质子泵抑制剂与结直肠癌发病率的Meta分析

Proton pump inhibitors and the risk of colorectal cancer: a meta analysis

目的有研究提示质子泵抑制剂(PPIs)可能与结直肠癌的发病率有关,长期使用PPIs可能会增加结直肠癌的发生率。本文利用Meta分析的方法探讨PPIs的使用与结直肠癌发病率的关系。方法广泛检索2009年12月前公开发表的有关PPIs与结直肠癌研究的相关文献。所有入选文献均进行发表偏倚和异质性分析。合并OR值使用固定或随机效应模型的95%置信区间。结果共有4篇文献符合纳入标准,包括了超过10万名患者,各研究间异质性明显(P<0.01),因此采用随机效用模型。结果表明PPIs的使用与结直肠的发生率无明显相关(OR=1.19;95%CI:0.90-1.57)。结论短期内常规剂量使用PPIs治疗消化性溃疡疾病并不会增加结直肠癌的发病率。

Objective Proton pump inhibitors(PPIs) have been thought to increase the risk of colorectal cancer(CRC). The aim of the study is to investigate the effect of PPI therapy on colorectal cancer incidence through a meta-analysis of the studies published on the subject.Methods A comprehensive literature search for studies published up to December 2009 was performed.All studies specifically designed to evaluate the association between PPIs and colorectal cancer were selected. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled odds ratio (OR) estimated with 95% confidence intervals(CIs) were calculated using the fixed- and random-effects models. Results Four studies involving more than one hundred thousand participants met the inclusion criteria. Heterogeneity was observed(P<0.01). So in a random-effects models, there was no evidence of an association between PPI use and the risk of colorectal cancer (OR=1.19; 95% CI: 0.90-1.57). Conclusions Our meta-analysis results do not support the hypothesis that a short term use of PPIs taken at usual doses for management of peptic ulcer disease may increase the risk of colorectal cancer. However, we cannot rule out an increased CRC risk associated with a long-term use of PPI with higher doses.