Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK.
Dis Esophagus. 2013 Nov-Dec;26(8):838-46. doi: 10.1111/j.1442-2050.2012.01412.x. Epub 2012 Sep 18.
The incidence of esophageal adenocarcinoma (EAC) is increasing significantly throughout the developed world. As yet, there are no proven chemopreventive strategies. In laboratory studies, aspirin, non-steroidal anti-inflammatory drugs and statins have promising chemopreventive actions. Several observational studies support a protective effect of aspirin and non-steroidal anti-inflammatory drugs, but there are only limited clinical data exploring the potential protective effect of statins. We conducted a case-control study examining aspirin and statin use in patients with EAC. Cancer cases were compared against age-sex-matched controls attending for diagnostic upper gastrointestinal endoscopy. Risk factor and drug exposure were established using standardized interviews. Logistic regression was used to compare statin exposure and correct for confounding factors. A total of 112 cases and 448 controls were enrolled. Statin use was associated with a significantly lower incidence of EAC (odds ratio 0.52, 95% confidence interval 0.27-0.92). Aspirin use was also associated with apparent protection against EAC (odds ratio 0.68, 95% confidence interval 0.28-0.92), and a significantly greater effect was seen with the combination of statin plus aspirin (odds ratio 0.27, 95% confidence interval 0.05-0.67). There was a significant trend for greater risk reduction with longer duration and higher doses of statin use. Simvastatin comprised the majority of statin use, but similar effects were seen with simvastatin and non-simvastatin agents. In this observational study, patients regularly using statins or aspirin had a lower incidence of EAC. Statins may have clinically useful effects in preventing the development of EAC.
食管腺癌（EAC）在发达国家的发病率显著上升。然而，目前还没有经过证实的化学预防策略。在实验室研究中，阿司匹林、非甾体抗炎药和他汀类药物具有有前途的化学预防作用。一些观察性研究支持阿司匹林和非甾体抗炎药的保护作用，但只有有限的临床数据探讨他汀类药物的潜在保护作用。我们进行了一项病例对照研究，研究了 EAC 患者中阿司匹林和他汀类药物的使用情况。癌症病例与接受诊断性上消化道内镜检查的年龄、性别匹配的对照组进行比较。使用标准化访谈确定危险因素和药物暴露情况。使用逻辑回归比较他汀类药物暴露情况并校正混杂因素。共纳入 112 例病例和 448 例对照。他汀类药物的使用与 EAC 的发生率显著降低相关（比值比 0.52，95%置信区间 0.27-0.92）。阿司匹林的使用也与 EAC 的明显保护作用相关（比值比 0.68，95%置信区间 0.28-0.92），并且他汀类药物联合阿司匹林的效果更为显著（比值比 0.27，95%置信区间 0.05-0.67）。他汀类药物使用时间较长、剂量较高，风险降低的趋势更为显著。辛伐他汀构成了他汀类药物使用的大部分，但辛伐他汀和非辛伐他汀药物也显示出类似的效果。在这项观察性研究中，经常使用他汀类药物或阿司匹林的患者 EAC 的发病率较低。他汀类药物可能对预防 EAC 的发生具有临床实用价值。
