熊去氧胆酸预防溃疡性结肠炎相关结直肠癌和上皮内瘤变的Meta分析
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篇名: 熊去氧胆酸预防溃疡性结肠炎相关结直肠癌和上皮内瘤变的Meta分析
TITLE:
摘要: 目的:系统评价熊去氧胆酸(UDCA)预防溃疡性结肠炎相关结直肠癌(UC-CRC)和上皮内瘤变(UC-Dys)的有效性,以为临床提供循证参考。方法 :计算机检索Cochrane 图书馆、EMBase、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库和万方数据库,收集UDCA(试验组)对比安慰剂(对照组)预防UC-CRC和UC-Dys有效性的随机对照试验(RCT)或队列研究,对符合纳入标准的研究进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入7项研究,包括3项RCT和4项队列研究,合计672例患者。3项RCT的Meta分析结果显示,两组患者UC-CRC和UC-Dys发生率比较,差异均无统计学意义[OR=0.95,95%CI(0.17,5.12),P=0.95];4项队列研究的Meta分析结果显示,两组患者UC-CRC和UC-Dys发生率比较,差异均无统计学差异[OR=0.74,95%CI(0.30,1.84),P=0.52]。亚组分析结果显示,试验组低剂量UDCA(<15 mg/kg) UC-CRC和UC-Dys发生率均显著低于对照组,差异均有统计学意义[OR=0.19,95%CI(0.08,0.49),P<0.001];两组高剂量UDCA(≥15 mg/kg)UC-CRC和UC-Dys发生率比较,差异均无统计学意义[OR=1.97,95%CI(0.53,7.25),P=0.31]。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:UDCA不能有效地降低UC-CRC和 UC-Dys发病率,但低剂量UDCA有降低UC-CRC和UC-Dys癌变发生风险的趋势。
ABSTRACT: OBJECTIVE: To systematically review the efficacy of ursodeoxycholic acid (UDCA) in the prevention ofulcerative colitisassociated colorectal cancer (UC-CRC) and dysplasia (UC-Dys), and provide evidence-based reference for clinic. METHODS: Retrieved from Cochrane Library, EMBase, PubMed, CJFD, CBM, VIP and Wanfang Database, randomized controlled trials (RCT) or cohort studies about UDCA (test group) versus placebo (control group) in the prevention of UC-CRC and UC-Dys were collected. Meta-analysis was performed by using Rev Man 5.3 software after quality evaluation and data extraction by Cochrane Manual 5.1.0. RESULTS: Totally 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the analysis, involving 672 patients. Results of Meta-analysis of 3 RCT showed that there was no significant difference in the incidence of UC-CRC and UC-Dys between 2 groups [OR=0.95,95%CI(0.17,5.12),P=0.95]; results of Meta-analysis of 4 cohort studiesshowed that there was no significant difference in the incidence of UC-CRC and UC-Dys between 2 groups[OR=0.74,95%CI(0.30, 1.84),P=0.52]. Results of subgroup analysis showed, the incidence of UC-CRC and UC-Dys in test group with low-dose UDCA(<15 mg/kg) was significantly lower than control group, the difference was statistically significant [OR=0.19, 95%CI(0.08, 0.49),P<0.001]; there were no signifficant diferences in the incidence of UC-CRC and UC-Dys in high-dose UDCA group[OR=1.97,95%Cl(0.53,7.25),P=0.31](≥15 mg/kg). There was no significant difference in the incidence of adverse reactions(P>0.05). CONCLUSIONS: UDCA can not decease the incidence of UC-CRC and UC-Dys, it only prompts a possible trend toward decreased UC-CRC and UC-Dys risk in low-doseUDCA.
期刊: 2016年第27卷第18期
作者: 崔静,花威,韩蕊蕊,崔广林
AUTHORS: CUI Jing,HUA Wei,HAN Ruirui,CUI Guanglin
关键字: 熊去氧胆酸;溃疡性结肠炎;结直肠癌;上皮内瘤变;Meta分析
KEYWORDS: Ursodeoxycholic acid; Ulcerative colitis; Colorectal cancer; Colorectal neoplasia; Meta-analysis
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