Intervention Review

Non steroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas

  1. Tracey K. Asano1,*,
  2. Robin S McLeod2

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 16 NOV 2003

DOI: 10.1002/14651858.CD004079.pub2

How to Cite

Asano TK, McLeod RS. Non steroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004079. DOI: 10.1002/14651858.CD004079.pub2.

Author Information

  1. 1

    University of Toronto, Surgery, Toronto, ONT, Canada

  2. 2

    Mount Sinai Hospital, Division of General Surgery, Toronto, Ontario, Canada

*Tracey K. Asano, Surgery, University of Toronto, c/o Dr. Robin McLeod, 600 University Ave Suite 449, Toronto, ONT, M5G 1X5, Canada. tasano@mtsinai.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Background

There is evidence from experimental animals studies, prospective and retrospective observational studies that nonsteroidal anti-inflammatory drugs (NSAIDS) may reduce the development of sporadic colorectal adenomas (CRAs) and cancer (CRC) and may induce the regression of adenomas in familial adenomatous polyposis (FAP).

Objectives

To conduct a systematic review to determine the effect of NSAIDS for the prevention or regression of CRAs and CRC.

Search methods

Randomized controlled trials (RCTs) up to September 2003 were identified.

Selection criteria

NSAIDS and aspirin (ASA) were the interventions. The primary outcomes were the number of subjects with at least one CRA, the change in polyp burden, and CRC. The secondary outcome was adverse events.

Data collection and analysis

Two reviewers independently extracted data and assessed trial quality. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence intervals (CI). The data were combined with the random effects model if clinically and statistically reasonable.

Main results

Nine trials with 150 familial adenomatous polyposis (FAP) and 24,143 population subjects met the inclusion criteria. The interventions included sulindac, celecoxib, or aspirin (ASA). From the combined results of three trials, significantly fewer subjects in the low dose ASA group developed recurrent sporadic CRAs [RR 0.77 (95% CI 0.61, 0.96), (NNT 12.5 (95% CI 7.7, 25)] after one to three years. In another three trials, phenotypic FAP subjects that received sulindac or celecoxib had a greater proportional reduction (range: 11.9% to 44%) in the number of CRAs compared to those in the control group (range: 4.5% to 10%). There was no significant difference for the outcomes of CRC or adverse events in any of the trials.

Authors' conclusions

There was evidence from three pooled RCTs that ASA significantly reduces the recurrence of sporadic adenomatous polyps after one to three years. There is evidence from short-term studies to support regression, but not elimination or prevention of CRAs in FAP.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Colorectal (bowel) cancer is common worldwide but is especially prevalent in industrialised countries. Genes, diet and lifestyle all seem to be important in the development of bowel cancer.

Experimental animals studies and observational studies have suggested that nonsteroidal anti-inflammatory drugs and aspirin may reduce the development of colorectal cancer and recurrence of adenomas in patients with familial adenomatous polyposis (FAP).

The review found some evidence to support the effectiveness of aspirin for reducing the risk of recurrent sporadic colorectal adenomas. Further, there is evidence from short-term studies to support regression, but not elimination or prevention of colorectal adenomas in FAP with NSAIDs.
The review suggests more research on the long-term role of NSAIDs.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

成人2型糖尿病的膳食疗法

研究背景

2型糖尿病患者一旦确诊就应立即进行饮食控制,这已成为公认的糖尿病治疗措施之一,但目前尚无正规的系统评价对其疗效与方法进行评价与总结。

研究目的

评价不同膳食疗法的措施及频率对成人2型糖尿病的疗效。

检索方法

全面检索 Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED等数据库及纳入研究的参考文献,并联系相关专家以获取额外资料。

纳入标准

纳入所有以膳食疗法为主要干预方式且为期6个月及以上的随机对照试验。

数据收集与分析

第一作者独立完成所有数据提取与质量评分,并由其他6名评价者中的一位再重复相同的工作,意见分歧时通过讨论和表决达成共识。联系原始研究作者获取缺失资料。

主要结果

最终纳入18项试验所发表的36篇文献(n=1467)。本研究所评价的膳食措施包括低脂/高碳水化合物膳食、高脂/低碳水化合物膳食、低热量(每天1000千卡)膳食、极低热量(每天500千卡)膳食以及改良型脂肪膳食。其中有两项试验比较了美国糖尿病协会的替代膳食方案与标准的低脂膳食方案的效果,有5项试验比较了低脂膳食与中脂膳食或低碳水化合物膳食的效果。还有两项试验比较了极低热量膳食与低热量膳食,6项试验比较了单用膳食疗法与膳食疗法加体育锻炼的效果,3项试验比较了单用膳食疗法与膳食疗法加行为疗法的效果。所有的研究均测量了体重和血糖控制指标,但并非所有发表的文献都报告了这些观测结果。其他结局指标还包括死亡率、血压、血清胆固醇(包括LDL(低密度脂蛋白胆固醇)和HDL(高密度脂蛋白胆固醇))、血清甘油三酯、最大运动能力和依从性。结果显示,有规律的体育锻炼是促进2型糖尿病患者血糖控制的有效方法,但纳入研究均存在较高的偏倚风险。

