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.
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。