Department of Internal Medicine, Dallas Veterans Affairs Medical Center, Dallas, TX, USA.
J Clin Gastroenterol. 2011 Feb;45(2):e12-6. doi: 10.1097/MCG.0b013e3181ea1044.
The long-term use of angiotensin converting enzyme (ACE) inhibitors may reduce the risk of developing colorectal cancer (CRC).
The aim of our study was to determine how long-term use of lisinopril influences the development of advanced adenomatous polyps (APs).
We performed a retrospective study of patients who were found to have 1 or more histologically confirmed APs on an index colonoscopy, and who also had a follow-up colonoscopy 3 to 5 years later. APs found on the follow-up colonoscopy were evaluated for location, size, number, and advanced features. Patients were divided into 2 groups: (1) those who used lisinopril continuously during the interval between colonoscopies and (2) those who were lisinopril naive. Clinical factors were evaluated for their association with advanced APs in both the groups.
A total of 4660 patients with a history of AP were identified. There were 1760 continuous lisinopril users and 2900 nonusers. Univariate analysis showed that patients with lisinopril use had fewer right-side APs (odds ratio=0.68, P<0.001) and fewer total number of APs (P<0.001). Lisinopril users had a 41% reduced incidence of advanced APs compared with the nonusers (odds ratio=0.59, P<0.001). A Mann-Whitney U test revealed that among lisinopril users, patients with advanced APs were on a lower dose of the medication compared with patients without advanced APs (mean dose=17.2 mg vs. 20.1 mg, respectively; P<0.001). Spearman correlation analyses indicated an inverse relationship between lisinopril dosage and number of polyps (P<0.001). There was also an inverse relationship between dosage and size of polyps (P<0.001); higher dosages of lisinopril were significantly associated with smaller size of polyps. The protective effect of lisinopril was significant even when adjusted for age, body mass index, aspirin/nonsteroidal anti-inflammatory drug use, and statin use.
The use of lisinopril was associated with a 41% reduction in the incidence of advanced APs during a period of 3 to 5 years, even after adjustment for other known polyp risk factors. We speculate that long-term ACE inhibitors use may reduce the development of CRCs by reducing the development of advanced APs.
长期使用血管紧张素转换酶（ACE）抑制剂可能降低结直肠癌（CRC）的发病风险。
本研究旨在确定长期使用赖诺普利对进展性腺瘤（AP）的发展有何影响。
我们对接受过一次结肠镜检查，且检查发现 1 个或多个组织学确认的腺瘤，并在 3 至 5 年后进行了随访结肠镜检查的患者进行了回顾性研究。对随访结肠镜检查中发现的腺瘤进行了位置、大小、数量和高级别特征的评估。将患者分为 2 组：（1）结肠镜检查间隔期间持续使用赖诺普利的患者；（2）赖诺普利初治的患者。评估了两组中与进展性腺瘤相关的临床因素。
共确定了 4660 例有 AP 病史的患者。其中，1760 例为连续使用赖诺普利者，2900 例为未使用者。单因素分析显示，赖诺普利使用者右侧 AP 较少（比值比=0.68，P<0.001），总 AP 数量也较少（P<0.001）。与未使用者相比，赖诺普利使用者进展性腺瘤的发生率降低了 41%（比值比=0.59，P<0.001）。曼-惠特尼 U 检验显示，在赖诺普利使用者中，进展性腺瘤患者的药物剂量低于无进展性腺瘤患者（平均剂量分别为 17.2 mg 和 20.1 mg；P<0.001）。Spearman 相关分析表明，赖诺普利剂量与息肉数量呈负相关（P<0.001）。赖诺普利剂量与息肉大小也呈负相关（P<0.001）；赖诺普利剂量越高，息肉越小。即使在调整了年龄、体重指数、阿司匹林/非甾体抗炎药使用和他汀类药物使用等其他已知息肉风险因素后，赖诺普利的保护作用仍然显著。
在 3 至 5 年期间，即使在调整了其他已知的息肉风险因素后，赖诺普利的使用与进展性腺瘤发生率降低 41%相关。我们推测，长期使用 ACE 抑制剂可能通过减少进展性腺瘤的发生来降低 CRC 的发生。
