Zhao Li-Na, Li Jie-Yao, Yu Tao, Chen Guang-Cheng, Yuan Yu-Hong, Chen Qi-Kui
Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China.
PLoS One. 2014 Apr 7;9(4):e94208. doi: 10.1371/journal.pone.0094208. eCollection 2014.
Although the chemopreventive effect of 5-aminosalicylates on patients with ulcerative colitis has been extensively studied, the results remain controversial. This updated review included more recent studies and evaluated the effectiveness of 5-aminosalicylates use on colorectal neoplasia prevention in patients with ulcerative colitis.
Up to July 2013, we searched Medline, Embase, Web of Science, Cochrane CENTRAL, and SinoMed of China for all relevant observational studies (case-control and cohort) about the effect of 5-aminosalicylates on the risk of colorectal neoplasia among patients with ulcerative colitis. The Newcastle-Ottawa Scale was used to assess the quality of studies. Adjusted odds ratios (ORs) were extracted from each study. A random-effects model was used to generate pooled ORs and 95% confidence intervals (95%CI). Publication bias and heterogeneity were assessed.
Seventeen studies containing 1,508 cases of colorectal neoplasia and a total of 20,193 subjects published from 1994 to 2012 were analyzed. 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis (OR 0.63; 95%CI 0.48-0.84). Pooled OR of a higher average daily dose of 5-aminosalicylates (sulfasalazine ≥ 2.0 g/d, mesalamine ≥ 1.2 g/d) was 0.51 [0.35-0.75]. Pooled OR of 5-aminosalicylates use in patients with extensive ulcerative colitis was 1.00 [0.53-1.89].
Our pooled results indicated that 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis, especially in the cases with a higher average daily dose of 5-aminosalicylates use. However, the chemopreventive benefit of 5-aminosalicylates use in patients with extensive ulcerative colitis was limited.
尽管5-氨基水杨酸酯对溃疡性结肠炎患者的化学预防作用已得到广泛研究，但其结果仍存在争议。本更新综述纳入了更多近期研究，并评估了使用5-氨基水杨酸酯预防溃疡性结肠炎患者结直肠肿瘤的有效性。
截至2013年7月，我们检索了Medline、Embase、科学网、考克兰中央对照试验注册库和中国生物医学文献数据库，以查找所有关于5-氨基水杨酸酯对溃疡性结肠炎患者结直肠肿瘤风险影响的相关观察性研究（病例对照研究和队列研究）。采用纽卡斯尔-渥太华量表评估研究质量。从每项研究中提取调整后的比值比（OR）。使用随机效应模型生成合并OR及95%置信区间（95%CI）。评估发表偏倚和异质性。
分析了1994年至2012年发表的17项研究，共纳入1508例结直肠肿瘤病例和20193名受试者。使用5-氨基水杨酸酯与溃疡性结肠炎患者结直肠肿瘤风险降低相关（OR 0.63；95%CI 0.48 - 0.84）。5-氨基水杨酸酯平均日剂量较高（柳氮磺胺吡啶≥2.0 g/d，美沙拉嗪≥1.2 g/d）时的合并OR为0.51[0.35 - 0.75]。广泛溃疡性结肠炎患者使用5-氨基水杨酸酯的合并OR为1.00[0.53 - 1.89]。
我们的合并结果表明，使用5-氨基水杨酸酯与溃疡性结肠炎患者结直肠肿瘤风险降低相关，尤其是在5-氨基水杨酸酯平均日剂量较高的情况下。然而，5-氨基水杨酸酯对广泛溃疡性结肠炎患者的化学预防益处有限。
