PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：乙型肝炎病毒（HBV）感染是肝脏相关发病率和死亡率的常见原因。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）减少肝纤维化，肝损伤和肝细胞癌（HCC）之间的中间步骤。我们的目的是调查使用ACEI和ARBs对HBV感染患者肝癌事件和肝脏相关死亡率之间的关联。
方法：我们对中国24家医院的新用户队列患者进行了一项基于人群的研究。我们纳入了开始ACEI或ARB（ACEI/ARB）的HBV感染成人患者，或钙通道阻滞剂或噻嗪类利尿剂（CCBs/THZs），从2012年1月至2022年12月。主要结果是肝癌事件;次要结果是肝脏相关的死亡率和新发肝硬化。我们使用倾向评分匹配和Cox比例风险回归来估计研究结果的风险比（HR）和95％置信区间（CI）。
结果：在32692名合格患者中（中位年龄58[四分位距（IQR）48-68]年，和18804男性[57.5%])，我们匹配了9946对开始使用ACEI/ARBs或CCBs/THZs的患者。在平均2.3年的随访中，在开始ACEI/ARB和CCB/THZs的患者中，每1000人年的HCC发病率分别为4.11和5.94，分别,在匹配的队列中。使用ACEI/ARB与HCC事件的风险较低相关（HR0.66，95％CI0.50-0.86），肝脏相关死亡率（HR0.77，95%CI0.64-0.93），和新发肝硬化（HR0.81，95％CI0.70-0.94）。
结论：在HBV感染患者的这个队列中，ACEI/ARBs的新用户发生HCC的风险较低，肝脏相关死亡率，和新发肝硬化比CCB/THZs的新用户。
方法：我们对中国24家医院的新用户队列患者进行了一项基于人群的研究。我们纳入了开始ACEI或ARB（ACEI/ARB）的HBV感染成人患者，或钙通道阻滞剂或噻嗪类利尿剂（CCBs/THZs），从2012年1月至2022年12月。主要结果是肝癌事件;次要结果是肝脏相关的死亡率和新发肝硬化。我们使用倾向评分匹配和Cox比例风险回归来估计研究结果的风险比（HR）和95％置信区间（CI）。
结果：在32692名合格患者中（中位年龄58[四分位距（IQR）48-68]年，和18804男性[57.5%])，我们匹配了9946对开始使用ACEI/ARBs或CCBs/THZs的患者。在平均2.3年的随访中，在开始ACEI/ARB和CCB/THZs的患者中，每1000人年的HCC发病率分别为4.11和5.94，分别,在匹配的队列中。使用ACEI/ARB与HCC事件的风险较低相关（HR0.66，95％CI0.50-0.86），肝脏相关死亡率（HR0.77，95%CI0.64-0.93），和新发肝硬化（HR0.81，95％CI0.70-0.94）。
结论：在HBV感染患者的这个队列中，ACEI/ARBs的新用户发生HCC的风险较低，肝脏相关死亡率，和新发肝硬化比CCB/THZs的新用户。
