。
从 2000 年至 2013 年，从台湾全民健康保险受益人群的代表性队列中确定肝硬化患者。选择累积规定日剂量（cDDD）≥28 的他汀类药物使用者，并将其作为病例队列。通过倾向评分匹配他汀类药物非使用者（<28 cDDD）。估计他汀类药物使用与肝失代偿、死亡率和 HCC 风险之间的关联。
共纳入 1350 例肝硬化患者。在肝硬化患者中，他汀类药物的使用与肝失代偿、死亡率和 HCC 的风险呈剂量依赖性降低（趋势 P 值<0.0001、<0.0001 和 0.009）。回归分析显示，慢性 HBV（调整后的危险比 [HR]，0.39；95%置信区间 [CI]，0.25-0.62）或 HCV 感染（HR，0.51；95% CI，0.29-0.93）相关肝硬化患者中他汀类药物的使用降低了肝失代偿的风险。他汀类药物使用者中酒精相关肝硬化的肝失代偿风险降低具有显著意义（HR，0.69；95% CI，0.45-1.07）。
他汀类药物的使用降低了 HBV 和 HCV 相关肝硬化的肝失代偿率。酒精相关肝硬化的肝失代偿率降低具有显著意义。
