脂肪性肝病伴高血压人群使用RASi与全因死亡的关联

doi:10.16352/j.issn.1001-6325.2026.05.0629

基础医学与临床 ›› 2026, Vol. 46 ›› Issue (5): 629-636.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

郝怡菲¹, 陈朔华², 杨晨露¹, 周地¹, 叶青峰¹, 吴寿岭^2*, 王丽^1*

1.中国医学科学院北京协和医学院基础医学研究所流行病与卫生统计学系,北京 100005;
2.开滦总医院心内科,河北唐山 063000

收稿日期:2026-01-05 修回日期:2026-03-24 出版日期:2026-05-05 发布日期:2026-04-28
通讯作者: ^*liwang@ibms.pumc.edu.cn; drwusl@163.com
基金资助:
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);中国医学科学院医学与健康科技创新工程(2021-I2M-1-023)

Clinical application of RASi and risk of all-cause mortality in patients with steatotic liver disease and hypertension

HAO Yifei¹, CHEN Shuohua², YANG Chenlu¹, ZHOU Di¹, YE Qingfeng¹, WU Shouling^2*, WANG Li^1*

1. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005;
2. Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China

Received:2026-01-05 Revised:2026-03-24 Online:2026-05-05 Published:2026-04-28
Contact: ^*liwang@ibms.pumc.edu.cn; drwusl@163.com

摘要/Abstract

摘要： 目的探讨在脂肪性肝病(SLD)伴高血压患者中,肾素血管紧张素系统抑制剂(RASi)使用与全因死亡风险之间的关联。方法采用模拟目标临床试验设计,纳入2006~2020年开滦队列参加慢性病管理的SLD伴高血压患者中单独使用RASi或单独使用钙通道阻滞剂(CCB)类药物至少60 d的新用药人群为研究对象,分别基于多因素校正以及倾向性评分(PS)匹配的方法平衡组间基线特征差异。在全人群及PS匹配人群中,采用Kaplan-Meier法分别绘制生存曲线,Log-rank检验比较组间差异;采用Cox比例风险回归模型评估RASi使用与全因死亡风险的关联。进一步采用界标方法探讨RASi累积用药时长与死亡风险的剂量反应关系。结果本研究共纳入了2 085例SLD伴高血压患者,经中位7.01年的随访,共510例患者死亡。RASi组病死率低于CCB组(8年死亡率:19.53% vs. 22.78%, P＜0.01);多因素校正基线后RASi组较CCB组全因死亡风险降低28%(HR=0.72, 95% CI:0.60~0.87);分层分析没有发现RASi与全因死亡风险的负向关联在不同亚组间的异质性。PS匹配人群结论一致(HR=0.77, 95% CI:0.62~0.96)。剂量反应关系分析发现,随RASi累积用药时长增加,全因死亡风险呈下降趋势(P_趋势＜0.05)。结论在SLD伴高血压人群中,RASi使用与更低的全因死亡风险相关,且该获益随RASi累积使用时间延长而增加,为该类人群的药物选择与长期管理提供了真实世界证据支持。

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

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 increasing 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 management in this population.

Key words: steatotic liver disease, hypertension, emulated target clinical trial, renin-angiotensin system inhibitor, all-cause mortality

中图分类号:

R181.3

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.

HAO Yifei, CHEN Shuohua, YANG Chenlu, ZHOU Di, YE Qingfeng, WU Shouling, WANG Li. Clinical application of RASi and risk of all-cause mortality in patients with steatotic liver disease and hypertension[J]. Basic & Clinical Medicine, 2026, 46(5): 629-636.

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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

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