Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
College of Pharmacy, Pusan National University, Busan, South Korea.
Clin Res Hepatol Gastroenterol. 2021 Jul;45(4):101510. doi: 10.1016/j.clinre.2020.07.015. Epub 2020 Dec 4.
To date, there has been a renewed interest in renin-angiotensin system inhibitors (RASi) for HCC prevention because they may reduce potent angiogenic factors.
This study set out to investigate associations between RASi use and HCC development.
We conducted a nested case-control study. A case was defined as a patient who was newly diagnosed with HCC. We selected 567 cases and controls using 1:1 propensity score matching. RASi exposure was classified into ever-user and never-user, then categorized according to cumulative dose and prescription period. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for HCC incidence according to RASi use were analyzed.
Overall, no significant association was found between exposure to RASi and HCC incidence (ever-user vs. never-user: aOR, 0.77; 95% CI, 0.56-1.07). In subgroup analysis, women receiving RASi ≥30 cumulative defined daily doses (cDDDs) showed significantly lower aORs (0.49; 95% CI, 0.24-0.95. Angiotensin II receptor blockers only-use ≥30 cDDD was significantly associated with reduced risk of HCC (aOR, 0.65; 95% CI, 0.43-0.97). In cases where subjects did not have diabetes mellitus and where the cDDD of RASi was 1800 or more, the risk of HCC development was significantly reduced compared to that in subjects with no RASi exposure (aOR, 0.26; 95% CI, 0.08-0.72).
The present study did not verify a significant overall association between RASi use and HCC but indicated lower HCC incidence in some subgroups. The possibility of a beneficial effect at a higher cumulative RASi dose was also presented.
迄今为止，人们对肾素-血管紧张素系统抑制剂（RASi）在 HCC 预防中的应用重新产生了兴趣，因为它们可能降低强效血管生成因子。
本研究旨在探讨 RASi 使用与 HCC 发生发展之间的关联。
我们进行了一项巢式病例对照研究。病例定义为新诊断为 HCC 的患者。我们使用 1:1 倾向评分匹配选择了 567 例病例和对照。根据累积剂量和处方周期，将 RASi 暴露分为曾经使用者和从未使用者，然后再进行分类。分析 RASi 使用与 HCC 发生率之间的调整后比值比（aOR）和 95%置信区间（CI）。
总体而言，RASi 暴露与 HCC 发生率之间没有显著关联（曾经使用者与从未使用者：aOR，0.77；95%CI，0.56-1.07）。在亚组分析中，接受 RASi ≥30 累积定义日剂量（cDDD）的女性表现出显著较低的 aOR（0.49；95%CI，0.24-0.95）。仅使用血管紧张素 II 受体阻滞剂 ≥30 cDDD 与 HCC 风险降低显著相关（aOR，0.65；95%CI，0.43-0.97）。在没有糖尿病且 RASi 的 cDDD 为 1800 或更高的情况下，与没有 RASi 暴露的受试者相比，HCC 发展的风险显著降低（aOR，0.26；95%CI，0.08-0.72）。
本研究没有证实 RASi 使用与 HCC 之间存在显著的总体关联，但在一些亚组中显示 HCC 发生率较低。还提出了更高累积 RASi 剂量可能产生有益效果的可能性。
