Wong J C-T, Chan H L-Y, Tse Y-K, Yip T C-F, Wong V W-S, Wong G L-H
Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Aliment Pharmacol Ther. 2017 Nov;46(10):1001-1010. doi: 10.1111/apt.14341. Epub 2017 Sep 21.
Decompensated liver disease due to portal hypertension leads to significant morbidity and mortality. Statins can modulate intrahepatic vascular tone, but the clinical significance remains uncertain.
To determine the effects of statin use on the risk of liver decompensation and death among patients with chronic viral hepatitis.
We conducted a population wide cohort study using a hospital based database from the Hong Kong Hospital Authority. Adults with chronic viral hepatitis without prior liver decompensation were identified from 2000 to 2012 by International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic codes. Statin use was defined as a cumulative defined daily dose of >28. Landmark analysis was used to overcome immortal time bias. Propensity score weighting was further performed to minimise baseline confounders. Primary outcome was a composite of portal hypertension related liver decompensation events, with adjustment for death as a competing risk.
A total of 69 184 patients with chronic viral hepatitis (2053 statin users and 67 131 statin non-users) were identified for the 2-year landmark analysis. After propensity score weighting of 23 baseline covariates, statin use was associated with a significant reduction in composite liver decompensation events (HR: 0.55; 95% CI: 0.36-0.83; P = .005), ascites (HR: 0.57; 95% CI: 0.36-0.92; P = .02), and a dose-dependent decrease in death (HR: 0.87; 95% CI: 0.76-0.99; P = .035) relative to no statin use.
Patients with chronic viral hepatitis who used statins have a reduced risk of liver decompensation and death compared to non-users in this propensity score weighted landmark analysis.
门静脉高压所致失代偿性肝病会导致严重的发病率和死亡率。他汀类药物可调节肝内血管张力，但其临床意义仍不确定。
确定使用他汀类药物对慢性病毒性肝炎患者肝失代偿风险和死亡风险的影响。
我们利用香港医院管理局的医院数据库进行了一项全人群队列研究。通过国际疾病分类第九版临床修订本诊断编码，从2000年至2012年识别出无既往肝失代偿的慢性病毒性肝炎成人患者。他汀类药物的使用定义为累积限定日剂量>28。采用地标性分析来克服不朽时间偏倚。进一步进行倾向评分加权以最小化基线混杂因素。主要结局是门静脉高压相关肝失代偿事件的复合结局，并将死亡作为竞争风险进行校正。
共纳入69184例慢性病毒性肝炎患者（2053例他汀类药物使用者和67131例非使用者）进行2年地标性分析。在对23个基线协变量进行倾向评分加权后，与未使用他汀类药物相比，使用他汀类药物与复合肝失代偿事件显著减少相关（风险比：0.55；95%置信区间：0.36 - 0.83；P = 0.005），腹水（风险比：0.57；95%置信区间：0.36 - 0.92；P = 0.02），且死亡呈剂量依赖性降低（风险比：0.87；95%置信区间：0.76 - 0.99；P = 0.035）。
在这项倾向评分加权地标性分析中，与未使用者相比，使用他汀类药物的慢性病毒性肝炎患者肝失代偿和死亡风险降低。
