非甾體類抗炎藥預防結直腸新生物的系統評價_《中國循證醫學雜志》

作者：

王一平 , 潘濤 , 楊錦林 , 王瓊 , 甘濤

四川大學華西醫院消化內科,成都,610041;

關鍵詞：

非甾體類抗炎藥阿司匹林化學預防結直腸新生物隨機對照試驗系統評價

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目的　評價非甾體類抗炎藥是否能預防結直腸新生物.
方法　全面收集已發表或未發表的有關化學預防結直腸新生物的隨機對照臨床試驗,采用Cochrane協作網系統評價的方法,進行系統評價.
結果　9個符合標準的隨機對照臨床試驗被納入系統評價.分析結果顯示,在一定的時間內阿司匹林可預防結直腸腺瘤的發生[RR0.81,95% CI (0.72,0.91), P=0.0005],但不支持阿司匹林預防結直腸癌[RR0.97,95% CI(0.79 ,1.20 ),P=0.79],也不支持蘇林酸和塞來昔布預防或治療結直腸息肉或家族性結腸息肉[RR 0.71,95% CI (0.49 ,1.03), P=0.07和RR 0.90,95% CI (0.76,1.07), P=0.23].
結論　阿司匹林可預防結直腸腺瘤的發生,在每10～18個病例中可預防1例病人發生腺瘤.但阿司匹林的預防能否代替腸鏡下結直腸息肉的切除是一個值得思考的問題,因此,非甾體類抗炎藥預防結直腸新生物的臨床意義值得考慮.

引用本文： 王一平,潘濤,楊錦林,王瓊,甘濤. 非甾體類抗炎藥預防結直腸新生物的系統評價. 中國循證醫學雜志, 2005, 05(6): 438-443. doi: 復制

