Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea.
Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-Gu, Seoul, South Korea.
Am J Gastroenterol. 2021 Jan 1;116(1):116-124. doi: 10.14309/ajg.0000000000000845.
The use of statins in nonalcoholic fatty liver disease (NAFLD) may reduce cardiovascular morbidity, although their effect on NAFLD itself is not well known. We aimed to investigate the role of statins on the development of de novo NAFLD and progression of significant liver fibrosis.
This study included 11,593,409 subjects from the National Health Information Database of the Republic of Korea entered in 2010 and followed up until 2016. NAFLD was diagnosed by calculating fatty liver index (FLI), and significant liver fibrosis was evaluated using the BARD score. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection.
Among 5,339,901 subjects that had a FLI < 30 and included in the non-NAFLD cohort, 164,856 subjects eventually had NAFLD developed. The use of statin was associated with a reduced risk of NAFLD development (adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.65-0.67) and was independent of associated diabetes mellitus (DM) (with DM: AOR 0.44; 95% CI 0.41-0.46, without DM: AOR 0.71; 95% CI 0.69-0.72). From 712,262 subjects with a FLI > 60 and selected in the NAFLD cohort, 111,257 subjects showed a BARD score ≥ 2 and were defined as liver fibrosis cases. The use of statins reduced the risk of significant liver fibrosis (AOR 0.43; 95% CI 0.42-0.44), independent of DM (with DM: AOR 0.31; 95% CI 0.31-0.32, without DM: AOR 0.52; 95% CI 0.51-0.52).
In this large population-based study, statin use decreased the risk of NAFLD occurrence and the risk of liver fibrosis once NAFLD developed.
在非酒精性脂肪性肝病（NAFLD）中使用他汀类药物可能会降低心血管发病率，尽管其对 NAFLD 本身的影响尚不清楚。我们旨在研究他汀类药物在新发 NAFLD 发展和显著肝纤维化进展中的作用。
本研究纳入了 2010 年至 2016 年期间韩国国家健康信息数据库中的 11593409 名受试者。NAFLD 通过计算脂肪肝指数（FLI）进行诊断，显著肝纤维化使用 BARD 评分进行评估。对照者是在选择时处于成为病例组风险的个体中以 1:5 的比例随机选择的。
在 5339901 名 FLI<30 且纳入非 NAFLD 队列的受试者中，有 164856 名受试者最终发生了 NAFLD。他汀类药物的使用与 NAFLD 发病风险降低相关（调整后的优势比[OR]0.66；95%置信区间[CI]0.65-0.67），且与相关的糖尿病（DM）无关（DM 时：OR 0.44；95%CI 0.41-0.46，无 DM 时：OR 0.71；95%CI 0.69-0.72）。在从 FLI>60 并纳入 NAFLD 队列的 712262 名受试者中，有 111257 名受试者 BARD 评分≥2，被定义为肝纤维化病例。他汀类药物的使用降低了显著肝纤维化的风险（OR 0.43；95%CI 0.42-0.44），与 DM 无关（DM 时：OR 0.31；95%CI 0.31-0.32，无 DM 时：OR 0.52；95%CI 0.51-0.52）。
在这项大型基于人群的研究中，他汀类药物的使用降低了 NAFLD 发生的风险，以及一旦发生 NAFLD 发展为肝纤维化的风险。
