基础医学与临床2026，Vol.46Issue(5)：629-636,8.DOI:10.16352/j.issn.1001-6325.2026.05.0629
脂肪性肝病伴高血压人群使用RASi与全因死亡的关联
Clinical application of RASi and risk of all-cause mortality in patients with steatotic liver disease and hypertension
摘要
Abstract
Objective To investigate the association between renin-angiotensin system inhibitor(RASi)use and the risk of all-cause mortality among patients with steatotic liver disease(SLD)and hypertension.Methods Using an emulated target clinical trial design,that included new users of either RASi or calcium channel blocker(CCB)for at least 60 days among patients with SLD and hypertension who participated in chronic disease manage-ment in the Kailuan cohort from 2006 to 2020.Baseline characteristic differences between the groups were balanced by multivariable adjustment and propensity score(PS)matching.Cox proportional hazards regression models were used to evaluate the association between RASi use and all-cause mortality risk.Furthermore,the landmark analysis was applied to explore the dose-response relationship between the cumulative duration of RASi use and all-cause mortality risk.Results A total of 2 085 patients with SLD and hypertension were included.During a median follow-up of 7.01 years,510 patients died.The mortality rate was lower in the RASi group than that in the CCB group(8-year mortality:19.53%vs. 22.78%,P＜0.01).After multivariable adjustment for baseline factors,the risk of all-cause mortality in the RASi group was reduced by 28%when compared to that in the CCB group(HR=0.72,95%CI:0.60-0.87).Stratified analyses found no heterogeneity in the negative association between RASi use and all-cause mortality risk across the subgroups.The results were consistent in the PS-matched population(HR=0.77,95%CI:0.62-0.96).Dose-response analysis indicated a decreasing trend in all-cause mortality risk with increas-ing cumulative duration of RASi use(P for trend＜0.05).Conclusions RASi use is associated with a reduced risk of all-cause mortality among patients with SLD and hypertension,and this benefit increases with longer cumulative duration of RASi use.These results provide strong evidence to guide medication selection and to long-term manage-ment in this population.关键词
脂肪性肝病/高血压/模拟目标临床试验/肾素血管紧张素系统抑制剂/全因死亡Key words
steatotic liver disease/hypertension/emulated target clinical trial/renin-angiotensin system inhibitor/all-cause mortality分类
医药卫生引用本文复制引用
郝怡菲,陈朔华,杨晨露,周地,叶青峰,吴寿岭,王丽..脂肪性肝病伴高血压人群使用RASi与全因死亡的关联[J].基础医学与临床,2026,46(5):629-636,8.基金项目
癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项(2023ZD0508705) （2023ZD0508705）
中国医学科学院医学与健康科技创新工程(2021-I2M-1-023) （2021-I2M-1-023）