1.	［1］Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL. Genetic alterations during colorectal-tumor development[J]. N Engl J Med, 1988; 319 (9): 525-532.
2.	［2］Peipins LA, sandler RS. Epidemiology of colorectal adenomas[J]. Epidemiol Rev, 1994; 16(2):272-297.
3.	［3］Neugut AI, Jacobson JS, DeVivo I. Epidemiology of colorectal adenomatous polyps[J]. Cancer Epidemiol Biomarkers Prev,1993; 2 (2): 159-176.
4.	［4］Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Jerome D. Waye, Melvin Schapiro, John H. Bond, Joel F. Panish, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy[J]. N Engl J Med,1993; 329 (27): 1977-1981.
5.	［5］Janne PA, Mayer RJ. Primary care: Chemoprevention of colorectal cancer[J]. N Engl J Med,2000; 342(26):1960-1968.
6.	［6］Collet JP, Sharpe C, Belzile E, Boivin JF, Hanley J, Abenhaim L. Colorectal cancer prevention by non-steroidal anti-inflammatory drugs: effects of dosage and timing[J]. Br J cancer, 1999; 81 (1): 62-68.
7.	［7］Gao X, Sun S, Sun F, Li M, Sun HB,Zhang WD, Song SQ. Nonsteroidal anti-inflammatory drugs and risk of polyposis, colorectal carcinoma[J]. Chinn J Prev Med, 2002; 36(5):332-335.
8.	高雪芹,孫素玲,孫方利,李敏,孫華賓,張維東,宋守芹. 非甾體類抗炎藥對腸息肉及結、直腸癌保護作用的病例對照研究[J]. 中華預防醫學雜志, 2002; 36(5):332～335.
9.	［8］Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Colditz GA.; Ascherio A; Willett WC. Aspirin Use and the Risk for Colorectal Cancer and adenomas in male health Professionals[J]. Annals of Internal Medicine,1994; 121(4):241-246.
10.	［9］Smalley W, Ray WA, Daugherty J, Griffin MR. Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: A population-based study[J]. Archives of Internal Medicine, 1999; 159(2):161-166.
11.	［10］Labayle D, Fischer D, Vielh P, Drouhin F, Pariente A, Bories C, Duhamel O, Trousset M, Attali P. Sulindac causes regression of rectal polyps in familial adenomatous polyposis[J]. Gastroenterology, 1991; 101(3):635-639.
12.	［11］Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, Booker SV, Robinson CR, Offerhaus GJ. Treatment of Colonic and Rectal Adenomas with Sulindac in Familial Adenomatous Polyosis[J]. N Engl J Med, 1993; 328(18):1313-1316.
13.	［12］Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, McKeown-Eyssen G, Summers RW, Rothstein R, Burke CA, Snover DC, Church TR, Allen JI, Beach M, Beck GJ, Bond JH, Byers T, Greenberg ER, Mandel JS, Marcon N, Mott LA, Pearson L, Saibil F, van Stolk RU. A randomized trial of aspirin to prevent colorectal adenomas[J]. N Engl J Med,2003; 348(10):891-899.
14.	［13］Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R. A randomized trial of aspirin to prevent colorectal adenomas in patients with provious colorectal cancer[J]. N Engl J Med, 2003; 348(10):883-890.
15.	［14］Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, Couturier D, Coste T, Little J, Chaussade S. Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial[J]. Gastroenterology, 2003; 125(2):328-336.
16.	［15］Steinbach G, Lynch PM, Phillips RK, Wallace MH, Hawk E, Gordon GB, Wakabayashi N, Saunders B, Shen Y, Fujimura T, Su LK, Levin B.The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis[J]. N Engl J Med, 2000; 342 (26):1946-1952.
17.	［16］Giardiello FM, Yang VW, Hylind LM, Krush AJ, Petersen GM, Trimbath JD, Piantadosi S, Garrett E, Geiman DE, Hubbard W, Offerhaus GJ, Hamilton SR. Primary Chemoprevention of Familial Adenomatous Polyposis with Sulindac[J]. N Engl J Med, 2002; 346(14):1054-1059.
18.	［17］Ladenheim J, Garcia G, Titzer D, Herzenberg H, Lavori P, Edson R, Omary MB. Effect of sulindac on sporadic colonic polyps[J]. Gastroenterology,1995; 108(4):1083-1087.
19.	［18］Chen HP, Han SX, Zeng LM, Xu G, Yang H. Sulindac for treatment of colorectal adenomas[J]. Chin J Dig, 2001; 21(5):340-341.
20.	陳和平,韓盛璽,曾利明,徐剛,楊紅. 舒林酸對散發性結腸腺瘤性息肉的療效[J]. 中華消化雜志, 2001; 21(5):340～341.
21.	［19］Nugent KP, Farmer KC, Spigelman AD, Williams CB, Phillips RK. Randomized controlled trial of effect of sulindac on duodenal and rectal polyposis and cell proliferationa in patients with familial adenomatous polyposis[J]. Br J surg, 1993; 80(12): 1618-1619.
22.	［20］Gann PH, Manson JE, Glynn RJ, Buring JE, Hennekens CH. Low-dose aspirin and incidence of colorectal tumors in a randomized trial[J]. Journal of the National Cancer Institute, 1993; 85(15):1220-1224.
23.	［21］Taketo MM. Cyclooxygenasa-2 inhibitor in tumorigenesis[J]. J Natl Cancer Inst, 1998; 90:1529-1536.
24.	［22］Giovannucci E, Egan KM, Hunter DJ, Stampfer MJ, Colditz GA, Willett WC, Speizer FE. Aspirin and the risk of colorectal Cancer in women[J]. N Engl J Med, 1995; 333 (10):609-614.
25.	［23］Derry S, Loke Yk. Risk of gastrointestinal haemorrhage with long term use of aspirin: Meta-analysis[J]. BMJ, 2000; 321: (7270):1183-1187.
26.	［24］Watson AJ. Are proximal colorectal cancers always associated with distal adenomas[J]? Gut, 2003; 52(3):317-318.
27.	［25］Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps[J]. The American Journal of Gastroenterology, 2000; 95(11):3053-3063.

