他汀类药物的使用与慢性肝病患者肝硬化及相关并发症风险的关系：系统评价和荟萃分析。
Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis.
机构信息
Division of Internal Medicine, Department of Medicine, University of California at San Diego, La Jolla, California.
Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, California.
出版信息
Clin Gastroenterol Hepatol. 2017 Oct;15(10):1521-1530.e8. doi: 10.1016/j.cgh.2017.04.039. Epub 2017 May 4.
BACKGROUND & AIMS: Statins have been variably shown to decrease risk and complications of chronic liver diseases (CLDs). We performed a systematic review and meta-analysis to evaluate the association between statins and risk of cirrhosis and related complications in patients with CLDs.
METHODS
Through a systematic literature search up to March 2017, we identified 13 studies (3 randomized trials, 10 cohort studies) in adults with CLDs, reporting the association between statin use and risk of development of cirrhosis, decompensated cirrhosis, improvements in portal hypertension, or mortality. Pooled relative risk (RR) estimates with 95% confidence interval (CIs) were calculated using random effects model. Grading of Recommendations Assessment, Development and Evaluation criteria were used to assess quality of evidence.
RESULTS
Among 121,058 patients with CLDs (84.5% with hepatitis C), 46% were exposed to statins. In patients with cirrhosis, statin use was associated with 46% lower risk of hepatic decompensation (4 studies; RR, 0.54; 95% CI, 0.46-0.62; I = 0%; moderate-quality evidence), and 46% lower mortality (5 studies; RR, 0.54; 95% CI, 0.47-0.61; I = 10%; moderate-quality evidence). In patients with CLD without cirrhosis, statin use was associated with a nonsignificant (58% lower) risk of development of cirrhosis or fibrosis progression (5 studies; RR, 0.42; 95% CI, 0.16-1.11; I = 99%; very-low-quality evidence). In 3 randomized controlled trials, statin use was associated with 27% lower risk of variceal bleeding or progression of portal hypertension (hazard ratio, 0.73; 95% CI, 0.59-0.91; I = 0%; moderate-quality evidence).
CONCLUSIONS
Based on a systematic review and meta-analysis, statin use is probably associated with lower risk of hepatic decompensation and mortality, and might reduce portal hypertension, in patients with CLDs. Prospective observational studies and randomized controlled trials are needed to confirm this observation.
背景与目的
他汀类药物已被证明可降低慢性肝病（CLD）的风险和并发症。我们进行了一项系统评价和荟萃分析，以评估他汀类药物与 CLD 患者肝硬化及其相关并发症风险之间的关系。
方法
通过系统的文献检索，我们确定了截至 2017 年 3 月的 13 项研究（3 项随机试验，10 项队列研究），这些研究报告了他汀类药物使用与肝硬化、失代偿性肝硬化、门静脉高压改善或死亡率发展之间的关系。使用随机效应模型计算合并相对风险（RR）估计值及其 95%置信区间（CI）。使用推荐评估、制定与评估（GRADE）标准来评估证据质量。
结果
在 121058 例 CLD 患者（84.5%为丙型肝炎）中，46%的患者接受了他汀类药物治疗。在肝硬化患者中，他汀类药物治疗与肝失代偿风险降低 46%相关（4 项研究；RR，0.54；95%CI，0.46-0.62；I ² = 0%；中等质量证据），死亡率降低 46%相关（5 项研究；RR，0.54；95%CI，0.47-0.61；I ² = 10%；中等质量证据）。在无肝硬化的 CLD 患者中，他汀类药物治疗与肝硬化或纤维化进展风险降低 58%相关（5 项研究；RR，0.42；95%CI，0.16-1.11；I ² = 99%；极低质量证据）。在 3 项随机对照试验中，他汀类药物治疗与静脉曲张出血或门静脉高压进展风险降低 27%相关（风险比，0.73；95%CI，0.59-0.91；I ² = 0%；中等质量证据）。
结论
基于系统评价和荟萃分析，他汀类药物治疗可能与 CLD 患者的肝失代偿和死亡率降低相关，并且可能降低门静脉高压。需要前瞻性观察性研究和随机对照试验来证实这一观察结果。
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