Department of Medicine, Visby Hospital, Visby, Sweden; Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2019 Aug;17(9):1860-1866.e1. doi: 10.1016/j.cgh.2018.11.002. Epub 2018 Nov 15.
BACKGROUND & AIMS: There is increasing evidence that statins can benefit patients with chronic liver diseases, but their effects have not been studied in patients with primary sclerosing cholangitis (PSC). We performed a nationwide study in Sweden to determine the effects of exposure to drugs, including statins, in patients with PSC.
We studied a population-based cohort of patients in Sweden with PSC and concomitant ulcerative colitis or Crohn's disease from 2005 through 2014 (n = 2914), followed through 2016. We collected analyzed data from the patient register, the prescribed drug register, the death certificate register and the cancer register. We calculated risk or death, liver transplantation, bleeding of esophageal varices, and cancer in relation to drug exposure.
The mean age of patients at the time of diagnosis with PSC was 41.4 years (inter-quartile range [IQR], 25.6-56.1 years). The total follow-up time was 11769 person-years, during which 3.4% of patients received liver transplants and 19.9% died. Proportions of patients exposed to drugs were: ursodeoxycholic acid, 60.2%; 5-aminosalicylic acid, 74.4%; azathioprine or mercaptopurins, 33.7%; and statins, 13.9%. Statin use was associated with a reduced risk of all-cause mortality (hazard ratio [HR], 0.68; 95% CI, 0.54-0.88) and death or liver transplantation (HR, 0.50; 95% CI, 0.28-0.66). Use of azathioprine was also associated with reduced mortality (HR, 0.66; 95% CI, 0.52-0.84) and risk of death or liver transplantation (HR, 0.65; 95% CI, 0.50-0.83). Exposure to ursodeoxycholic acid did not affect mortality (HR, 1.04; 95% CI, 0.87-1.25).
In a population-based cohort of patients in Sweden with PSC, we associated use of statins and azathioprine with decreased risks of death and death or liver transplantation. Exposure to ursodeoxycholic acid was not associated with reduced mortality.
越来越多的证据表明他汀类药物可使慢性肝病患者获益，但尚未研究其在原发性硬化性胆管炎（PSC）患者中的作用。我们在瑞典进行了一项全国性研究，以确定在 PSC 患者中暴露于药物（包括他汀类药物）的效果。
我们研究了 2005 年至 2014 年期间（n = 2914）瑞典患有 PSC 并伴有溃疡性结肠炎或克罗恩病的基于人群的队列中的患者，并随访至 2016 年。我们从患者登记处、处方药物登记处、死亡证明登记处和癌症登记处收集并分析了数据。我们计算了与药物暴露相关的风险或死亡、肝移植、食管静脉曲张出血和癌症。
PSC 患者诊断时的平均年龄为 41.4 岁（四分位距 [IQR]，25.6-56.1 岁）。总随访时间为 11769 人年，在此期间 3.4%的患者接受了肝移植，19.9%的患者死亡。暴露于药物的患者比例分别为：熊去氧胆酸 60.2%；5-氨基水杨酸 74.4%；硫唑嘌呤或巯嘌呤 33.7%；和他汀类药物 13.9%。他汀类药物的使用与全因死亡率降低相关（风险比 [HR]，0.68；95%CI，0.54-0.88）和死亡或肝移植（HR，0.50；95%CI，0.28-0.66）。使用硫唑嘌呤也与死亡率降低相关（HR，0.66；95%CI，0.52-0.84）和死亡或肝移植风险（HR，0.65；95%CI，0.50-0.83）。熊去氧胆酸的暴露与死亡率降低无关（HR，1.04；95%CI，0.87-1.25）。
在瑞典的 PSC 患者基于人群的队列中，我们发现使用他汀类药物和硫唑嘌呤与死亡和死亡或肝移植风险降低相关。熊去氧胆酸的暴露与死亡率降低无关。
