阿司匹林预防结直肠腺瘤的系统评价

Aspirin for the prevention of colorectal adenomas： a systematic review

目的对已发表的文献进行Meta分析，评价服用阿司匹林对结直肠腺瘤的化学预防。方法采用Cochrane系统评价方法，检索PubMed、EMBase、CochraneLibrary、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（CSJD）等，并辅以手工检索和其他检索。结果共6个随机对照试验2858例患者纳入研究，其中4个随机对照研究来自欧美国家，2个来自中国。Meta分析结果显示阿司匹林可以预防结直肠腺瘤的复发（P=0．003，RR=0．66，95％CI：0．50～0．86），对预防结直肠癌的发生无统计学意义（P=0．29，RR=0．65，95％CI：0．30～1．44）。亚组分析显示，服用高剂量（≥300mg／d）、低剂量（〈300mg／d）阿司匹林均可影响结直肠腺瘤的发生（P=0．10，RR=0．85，95％CI：0．710-1．03；P=0．02，RR=0．57，95％CI：0．36～0．90），显示阿司匹林预防腺瘤复发有剂量依赖关系。各剂量阿司匹林组间不良反应的发生无统计学意义，但中风的发生高于安慰剂组（P=0．04）。结论长期服用阿司匹林可以降低结直肠腺瘤的复发，但对结直肠癌的发生无影响。

Objective To assess the effect of aspirin for the chemoprevention of colorectal adenomas by meta analysis of the published literature. Methods Cochrane strategy in combination with manual search was used to identify previously published randomized controlled trials by searching PubMed, EMBase, Cochrane Library, China Journal Full-text Database（ CNKI）, Chinese Scientific Journal Full-text Database （CSJD） and Chinese Biomedical Literature Database （CBM）. Results Six randomized controlled trials involving a total of 2 858 patients were studied. Of the six trials, two trials were performed in China, four trials were in the Europe and the United States. Some sufficient evidence were found to support that aspirin could prevent of colorectal adenomas compared with placebo group （P = O. 003 ,RR = 0.66,95% CI：0. 50-0. 86）. No adaquate evidence supported the role of aspirin in the prevention of development of colorectal cancer （P = 0.29, RR = 0.65,95% CI：O. 30-1.44）. High-dose aspirin （P =0.10, RR =0.85, 95% CI：O. 71-1.30） and low-dose aspirin could prevent coloreetal adenomas compared with placebo group（ P = 0.02, RR = O. 57, 95% CI：O. 36-0.90）, and a dose-dependent associtation was found. The risk of stroke was higher in any dose of aspirin compared with placebo group （ P = 0.04 ）, and the risks of adverse events had no significant differences in all groups. Conclusion Aspirin might prevent the development of colorectal adenomas in individuals, but could not prevent the colorectal cancer.