Application of statins in the treatment of esophagogastric varices in patients with liver cirrhosis

doi:10.3877/cma.j.issn.2095-2015.2026.04.015

Abstract

Abstract:

Cirrhosis decompensated stage is the end stage of all kinds of liver diseases, portal hypertension is its main clinical manifestation, statins have been proved to reduce portal pressure, improve hepatic hemodynamics, and have the effect of improving intrahepatic fat accumulation, lowering cholesterol, etc, so as to improve the clinical prognosis of patients. This article summarizes the application of statins in the primary and secondary prevention of esophagogastric variceal bleeding in cirrhosis and the normative recommendations for portal hypertension in recent years, providing reference for clinical diagnosis and treatment practice.

Key words: Statins, Cirrhosis, Portal hypertension, Varicose veins

Xiao Liu, Lianhui Zhao, Guangchuan Wang, Chunqing Zhang. Application of statins in the treatment of esophagogastric varices in patients with liver cirrhosis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(04): 374-379.

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References 45

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首发时间	研究设计	患者特征	主要终点	结论
Abraldes等，2009^[44]	随机对照试验	肝硬化伴重度门脉高压（HVPG≥12 mmHg）	HVPG的变化	辛伐他汀通过降低肝血管阻力改善肝灌注并降低HVPG，不影响体循环，与肝血流变化无关。
Motzkus-Feagans等，2013 ^[29]	回顾性队列研究	诊断为肝硬化患者	住院期间首次严重感染或死亡的时间	他汀类药物的使用可能会降低肝硬化患者感染的风险。
Kumar等，2014^[27]	回顾性队列研究	接受他汀治疗≥3个月的肝硬化患者。	肝硬化失代偿和死亡率	他汀类药物不增加肝硬化患者死亡风险，可能延缓肝功能失代偿的发生。
Pollo-Flores等，2015 ^[18]	随机对照试验	肝硬化合并胃食管静脉曲张	HVPG的变化	辛伐他汀可降低门静脉压并改善肝功能，对重度门静脉高压症患者血流动力学影响更显著。
Mohanty等，2016^[22]	回顾性队列研究	代偿期丙型肝炎肝硬化患者。	肝硬化失代偿和死亡	他汀类药物使丙型肝炎伴代偿性肝硬化患者失代偿和死亡风险降低40%以上。
Huang等，2016^[23]	回顾性队列研究	未发生肝硬化的慢性乙型肝炎患者	发生肝硬化以及失代偿事件	他汀类药物剂量依赖性降低慢性乙肝患者肝硬化及失代偿风险。
Simon等，2016^[24]	回顾性队列研究	抗丙型肝炎治疗≥14d的患者	肝硬化的进展以及肝细胞癌的发生率	他汀类药物，尤其是阿托伐他汀和氟伐他汀，可能通过降低肝硬化和肝癌风险，对慢性丙型肝炎患者发挥保护作用。
Abraldes等，2016^[19]	随机对照试验	5~10 d内有静脉出血史的肝硬化患者	再出血或死亡的复合终点	在标准治疗中加入辛伐他汀并没有减少再出血，但与ChildPugh A级或B级肝硬化患者的生存获益相关。
Chang等，2017^[25]	回顾性队列研究	NHIRD数据中肝硬化患者	肝硬化失代偿、肝细胞癌和死亡率	他汀类药物以剂量依赖方式降低HBV/HCV肝硬化失代偿率，对酒精性肝硬化失代偿率降低有临界意义。
Bang等，2017^[28]	回顾性队列研究	酒精性肝硬化患者	肝硬化失代偿和死亡率	他汀类药物可降低酒精性肝硬化患者的代偿失代偿和死亡风险，且较非肝硬化患者相关性更强。
Wani等，2017^[15]	随机对照试验	无出血史的食管静脉曲张肝硬化患者，基线HVPG>12 mmHg	HVPG的变化	卡维地洛无应答者的基础上加用辛伐他汀可能是门静脉高压症患者的一种极好的抢救治疗方法。
Bishnu等，2018^[45]	随机对照试验	有静脉曲张出血、腹水、脾肿大、食管静脉曲张或内镜下曲张静脉套扎术史的肝硬化患者	HVPG的变化	阿托伐他汀联合心得安较单用心得安显著降低肝硬化患者HVPG，可能通过减少肝血管阻力实现。
Alvarado-Tapias等，2024^[14]	随机对照实验	肝硬化（代偿/失代偿）伴高危静脉曲张且无出血史的患者	HVPG变化	在严重门静脉高压症患者中（伴高危静脉曲张且对非选择性β受体阻滞剂反应不佳），卡维地洛联合辛伐他汀较单药治疗进一步降低门静脉压，改善内皮功能障碍，并减轻炎症反应。

