NEJM:服用低剂量阿司匹林或降低慢性肝炎患者的肝癌风险
创作:王文东 审核:szx 03月28日
  • 纳入50275名无阿司匹林(AP)服用史的慢性乙肝或丙肝患者,平均随访7.9年,14205名开始连续服用低剂量AP 90次或以上;
  • 服用AP者与未服用AP者的肝细胞癌累积发病率分别为4.0%及8.3%,校正后风险比(AHR)为0.69;
  • 服用AP与肝细胞癌发病率的关联依赖于持续时间,相比于服用3月-1年,服用1-3年、3-5年和大于5年的AHR分别为0.90、0.66和0.57;
  • 服用AP者与未服用AP者的10年肝相关死亡率分别为11.0%及17.9%,AHR为0.73。
主编推荐语
szx
New England Journal of Medicine上发表的一项最新研究,对5万多名慢性乙肝或丙肝患者进行平均7.9年的随访,发现服用低剂量阿司匹林与较低肝细胞癌发病率相关,且服用时间越长,肝细胞癌发病率越低。另外,服用阿司匹林还与较低的肝相关死亡率相关。同时,服用低剂量阿司匹林并未显著增加胃肠道出血的风险。
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Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality

阿司匹林与肝细胞癌和肝相关死亡率的关系

10.1056/NEJMoa1912035

03-12, Article

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BACKGROUND: More information is needed about the long-term effects of low-dose aspirin (≤160 mg) on incident hepatocellular carcinoma, liver-related mortality, and gastrointestinal bleeding in persons with chronic hepatitis B or hepatitis C virus infection.
METHODS: Using nationwide Swedish registries, we identified all adults who received a diagnosis of chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use (50,275 patients). Patients who were starting to take low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, we estimated the risk of hepatocellular carcinoma and liver-related mortality, accounting for competing events.
RESULTS: With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (difference, −4.3 percentage points; 95% confidence interval [CI], −5.0 to −3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference, −6.9 percentage points [95% CI, −8.1 to −5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, −0.6 to 2.4).
CONCLUSIONS: In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. (Funded by the National Institutes of Health and others.)

First Authors:
Tracey G Simon

Correspondence Authors:
Jonas F Ludvigsson

All Authors:
Tracey G Simon,Ann‑Sofi Duberg,Soo Aleman,Raymond T Chung,Andrew T Chan,Jonas F Ludvigsson

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