Bang U C, Benfield T, Bendtsen F
Gastrounit, Medical Section, University Hospital of Hvidovre, Hvidovre, Denmark.
Department of Infectious Diseases, University Hospital of Hvidovre, Hvidovre, Denmark.
Aliment Pharmacol Ther. 2017 Oct;46(7):673-680. doi: 10.1111/apt.14243.
Reports have indicated that the use of statins may ameliorate the course of cirrhosis.
To determine the relationship between use of statins and mortality rate in patients with cirrhosis.
We did a retrospective case-cohort analysis based on data from the Danish registers from the period 1995 through 2014. Index date was time of diagnosis of cirrhosis (ICD-10: K703) and cohort entry depended on whether the patient was statin user or not. We used propensity score matching with a statin:non-statin ratio of 1:2. We included the exposure to statins (ATC classification C10AA) from the index date until death or end of follow-up based on prescription claims. Use of statins based on at least two statin claims as well as the longitudinal pattern over time of statin claims was tested against mortality. The main outcome was mortality rate.
A total of 24 748 patients with alcoholic cirrhosis were identified and 5417 were eligible for matching. The mean age was 56 (SD 10) years and 36% were females. The prevalence of use of statins was 15%. We included 744 in the matched cohort. Mortality rates were 88 (95% CI 73-105) per 1000 years for patients using statin and 127 (95% CI 114-141) for non-statin patients with a HR of 0.57 (95% CI 0.45-0.71). A more regular pattern of statin claims was related to a lower risk of death.
Our results showed an association between regular use of statins and reduced mortality in patients with alcoholic cirrhosis.
有报告表明，使用他汀类药物可能改善肝硬化病程。
确定他汀类药物的使用与肝硬化患者死亡率之间的关系。
我们基于1995年至2014年丹麦登记处的数据进行了一项回顾性病例队列分析。索引日期为肝硬化诊断时间（国际疾病分类第十版：K703），队列进入取决于患者是否为他汀类药物使用者。我们采用倾向评分匹配，他汀类药物与非他汀类药物的比例为1:2。根据处方声明，我们纳入了从索引日期到死亡或随访结束期间的他汀类药物暴露情况（解剖治疗化学分类C10AA）。针对死亡率，测试了基于至少两项他汀类药物声明的他汀类药物使用情况以及他汀类药物声明随时间的纵向模式。主要结局是死亡率。
共识别出24748例酒精性肝硬化患者，其中5417例符合匹配条件。平均年龄为56（标准差10）岁，女性占36%。他汀类药物的使用率为15%。我们在匹配队列中纳入了744例患者。使用他汀类药物的患者每1000人年的死亡率为88（95%置信区间73 - 105），非他汀类药物患者为127（95%置信区间114 - 141），风险比为0.57（95%置信区间0.45 - 0.71）。更规律的他汀类药物声明模式与较低的死亡风险相关。
我们的结果表明，酒精性肝硬化患者经常使用他汀类药物与死亡率降低之间存在关联。
