Department of Medicine, North Shore Medical Center, Salem, MA, USA.
Department of Medicine, University of Massachusetts Medical School, Worcester MA, USA.
Can J Gastroenterol Hepatol. 2018 Sep 23;2018:9430953. doi: 10.1155/2018/9430953. eCollection 2018.
The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals.
We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4].
Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]).
Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.
大麻使用对慢性肝病（CLD）的影响一直存在争议，慢性肝病是丙型肝炎病毒（HCV）感染的最常见原因。在这里，我们研究了大麻使用对 HCV 感染个体中 CLD 患病率的影响。
我们分析了 2007 年至 2014 年全国住院患者样本（NIS）中年龄≥18 岁的 HCV 阳性成人患者的住院记录。我们排除了其他慢性肝病（酒精、血色病、非酒精性脂肪性肝病、原发性胆汁性胆管炎、HBV 等）的记录。在 188333 条记录中，我们使用基于倾向的匹配系统，使用严格的算法，将大麻使用者与非使用者以 1:1 的比例（4728：4728）进行匹配。然后，我们使用具有广义估计方程的条件回归模型来测量肝硬化（及其并发症）、癌、死亡率、出院处置以及总住院费用和住院时间（LOS）的调整平均值比（aMR）[SAS 9.4]。
我们的研究表明，大麻使用者（CU）的肝硬化患病率降低（调整后的患病率比[aPRR]：0.81[0.72-0.91]），出院处置情况较差（0.87[0.78-0.96]），总医疗费用较低（39642 美元[36220 美元-43387 美元]，而 45566 美元[42244 美元-49150 美元]），而非大麻使用者（NCU）。然而，CU 和 NCU 之间肝癌的发生率（0.79[0.55-1.13]）、院内死亡率（0.84[0.60-1.17]）和 LOS（5.58[5.10-6.09]与 5.66[5.25-6.01]）没有差异。在 CU 中，与非依赖使用相比，依赖使用大麻与肝硬化的低患病率相关（0.62[0.41-0.93]）。
我们的研究结果表明，大麻使用与 HCV 患者肝硬化的发生率降低有关，但与死亡率或 LOS 无关。这些新的观察结果需要进一步的分子机制研究。
