Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Drug Alcohol Depend. 2021 Feb 1;219:108495. doi: 10.1016/j.drugalcdep.2020.108495. Epub 2020 Dec 31.
Research has proposed that selective serotonin reuptake inhibitors (SSRIs) were associated with a reduction of the risk of hepatocellular carcinoma (HCC). The objective of this study is to investigate whether SSRIs use is associated with decreased risk of HCC in patients with alcohol use disorder (AUD).
We conducted a retrospective population-based cohort study using Taiwan's National Health Insurance Research Database (NHIRD) from 1997 to 2013 and enrolled patients with newly diagnosed AUD. After propensity scores matching at a ratio 1:4, total of 4945 SSRI users and 19,785 non-SSRI users were included in the matched cohort. Patients were followed up from the 365th day after the date of first exposure to SSRIs to occurrence of HCC, the date of death, or the end of 2013. Cox proportional hazard regressions were performed to evaluate hazard ratio (HRs) for HCC in SSRI-exposed patients compared with unexposed patients.
In the main study cohort, SSRI use was associated with significant lower risk of HCC compared to the non-SSRI users after adjusting for age, sex, income, urbanization, alcoholic fatty liver, alcoholic hepatitis and diabetes (adjusted hazard ratio [aHR] = 0.31, 95 % CI = 0.24-0.39). The negative association of SSRI use and HCC was replicated in the matched cohort (aHR = 0.58, 95 % CI = 0.44-0.77). The effect of SSRI use on HCC was dose-related in both cohorts (p for trend < 0.0001).
This study showed that SSRIs use was associated with a reduction risk of HCC among AUD patients in a cumulative dose effect manner.
研究表明，选择性 5-羟色胺再摄取抑制剂（SSRIs）与降低肝细胞癌（HCC）的风险有关。本研究旨在探讨 SSRIs 的使用是否与酒精使用障碍（AUD）患者 HCC 风险降低相关。
我们使用台湾国家健康保险研究数据库（NHIRD）进行了一项回顾性基于人群的队列研究，研究时间为 1997 年至 2013 年，纳入了新诊断为 AUD 的患者。在以 1:4 的比例进行倾向评分匹配后，共有 4945 名 SSRIs 使用者和 19785 名非 SSRIs 使用者纳入匹配队列。患者从首次暴露于 SSRIs 后的第 365 天开始随访，直至发生 HCC、死亡或 2013 年底。使用 Cox 比例风险回归评估与未暴露患者相比，SSRIs 暴露患者 HCC 的风险比（HR）。
在主要研究队列中，调整年龄、性别、收入、城市化程度、酒精性脂肪肝、酒精性肝炎和糖尿病后，SSRIs 使用者与 HCC 风险显著降低相关（调整后的 HR [aHR] = 0.31，95%CI = 0.24-0.39）。SSRIs 使用者与 HCC 之间的负相关关系在匹配队列中得到了复制（aHR = 0.58，95%CI = 0.44-0.77）。在两个队列中，SSRIs 使用对 HCC 的影响均呈剂量依赖性（趋势检验的 P 值均<0.0001）。
本研究表明，SSRIs 的使用与 AUD 患者 HCC 风险降低相关，呈累积剂量效应。
