Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA.
Hepatology. 2023 Dec 1;78(6):1896-1906. doi: 10.1097/HEP.0000000000000278. Epub 2023 Jan 3.
Statins, the most widely used lipid-lowering drugs, are increasingly recognized to have pleiotropic effects including anti-inflammatory and antiangiogenic properties as well as effects on fibrogenesis and liver endothelial function. Given these pathophysiological effects, there is a growing interest in clinical use of statins in persons with cirrhosis. In this review, we summarize available data regarding the safety, adverse effects, and pharmacokinetics of statins in cirrhosis. We review clinical evidence, derived primarily from retrospective cohort and population-based studies, on the association between statin use and reduction in risk for hepatic decompensation and mortality in persons with established cirrhosis. We also review evidence to date regarding the effects of statins on portal hypertension and in chemoprevention of HCC. Finally, we highlight ongoing prospective randomized controlled trials that we expect will expand our understanding of the safety, pharmacokinetics, and efficacy of statins in cirrhosis and guide clinical practice.
他汀类药物是最广泛使用的降脂药物，越来越多的研究表明其具有多种作用，包括抗炎、抗血管生成作用，以及对纤维生成和肝内皮功能的影响。鉴于这些病理生理作用，人们越来越关注他汀类药物在肝硬化患者中的临床应用。在这篇综述中，我们总结了关于他汀类药物在肝硬化中的安全性、不良反应和药代动力学的现有数据。我们回顾了主要来自回顾性队列和基于人群研究的临床证据，探讨了他汀类药物的使用与降低已确诊肝硬化患者肝失代偿和死亡风险之间的关联。我们还回顾了目前关于他汀类药物对门脉高压和 HCC 化学预防作用的证据。最后，我们强调了正在进行的前瞻性随机对照试验，我们希望这些试验将扩大我们对肝硬化患者中他汀类药物的安全性、药代动力学和疗效的理解，并指导临床实践。
