State Key Laboratory of Organ Failure Research (Chen, Zhou, Liu, Su, Y. Li, Zhang, Luo, Gao, Lin, Guo, Cao, Xu, Nie), National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Oncology, Nanfang Hospital (L. Li, Fang), Southern Medical University, Guangzhou, Guangdong, China.
State Key Laboratory of Organ Failure Research (Chen, Zhou, Liu, Su, Y. Li, Zhang, Luo, Gao, Lin, Guo, Cao, Xu, Nie), National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Oncology, Nanfang Hospital (L. Li, Fang), Southern Medical University, Guangzhou, Guangdong, China
CMAJ. 2024 Aug 11;196(27):E931-E939. doi: 10.1503/cmaj.240003.
Hepatitis B virus (HBV) infection is a common cause of liver-related morbidity and mortality. Evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) decrease liver fibrosis, an intermediate step between liver injury and hepatocellular carcinoma (HCC). Our aim was to investigate the association between the use of ACEIs and ARBs on incident HCC and liver-related mortality among patients with HBV infection.
We conducted a population-based study on a new-user cohort of patients seen at 24 hospitals across China. We included adult patients with HBV infection who started ACEIs or ARBs (ACEIs/ARBs), or calcium channel blockers or thiazide diuretics (CCBs/THZs) from January 2012 to December 2022. The primary outcome was incident HCC; secondary outcomes were liver-related mortality and new-onset cirrhosis. We used propensity score matching and Cox proportional hazards regression to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of study outcomes.
Among 32 692 eligible patients (median age 58 [interquartile range (IQR) 48-68] yr, and 18 804 male [57.5%]), we matched 9946 pairs of patients starting ACEIs/ARBs or CCBs/THZs. During a mean follow-up of 2.3 years, the incidence rate of HCC per 1000 person-years was 4.11 and 5.94 among patients who started ACEIs/ARBs and CCBs/THZs, respectively, in the matched cohort. Use of ACEIs/ARBs was associated with lower risks of incident HCC (HR 0.66, 95% CI 0.50-0.86), liver-related mortality (HR 0.77, 95% CI 0.64-0.93), and new-onset cirrhosis (HR 0.81, 95% CI 0.70-0.94).
In this cohort of patients with HBV infection, new users of ACEIs/ARBs had a lower risk of incident HCC, liver-related mortality, and new-onset cirrhosis than new users of CCBs/THZs.
乙型肝炎病毒 (HBV) 感染是导致肝脏相关发病率和死亡率的常见原因。有证据表明，血管紧张素转换酶抑制剂 (ACEI) 和血管紧张素 II 受体阻滞剂 (ARB) 可减少肝纤维化，肝纤维化是肝损伤与肝细胞癌 (HCC) 之间的中间步骤。我们的目的是研究 HBV 感染患者中使用 ACEI 和 ARB 与 HCC 发病和肝脏相关死亡率之间的关系。
我们在中国 24 家医院的新使用者队列中进行了一项基于人群的研究。我们纳入了 2012 年 1 月至 2022 年 12 月开始使用 ACEI 或 ARB（ACEI/ARB）或钙通道阻滞剂或噻嗪类利尿剂（CCB/THZ）的 HBV 感染成年患者。主要结局是 HCC 发病；次要结局是肝脏相关死亡率和新发生的肝硬化。我们使用倾向评分匹配和 Cox 比例风险回归来估计研究结局的风险比 (HR) 和 95%置信区间 (CI)。
在 32692 名符合条件的患者中（中位年龄 58 岁[四分位距 (IQR) 48-68]岁，18804 名男性[57.5%]），我们匹配了 9946 对开始使用 ACEI/ARB 或 CCB/THZ 的患者。在平均 2.3 年的随访期间，匹配队列中开始使用 ACEI/ARB 和 CCB/THZ 的患者的 HCC 发病率分别为每 1000 人年 4.11 和 5.94。使用 ACEI/ARB 与 HCC 发病风险降低相关（HR 0.66，95%CI 0.50-0.86）、肝脏相关死亡率（HR 0.77，95%CI 0.64-0.93）和新发肝硬化（HR 0.81，95%CI 0.70-0.94）。
在本项 HBV 感染患者队列研究中，与新使用 CCB/THZ 的患者相比，新使用 ACEI/ARB 的患者 HCC 发病、肝脏相关死亡率和新发肝硬化的风险较低。
