他汀类药物与非肝硬化慢性肝病患者严重肝病风险降低相关。
Statins Are Associated With a Decreased Risk of Severe Liver Disease in Individuals With Noncirrhotic Chronic Liver Disease.
机构信息
Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
出版信息
Clin Gastroenterol Hepatol. 2024 Apr;22(4):749-759.e19. doi: 10.1016/j.cgh.2023.04.017. Epub 2023 Apr 28.
BACKGROUND & AIMS: Little is known about the potential impact of statins on the progression of noncirrhotic chronic liver diseases (CLDs) to severe liver disease.
METHODS
Using liver histopathology data in a nationwide Swedish cohort, we identified 3862 noncirrhotic individuals with CLD and statin exposure, defined as a statin prescription filled for 30 or more cumulative defined daily doses. Statin users were matched to 3862 (statin) nonusers with CLD through direct 1:1 matching followed by propensity score matching. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome of incident severe liver disease (a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation/liver-related mortality).
RESULTS
A total of 45.3% of CLD patients had nonalcoholic fatty liver disease, 21.9% had alcohol-related liver disease, 17.7% had viral hepatitis, and 15.1% had autoimmune hepatitis. During follow-up evaluation, 234 (6.1%) statin users vs 276 (7.1%) nonusers developed severe liver disease. Statin use was associated with a decreased risk of developing severe liver disease (HR, 0.60; 95% CI, 0.48-0.74). Statistically significantly lower rates of severe liver disease were seen in alcohol-related liver disease (HR, 0.30; 95% CI, 0.19-0.49) and in nonalcoholic fatty liver disease (HR, 0.68; 95% CI, 0.45-1.00), but not in viral hepatitis (HR, 0.76; 95% CI, 0.51-1.14) or autoimmune hepatitis (HR, 0.88; 95% CI, 0.48-1.58). Statin use had a protective association in both prefibrosis and fibrosis stages at diagnosis. Statin use was associated with lower rates of progression to cirrhosis (HR, 0.62; 95% CI, 0.49-0.78), hepatocellular carcinoma (HR, 0.44; 95% CI, 0.27-0.71), and liver-related mortality (HR, 0.55; 95% CI, 0.36-0.82).
CONCLUSIONS
Among individuals with noncirrhotic CLD, incident statin use was linked to lower rates of severe liver disease, suggesting a potential disease-modifying role.
背景与目的
他汀类药物对非肝硬化慢性肝病（CLD）进展为严重肝病的潜在影响知之甚少。
方法
我们利用全国性瑞典队列的肝组织病理学数据，确定了 3862 名非肝硬化合并 CLD 的他汀类药物暴露患者，定义为接受 30 剂或更多累积特定日剂量的他汀类药物处方。通过直接 1:1 匹配后再进行倾向评分匹配，为 3862 名（他汀类药物）非使用者匹配了他汀类药物使用者。使用 Cox 回归估计主要结局（肝硬化、肝细胞癌和肝移植/与肝脏相关的死亡率的复合事件）的发生率严重肝病的风险比（HR）。
结果
CLD 患者中，非酒精性脂肪性肝病占 45.3%，酒精相关性肝病占 21.9%，病毒性肝炎占 17.7%，自身免疫性肝炎占 15.1%。在随访评估期间，234 名（6.1%）他汀类药物使用者与 276 名（7.1%）非使用者发生严重肝病。他汀类药物的使用与发生严重肝病的风险降低相关（HR，0.60；95%CI，0.48-0.74）。在酒精相关性肝病（HR，0.30；95%CI，0.19-0.49）和非酒精性脂肪性肝病（HR，0.68；95%CI，0.45-1.00）中观察到严重肝病的发生率明显较低，但在病毒性肝炎（HR，0.76；95%CI，0.51-1.14）或自身免疫性肝炎（HR，0.88；95%CI，0.48-1.58）中未见差异。他汀类药物的使用在诊断时的纤维化前和纤维化阶段均具有保护作用。他汀类药物的使用与肝硬化（HR，0.62；95%CI，0.49-0.78）、肝细胞癌（HR，0.44；95%CI，0.27-0.71）和与肝脏相关的死亡率（HR，0.55；95%CI，0.36-0.82）的进展率降低相关。
结论
在非肝硬化 CLD 患者中，他汀类药物的使用与严重肝病的发生率较低相关，提示他汀类药物可能具有疾病修饰作用。
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