Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yongin, Gyeonggi-do, South Korea.
Sci Rep. 2022 Jun 25;12(1):10807. doi: 10.1038/s41598-022-14713-w.
Statin use in end-stage kidney disease (ESKD) patients are not encouraged due to low cardioprotective effects. Although the risk of hepatocellular carcinoma (HCC), a frequently occurring cancer in East Asia, is elevated in ESKD patients, the relationship between statins and HCC is not known despite its possible chemopreventive effect. The relationship between statin use and HCC development in ESKD patients with chronic hepatitis was evaluated. In total, 6165 dialysis patients with chronic hepatitis B or C were selected from a national health insurance database. Patients prescribed with ≥ 28 cumulative defined daily doses of statins during the first 3 months after dialysis commencement were defined as statin users, while those not prescribed with statins were considered as non-users. Primary outcome was the first diagnosis of HCC. Sub-distribution hazard model with inverse probability of treatment weighting was used to estimate HCC risk considering death as competing risk. During a median follow-up of 2.8 years, HCC occurred in 114 (3.2%) statin non-users and 33 (1.2%) statin users. The HCC risk was 41% lower in statin users than in non-users (sub-distribution hazard ratio, 0.59; 95% confidence interval [CI], 0.42-0.81). The weighted incidence rate of HCC was lower in statin users than in statin non-users (incidence rate difference, - 3.7; 95% CI - 5.7 to - 1.7; P < 0.001). Incidence rate ratio (IRR) was also consistent with other analyses (IRR, 0.56; 95% CI, 0.41 to 0.78; P < 0.001). Statin use was associated with a lower risk of incident HCC in dialysis patients with chronic hepatitis B or C infection.
在终末期肾病（ESKD）患者中不鼓励使用他汀类药物，因为其心脏保护作用较低。尽管东亚地区高发的肝细胞癌（HCC）在 ESKD 患者中的风险升高，但他汀类药物与 HCC 之间的关系尚不清楚，尽管其可能具有化学预防作用。本研究评估了他汀类药物在接受透析治疗的慢性乙型或丙型肝炎患者中的使用与 HCC 发展之间的关系。从国家健康保险数据库中选择了 6165 名接受透析治疗的慢性乙型或丙型肝炎患者。在透析开始后的前 3 个月内，接受≥28 个累积规定日剂量他汀类药物治疗的患者定义为他汀类药物使用者，而未接受他汀类药物治疗的患者则定义为非使用者。主要结局是 HCC 的首次诊断。使用逆概率治疗加权的亚分布风险模型来估计 HCC 风险，将死亡视为竞争风险。在中位随访 2.8 年期间，114 名（3.2%）非他汀类药物使用者和 33 名（1.2%）他汀类药物使用者发生 HCC。他汀类药物使用者的 HCC 风险比非使用者低 41%（亚分布风险比，0.59；95%置信区间 [CI]，0.42-0.81）。他汀类药物使用者的 HCC 发生率低于非他汀类药物使用者（发生率差异，-3.7；95%CI，-5.7 至-1.7；P<0.001）。发生率比（IRR）也与其他分析结果一致（IRR，0.56；95%CI，0.41 至 0.78；P<0.001）。在接受透析治疗的慢性乙型或丙型肝炎感染患者中，他汀类药物的使用与 HCC 发病风险降低相关。
