Statin use in cirrhosis and its association with incidence of portal vein thrombosis.
Statin use in cirrhosis and its association with incidence of portal vein thrombosis.
复制标题
他汀类药物在肝硬化中的使用及其与门静脉血栓形成发生率的关系。
DOI：
10.1111/jgh.16495
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发表时间：
2024
影响因子：
4.1
通讯作者：
Lai,Michelle
中科院分区：
文献类型：
--
作者：
Amjad,Waseem;Jiang,Zhenghui;Lai,Michelle
背景和目的他汀类药物的应用已显示出减少肝失代偿和门静脉高压症。其与门静脉血栓形成（PVT）发生率的关系尚不清楚。我们的目的是比较有和没有他汀类药物使用的患者的PVT发病率。MethodsWe排除了有肝细胞癌、肝移植、Budd-Chiari综合征和腹腔内恶性肿瘤病史的患者。对肝硬化患者进行了180天的随访，从他们的第一次肝病专家临床就诊（2016年1月1日至2021年1月31日）开始，以确定PVT的发生率。我们使用1：1的倾向评分（PS）匹配和考克斯比例风险回归分析了他汀类药物使用与PVT的相关性。ResultsWe分析了2785例肝硬化患者（平均年龄：61.0 ± 12.3岁，44.3%为女性，63.8%为白色，平均MELD-Na评分：11.7 ± 6.1，他汀类药物用途：23.1%）。随访期间共有89例患者发生PVT，使用他汀类药物的患者发生率低于未使用他汀类药物的患者（1.3%vs3.8%，P = 0.001，未校正HR：0.28，95%CI：0.13- 0.62，P = 0.001）。在匹配人口统计学、合并症和肝功能失代偿事件后，与未使用他汀类药物的患者相比，使用他汀类药物的患者在180天随访中发生PVT的风险较低（HR：0. 24，95% CI：0. 10 - 0. 55，P = 0. 001）。亚组分析显示，与未使用他汀类药物的患者相比，使用他汀类药物的非NASH患者（HR：0.20，95%CI：0.07- 0.54，P = 0.002）和失代偿期肝硬化患者（HR：0.12，95%CI：0.03- 0.53，P = 0.005）的PVT发生率较低。然而，这一发现需要在随机对照试验中进一步验证。
Background and AimStatin use has shown a reduction in hepatic decompensation and portal hypertension. Its association with portal vein thrombosis (PVT) incidence is unknown. We aim to compare the incidence of PVT in patients with and without statin use.MethodsWe excluded patients with a history of hepatocellular cancer, liver transplants, Budd–Chiari syndrome, and intra‐abdominal malignancies. Patients with cirrhosis were followed from their first hepatologist clinical encounter (January 1, 2016, to January 31, 2021) for 180 days to determine PVT incidence. We tested the association of statin use with PVT using 1:1 propensity score (PS) matching and Cox proportional hazard regression.ResultsWe analyzed 2785 patients with cirrhosis (mean age:61.0 ± 12.3 years, 44.3% female, 63.8% White, mean MELD‐Na score:11.7 ± 6.1, and statin use:23.1%). A total of 89 patients developed PVT during the follow‐up, which was lower in patients with statin use as compared to no statin use (1.3%vs3.8%,P= 0.001, unadjusted HR:0.28, 95% CI: 0.13–0.62,P= 0.001). After matching for demographics, comorbidities, and hepatic decompensation events, patients with statin use had a lower risk of developing PVT in 180‐day follow‐up as compared to those without statin use (HR:0.24, 95% CI: 0.10–0.55,P= 0.001). Subgroup analysis showed that statin use was associated with lower PVT incidence in non‐NASH (HR: 0.20, 95% CI: 0.07–0.54,P= 0.002) and decompensated cirrhosis (HR: 0.12, 95% CI:0.03–0.53,P= 0.005) than no statin use.ConclusionPVT incidence was lower in decompensated cirrhosis patients with statin use than in those with no statin use. However, this finding needs to be further tested in randomized control trials.