作者结论

目前对2型糖尿病患者的膳食疗法还缺乏高质量的研究。但现有资料显示,体育锻炼对患者随访第6和第12个月的糖化血红蛋白指标有明显改善作用。已有1个高质量的试验正在进行,但仍迫切需要评价各种干预措施在多个随访时点效果的高质量研究。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

成人2型糖尿病的膳食疗法

成人2型糖尿病的膳食疗法

目前仍缺乏高质量研究证据证实膳食疗法对2型糖尿病的效果。本研究系统评价了膳食疗法单独或联合体育锻炼/行为疗法的效果。共纳入18项试验,均未报告糖尿病血管并发症、死亡率或生命质量等指标。由于资料有限,本研究很难得出可靠的结论。但体育锻炼配合膳食疗法,有益于随访6至12个月后的代谢控制效果。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

背景

非類固醇抗發炎藥物(Non steroidal antiinflammatory drugs,NSAID)和阿斯匹靈對於預防大腸腺瘤(colorectal adenomas)和大腸癌(colorectal carcinomas)的影響

有一些由動物試驗、前瞻性觀察研究(prospective observational study)和回溯性觀察研究(retrospective observational study)所獲得的證據顯示,NSAID可能可以降低偶發性大腸腺瘤(sporadic colorectal adenomas ,CRAs)和大腸癌(colorectal cancer,CRC)的發生率,也可能會使遺傳性大腸息肉症(Familial adenomatous polyposis,FAP)的腺瘤產生退化

目標

本研究的主要目的在於建構一個系統性的觀點,以決定NSAIDS對於CRA和CRC的預防及復原的影響

搜尋策略

2003年月以前的RCT試驗都會接受確認

選擇標準

NSAIDS和阿斯匹靈(ASA)都是一種介入治療方法,主要的試驗成果為至少患有CRA的受試者人數、息肉負荷(polyp burden)的改變、和CRC的改變。次要試驗成果則是不良事件(副作用)

資料收集與分析

有2個審閱者分別獨立將數據萃取出並且評估試驗品質,二元化的試驗果會以相對風險(RR值)和95%的信心區間數值進行表示,在臨床上和統計上可理解的範圍內將數據與隨機效應模式進行合併

主要結論

九個含有150名FAP患者和24143個受試者的試驗被納入研究中,介入性治療包括使用sulindac、celecoxib和ASA,由3個試驗綜合的結果顯示,在接受治療1至3年後,使用低劑量ASA的組別中有明顯少數的患者引發復發性偶發CRA(RR值為0.77,95%的信心區間介於0.61至0.96之間,需要進行治療的人數為12.5人[95%的信心區間介於7.7至25之間]),在其他3個試驗中,表現型FAP患者接受sulindac或celecoxib進行治療後,復發的機率大幅度成比例的降低(由11.9%至44%)在這些試驗中,CRC的成果及副作用沒有顯著差異

作者結論

由這三個聚集性的RCT試驗得到的證據顯示,在接受ASA治療的組別在接受治療的1至3年間,偶發性大腸息肉的復發率有明顯的降低趨勢,由短期性的試驗來可以支持其對腫瘤衰退的效用,但是無法消除或預防FAP組中的CRA發生

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

大腸癌是一種普遍性的疾病,但是在工業國家又特別的盛行,基因、飲食和生活習慣似乎都對大腸癌的發生十分重要,動物實驗和觀察實驗都認為非類固醇性的抗發炎藥物和阿斯匹靈可能可以降低FAP患者身上大腸癌的發生和腺瘤的復發的機率,本研究發現一些證據可以支持阿斯匹靈對於降低偶發性大腸癌風險的效用,此外,由短期性的實驗也可以推測其對大腸腺瘤的退化,但是對於使用NSAIDS的FAP患者,無法消除或預防大腸腺瘤。本研究認為需要進行更多研究來瞭解NSAIDS對於長期治療所扮演的角色