非甾体类抗炎药预防结直肠新生物的系统评价(英文)

Nonsteroidal Anti-inflammatory Drugs for Prevention of Col orectal Neoplasms: A Systematic Review

目的评价非甾体类抗炎药是否能预防结直肠新生物.方法全面收集已发表或未发表的有关化学预防结直肠新生物的随机对照临床试验,采用Cochrane协作网系统评价的方法,进行系统评价.结果 9个符合标准的随机对照临床试验被纳入系统评价.分析结果显示,在一定的时间内阿司匹林可预防结直肠腺瘤的发生[RR0.81,95% CI (0.72,0.91), P=0.0005],但不支持阿司匹林预防结直肠癌[RR0.97,95% CI(0.79 ,1.20 ),P=0.79],也不支持苏林酸和塞来昔布预防或治疗结直肠息肉或家族性结肠息肉[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].结论阿司匹林可预防结直肠腺瘤的发生,在每10～18个病例中可预防1例病人发生腺瘤.但阿司匹林的预防能否代替肠镜下结直肠息肉的切除是一个值得思考的问题,因此,非甾体类抗炎药预防结直肠新生物的临床意义值得考虑.

Objective To assess the effect of nonsteroidal anti-inflammat ory drugs (NSAIDs) for the prevention of colorectal neoplasia.Method s A systematic review of all relevant randomized controll ed trials and quasi-randomized controlled trials of NSAIDs for prevention of co lorectal neoplasms was performed by using The Cochrane Collaboration recommended methods.Results Nine trials were included and assessed. There was sufficient evidence for aspirin to prevent the development of colorectal adenomas compared with placebo in three trials of hig h quality and large sample size with relative risk (RR) 0.81, 95% confidence i nterval( CI) 0.72 to 0.91 and P=0.000 5 . No adequate eviden ce supported aspirin in the prevention of development of colorectal cancer (RR 0 .97, 95% CI 0.79 to 1.20 ,P= 0.79). However, there was no e vidence to support sulindac and celecoxib curing or preventing colorectal adenom as or familial adenomatous polyposis (RR 0.71, 95% CI 0.49 to 1.03, P = 0.07 and RR 0.90, 95% CI 0.76 to 1.07, P=0.23). No evidence on the dose of NSAIDs was used for prevention of colorectal adenomas at present. No significant difference was seen in the number of adverse events between patients taking NSAIDs and those taking placebo (P=0.9 ).Conclusions Aspirin may prevent the development of colorectal adenomas and may avoid polypectomy for 1 in every 10 to 18 persons but we don’t know whether aspirin can be substituted for endos copically removed colorectal polyps. However, the true clinical benefit for pre vention of colorectal neoplasia of NSAIDs should be considered.