Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Curr Opin Gastroenterol. 2021 May 1;37(3):200-207. doi: 10.1097/MOG.0000000000000716.
Statins are a class of lipid lower medications used primarily in patients with high-risk cardiovascular disease. Since their development, statins have been considered to be harmful in patients with liver disease, and many of the prescribing information labels consider them to be contraindicated in patients with active liver disease. However, recent studies have shown the contrary, warranting further investigation and discussion. This review aims to describe the latest literature on the mechanism, safety profile and potential benefits of statins use on the natural history of chronic liver disease (CLD) progression and its complications.
A number of recently published studies have added to the existing body of literature supporting the concept that statins are safe and likely to be beneficial for treating patients with CLD. Patients with CLD including hepatitis B virus infection, hepatitis C virus infection, nonalcoholic fatty liver disease and alcohol on statins have been shown to have a lower rate of decompensating events, lower incidence of hepatocellular cancer, a lower rate of infections, and increased survival. However, the majority of the available literature supporting statin use in patients with liver disease comes from retrospective observational studies with high potential for bias.
Statins appear to be safe in patients with compensated cirrhosis, and evidence suggests that they may reduce fibrosis, even in patients with advanced fibrosis and cirrhosis. Further high-quality research on this topic is needed to fully delineate the effect of statins in patients with liver disease.
他汀类药物是一类主要用于心血管疾病高危患者的降脂药物。自问世以来，他汀类药物一直被认为对肝病患者有害，许多处方信息标签将其视为活动性肝病患者的禁忌。然而，最近的研究结果却恰恰相反，这需要进一步的研究和讨论。本综述旨在描述他汀类药物在慢性肝病（CLD）进展及其并发症的自然史中的作用、安全性概况和潜在获益的最新文献。
许多最近发表的研究增加了现有的文献，支持他汀类药物治疗 CLD 患者安全且可能有益的概念。接受他汀类药物治疗的 CLD 患者，包括乙型肝炎病毒感染、丙型肝炎病毒感染、非酒精性脂肪性肝病和酒精性肝病，其失代偿事件发生率较低、肝细胞癌发生率较低、感染率较低、生存率提高。然而，支持肝病患者使用他汀类药物的大多数现有文献来自于具有高度偏倚风险的回顾性观察性研究。
他汀类药物在代偿性肝硬化患者中似乎是安全的，有证据表明它们可能减少纤维化，甚至在纤维化和肝硬化患者中也是如此。需要进一步开展高质量的研究，以充分阐明他汀类药物在肝病患者中的作用。