首发时间	研究设计	患者特征	主要终点	结论
Abraldes等，2009^[44]	随机对照试验	肝硬化伴重度门脉高压（HVPG≥12 mmHg）	HVPG的变化	辛伐他汀通过降低肝血管阻力改善肝灌注并降低HVPG，不影响体循环，与肝血流变化无关。
Motzkus-Feagans等，2013 ^[29]	回顾性队列研究	诊断为肝硬化患者	住院期间首次严重感染或死亡的时间	他汀类药物的使用可能会降低肝硬化患者感染的风险。
Kumar等，2014^[27]	回顾性队列研究	接受他汀治疗≥3个月的肝硬化患者。	肝硬化失代偿和死亡率	他汀类药物不增加肝硬化患者死亡风险，可能延缓肝功能失代偿的发生。
Pollo-Flores等，2015 ^[18]	随机对照试验	肝硬化合并胃食管静脉曲张	HVPG的变化	辛伐他汀可降低门静脉压并改善肝功能，对重度门静脉高压症患者血流动力学影响更显著。
Mohanty等，2016^[22]	回顾性队列研究	代偿期丙型肝炎肝硬化患者。	肝硬化失代偿和死亡	他汀类药物使丙型肝炎伴代偿性肝硬化患者失代偿和死亡风险降低40%以上。
Huang等，2016^[23]	回顾性队列研究	未发生肝硬化的慢性乙型肝炎患者	发生肝硬化以及失代偿事件	他汀类药物剂量依赖性降低慢性乙肝患者肝硬化及失代偿风险。
Simon等，2016^[24]	回顾性队列研究	抗丙型肝炎治疗≥14d的患者	肝硬化的进展以及肝细胞癌的发生率	他汀类药物，尤其是阿托伐他汀和氟伐他汀，可能通过降低肝硬化和肝癌风险，对慢性丙型肝炎患者发挥保护作用。
Abraldes等，2016^[19]	随机对照试验	5~10 d内有静脉出血史的肝硬化患者	再出血或死亡的复合终点	在标准治疗中加入辛伐他汀并没有减少再出血，但与ChildPugh A级或B级肝硬化患者的生存获益相关。
Chang等，2017^[25]	回顾性队列研究	NHIRD数据中肝硬化患者	肝硬化失代偿、肝细胞癌和死亡率	他汀类药物以剂量依赖方式降低HBV/HCV肝硬化失代偿率，对酒精性肝硬化失代偿率降低有临界意义。
Bang等，2017^[28]	回顾性队列研究	酒精性肝硬化患者	肝硬化失代偿和死亡率	他汀类药物可降低酒精性肝硬化患者的代偿失代偿和死亡风险，且较非肝硬化患者相关性更强。
Wani等，2017^[15]	随机对照试验	无出血史的食管静脉曲张肝硬化患者，基线HVPG>12 mmHg	HVPG的变化	卡维地洛无应答者的基础上加用辛伐他汀可能是门静脉高压症患者的一种极好的抢救治疗方法。
Bishnu等，2018^[45]	随机对照试验	有静脉曲张出血、腹水、脾肿大、食管静脉曲张或内镜下曲张静脉套扎术史的肝硬化患者	HVPG的变化	阿托伐他汀联合心得安较单用心得安显著降低肝硬化患者HVPG，可能通过减少肝血管阻力实现。
Alvarado-Tapias等，2024^[14]	随机对照实验	肝硬化（代偿/失代偿）伴高危静脉曲张且无出血史的患者	HVPG变化	在严重门静脉高压症患者中（伴高危静脉曲张且对非选择性β受体阻滞剂反应不佳），卡维地洛联合辛伐他汀较单药治疗进一步降低门静脉压，改善内皮功能障碍，并减轻炎症反应。

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