1. ［1］Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL. Genetic alterations during colorectal-tumor development[J]. N Engl J Med, 1988; 319 (9): 525-532.
2. ［2］Peipins LA, sandler RS. Epidemiology of colorectal adenomas[J]. Epidemiol Rev, 1994; 16(2):272-297.
3. ［3］Neugut AI, Jacobson JS, DeVivo I. Epidemiology of colorectal adenomatous polyps[J]. Cancer Epidemiol Biomarkers Prev,1993; 2 (2): 159-176.
4. ［4］Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Jerome D. Waye, Melvin Schapiro, John H. Bond, Joel F. Panish, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy[J]. N Engl J Med,1993; 329 (27): 1977-1981.
5. ［5］Janne PA, Mayer RJ. Primary care: Chemoprevention of colorectal cancer[J]. N Engl J Med,2000; 342(26):1960-1968.
6. ［6］Collet JP, Sharpe C, Belzile E, Boivin JF, Hanley J, Abenhaim L. Colorectal cancer prevention by non-steroidal anti-inflammatory drugs: effects of dosage and timing[J]. Br J cancer, 1999; 81 (1): 62-68.
7. ［7］Gao X, Sun S, Sun F, Li M, Sun HB,Zhang WD, Song SQ. Nonsteroidal anti-inflammatory drugs and risk of polyposis, colorectal carcinoma[J]. Chinn J Prev Med, 2002; 36(5):332-335.
8. 高雪芹,孫素玲,孫方利,李敏,孫華賓,張維東,宋守芹. 非甾體類抗炎藥對腸息肉及結、直腸癌保護作用的病例對照研究[J]. 中華預防醫學雜志, 2002; 36(5):332～335.
9. ［8］Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Colditz GA.; Ascherio A; Willett WC. Aspirin Use and the Risk for Colorectal Cancer and adenomas in male health Professionals[J]. Annals of Internal Medicine,1994; 121(4):241-246.
10. ［9］Smalley W, Ray WA, Daugherty J, Griffin MR. Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: A population-based study[J]. Archives of Internal Medicine, 1999; 159(2):161-166.
11. ［10］Labayle D, Fischer D, Vielh P, Drouhin F, Pariente A, Bories C, Duhamel O, Trousset M, Attali P. Sulindac causes regression of rectal polyps in familial adenomatous polyposis[J]. Gastroenterology, 1991; 101(3):635-639.
12. ［11］Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, Booker SV, Robinson CR, Offerhaus GJ. Treatment of Colonic and Rectal Adenomas with Sulindac in Familial Adenomatous Polyosis[J]. N Engl J Med, 1993; 328(18):1313-1316.
13. ［12］Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, McKeown-Eyssen G, Summers RW, Rothstein R, Burke CA, Snover DC, Church TR, Allen JI, Beach M, Beck GJ, Bond JH, Byers T, Greenberg ER, Mandel JS, Marcon N, Mott LA, Pearson L, Saibil F, van Stolk RU. A randomized trial of aspirin to prevent colorectal adenomas[J]. N Engl J Med,2003; 348(10):891-899.
14. ［13］Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R. A randomized trial of aspirin to prevent colorectal adenomas in patients with provious colorectal cancer[J]. N Engl J Med, 2003; 348(10):883-890.
15. ［14］Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, Couturier D, Coste T, Little J, Chaussade S. Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial[J]. Gastroenterology, 2003; 125(2):328-336.
16. ［15］Steinbach G, Lynch PM, Phillips RK, Wallace MH, Hawk E, Gordon GB, Wakabayashi N, Saunders B, Shen Y, Fujimura T, Su LK, Levin B.The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis[J]. N Engl J Med, 2000; 342 (26):1946-1952.
17. ［16］Giardiello FM, Yang VW, Hylind LM, Krush AJ, Petersen GM, Trimbath JD, Piantadosi S, Garrett E, Geiman DE, Hubbard W, Offerhaus GJ, Hamilton SR. Primary Chemoprevention of Familial Adenomatous Polyposis with Sulindac[J]. N Engl J Med, 2002; 346(14):1054-1059.
18. ［17］Ladenheim J, Garcia G, Titzer D, Herzenberg H, Lavori P, Edson R, Omary MB. Effect of sulindac on sporadic colonic polyps[J]. Gastroenterology,1995; 108(4):1083-1087.
19. ［18］Chen HP, Han SX, Zeng LM, Xu G, Yang H. Sulindac for treatment of colorectal adenomas[J]. Chin J Dig, 2001; 21(5):340-341.
20. 陳和平,韓盛璽,曾利明,徐剛,楊紅. 舒林酸對散發性結腸腺瘤性息肉的療效[J]. 中華消化雜志, 2001; 21(5):340～341.
21. ［19］Nugent KP, Farmer KC, Spigelman AD, Williams CB, Phillips RK. Randomized controlled trial of effect of sulindac on duodenal and rectal polyposis and cell proliferationa in patients with familial adenomatous polyposis[J]. Br J surg, 1993; 80(12): 1618-1619.
22. ［20］Gann PH, Manson JE, Glynn RJ, Buring JE, Hennekens CH. Low-dose aspirin and incidence of colorectal tumors in a randomized trial[J]. Journal of the National Cancer Institute, 1993; 85(15):1220-1224.
23. ［21］Taketo MM. Cyclooxygenasa-2 inhibitor in tumorigenesis[J]. J Natl Cancer Inst, 1998; 90:1529-1536.
24. ［22］Giovannucci E, Egan KM, Hunter DJ, Stampfer MJ, Colditz GA, Willett WC, Speizer FE. Aspirin and the risk of colorectal Cancer in women[J]. N Engl J Med, 1995; 333 (10):609-614.
25. ［23］Derry S, Loke Yk. Risk of gastrointestinal haemorrhage with long term use of aspirin: Meta-analysis[J]. BMJ, 2000; 321: (7270):1183-1187.
26. ［24］Watson AJ. Are proximal colorectal cancers always associated with distal adenomas[J]? Gut, 2003; 52(3):317-318.
27. ［25］Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps[J]. The American Journal of Gastroenterology, 2000; 95(11):3053-3063.

《中國循證醫學雜志》

非甾體類抗炎藥預防結直腸新生物的系統評價

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《中國循證醫學雜志》

非甾體類抗炎藥預防結直腸新生物的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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