• 四川大學(xué)華西醫(yī)院消化內(nèi)科,成都,610041;

目的 　評(píng)價(jià)非甾體類抗炎藥是否能預(yù)防結(jié)直腸新生物.
方法 　全面收集已發(fā)表或未發(fā)表的有關(guān)化學(xué)預(yù)防結(jié)直腸新生物的隨機(jī)對(duì)照臨床試驗(yàn),采用Cochrane協(xié)作網(wǎng)系統(tǒng)評(píng)價(jià)的方法,進(jìn)行系統(tǒng)評(píng)價(jià).
結(jié)果 　9個(gè)符合標(biāo)準(zhǔn)的隨機(jī)對(duì)照臨床試驗(yàn)被納入系統(tǒng)評(píng)價(jià).分析結(jié)果顯示,在一定的時(shí)間內(nèi)阿司匹林可預(yù)防結(jié)直腸腺瘤的發(fā)生[RR0.81,95% CI (0.72,0.91), P=0.0005],但不支持阿司匹林預(yù)防結(jié)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(yù)防或治療結(jié)直腸息肉或家族性結(jié)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(jié)論 　阿司匹林可預(yù)防結(jié)直腸腺瘤的發(fā)生,在每10～18個(gè)病例中可預(yù)防1例病人發(fā)生腺瘤.但阿司匹林的預(yù)防能否代替腸鏡下結(jié)直腸息肉的切除是一個(gè)值得思考的問題,因此,非甾體類抗炎藥預(yù)防結(jié)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(yù)防結(jié)直腸新生物的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(6): 438-443. doi: 復(fù)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(duì)腸息肉及結(jié)、直腸癌保護(hù)作用的病例對(duì)照研究[J]. 中華預(yù)防醫(yī)學(xué)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(duì)散發(fā)性結(jié)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. ［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. ［2］Peipins LA, sandler RS. Epidemiology of colorectal adenomas[J]. Epidemiol Rev, 1994; 16(2):272-297.
  3. 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. ［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. ［5］Janne PA, Mayer RJ. Primary care: Chemoprevention of colorectal cancer[J]. N Engl J Med,2000; 342(26):1960-1968.
  6. 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. ［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. 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(duì)腸息肉及結(jié)、直腸癌保護(hù)作用的病例對(duì)照研究[J]. 中華預(yù)防醫(yī)學(xué)雜志, 2002; 36(5):332～335.
  9. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 20. 陳和平,韓盛璽,曾利明,徐剛,楊紅. 舒林酸對(duì)散發(fā)性結(jié)腸腺瘤性息肉的療效[J]. 中華消化雜志, 2001; 21(5):340～341.
  21. 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. 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. 23. ［21］Taketo MM. Cyclooxygenasa-2 inhibitor in tumorigenesis[J]. J Natl Cancer Inst, 1998; 90:1529-1536.
  24. 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. 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. 26. ［24］Watson AJ. Are proximal colorectal cancers always associated with distal adenomas[J]? Gut, 2003; 52(3):317-318.
  27. 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.