Bang Ulrich C, Watanabe Tomohiro, Bendtsen Flemming
Gastrounit, Medical Section, University Hospital of Hvidovre, Hvidovre.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur J Gastroenterol Hepatol. 2018 Mar;30(3):346-351. doi: 10.1097/MEG.0000000000001060.
Chronic pancreatitis (CP) is associated with a shortened life expectancy. Statins have anti-inflammatory properties and we aimed to evaluate the association between the use of statins and the risk of death, progression of CP, and pancreatic cancer in patients with CP.
We carried out a nested case-cohort study and included patients with CP. We used claims of proton pump inhibitors as an active comparator. Patients with cirrhosis or cancer were excluded. We evaluated the exposure on the basis of pharmacy claims of statins. We used propensity score matching with a statins : nonstatins ratio of 1 : 1.
A total of 4807 patients were eligible for propensity score matching; 33% were women and the mean (SD) age at cohort entry was 56 (10) years. During follow-up, a total of 2073 (43%) patients had died and the risk of death was significantly lower among patients using statins versus no statins among 678 matched patients [hazard ratio (HR) 0.64; 95% confidence interval (CI): 0.49-0.83]. Use of statins versus no statins was associated with decreased progression of CP, with an HR of 0.21 (95% CI: 0.17-0.26). Pancreatic cancer occurred in 117 (2.4%) patients and we found a lower risk of pancreatic cancer in statin-treated patients compared with no statins, with a HR of 0.21 (95% CI: 0.06-0.70).
In this nationwide study, we found lower risks of mortality, disease progression, and pancreatic cancer in patients with CP using statins. The study is limited by its retrospective design, but supports the hypothesis that statins may affect the course of CP.
慢性胰腺炎（CP）与预期寿命缩短有关。他汀类药物具有抗炎特性，我们旨在评估CP患者使用他汀类药物与死亡风险、CP进展及胰腺癌之间的关联。
我们开展了一项巢式病例对照研究，纳入CP患者。我们将质子泵抑制剂的使用情况作为活性对照。排除肝硬化或癌症患者。我们根据他汀类药物的药房报销记录评估暴露情况。我们采用倾向评分匹配法，使他汀类药物使用者与非使用者的比例为1∶1。
共有4807例患者符合倾向评分匹配条件；其中33%为女性，队列入组时的平均（标准差）年龄为56（10）岁。随访期间，共有2073例（43%）患者死亡，在678例匹配患者中，使用他汀类药物的患者死亡风险显著低于未使用他汀类药物的患者[风险比（HR）0.64；95%置信区间（CI）：0.49 - 0.83]。使用他汀类药物与未使用相比，CP进展有所减缓，HR为0.21（95% CI：0.17 - 0.26）。117例（2.4%）患者发生胰腺癌，我们发现他汀类药物治疗的患者患胰腺癌的风险低于未使用他汀类药物的患者，HR为0.21（95% CI：0.06 - 0.70）。
在这项全国性研究中，我们发现CP患者使用他汀类药物可降低死亡、疾病进展及患胰腺癌的风险。本研究受其回顾性设计的限制，但支持他汀类药物可能影响CP病程这一假说。
