| Part I The association between statin therapy and the prognosis of chronic viral hepatitis: a systematic review and Meta-analysisObjective: To evaluate the effects of statins in connection with the risk of development of cirrhosis,hepatocellular and mortality in chronic viral hepatitis.Method: Pub Med,EMBASE,The Cochrane Library,Web of science,China National Knowledge Infrastructure(CNKI),Wan Fang Digital Journal Full-text Database,and database for Chinese Technical Periodicals(VIP)were searched for the studies in evaluating the effect of statins on chronic viral hepatitis.A meta-analysis was performed using Stata 12.0.Result: A total of 13 original articles involving 602180 patients(including 1 case-control study and 12 control studies)met the inclusion criteria,of which 6 articles were related to chronic viral hepatitis B(CHB)including 226074 subjects,and the other 9 studies were articles related to chronic viral hepatitis C(CHC)including 376106 subjects.Among these cohort studies,study groups used statin therapy and control groups received no treatment.The results of meta-analysis were as follow.(1)Compared with the control group,chronic viral hepatitis patients with statin use were found to be associated with 51% reduced risk of cirrhosis(HR=0.49,95%CI:0.27-0.71,P=0.000),50% reduced risk of hepatocellular carcinoma(HCC)(HR=0.50,95%CI:0.40-0.59,P=0.000)and 28% reduced risk of mortality(HR=0.72,95%CI:0.52-0.92,P=0.000).(2)Subgroup analysis suggested that statins can reduce the risk of HCC by 51% in CHB(HR=0.49,95%CI:0.34-0.64,P=0.000),the risk of mortality by 34% in CHB(HR=0.66,95%CI:0.14-1.18,P=0.012);and the risk of cirrhosis by 51% in CHC(HR=0.49,95%CI:0.23-0.74,P=0.000),the risk of HCC by 47% in CHC(HR=0.53,95%CI:0.49-0.57,P=0.000),and the risk of mortality by 42% in CHC(HR=0.58,95%CI:0.47-0.70,P=0.000).Conclusion: Statin therapy may lower the risk of cirrhosis,HCC and mortality among chronic viral hepatitis patients.Part II The effects of statins in treatment of portal hypertension in cirrhotic patients and rats: a systematic review and Meta-analysisObjective: To evaluate the effects of the statins in reducing portal hypertension(PHT)in patients or rats with cirrhosis.Method: Pub Med,EMBASE,The Cochrane Library,Web of science,China National Knowledge Infrastructure(CNKI),Wan Fang Digital Journal Full-text Database,and database for Chinese Technical Periodicals(VIP)were searched.A meta-analysis was performed using Stata 12.0.Result: A total of eleven randomized controlled trials(RCT)met the inclusion criteria,in which 4 trials were analyzed to compare the statins with the control in patients with cirrhosis(119 patients)and the other 7 trials were in rats(134 rats).The results of meta-analysis were as follow.(1)Compared with the control group,the statins were associated with a greater reduction of hepatic vein pressure gradient(HVPG)inpatients with cirrhosis(WMD)=-1.67 mm Hg,95%CI(-2.22~-1.11)mm Hg,P= 0.000),and the portal pressure(PP)of the rats in treatment group was lower than in control group(WMD=-2.41 mm Hg,95%CI(-3.47~-1.34)mm Hg,P= 0.000).(2)Subgroup analysis showed that the effective rate of the statins to reduce HVPG in patients with decompensated liver cirrhosis was not statistically different from that of patients with compensated cirrhosis(RR=0.50,95%CI:0.13-1.98,P=0.325).(3)There were no statistically significant differences in the incidence of adverse events between the statins treatment group and the control group(RR=0.87,95%CI:0.19-3.90,P=0.856).Conclusion: The statins are effective in reducing portal pressure in cirrhotic patients and rats with PHT,and there are fewer adverse reactions.Statins may become a new type drug to reduce portal pressure in patients with PHT. |
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