Academic Section of Urology, Division of Cancer Research, School of Medicine, University of Dundee, Scotland, UK.
Academic Section of Urology, Division of Cancer Research, School of Medicine, University of Dundee, Scotland, UK.
Int J Radiat Oncol Biol Phys. 2016 Jan 1;94(1):93-101. doi: 10.1016/j.ijrobp.2015.09.013. Epub 2015 Sep 18.
To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.
A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.
The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).
Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.
确定服用血管紧张素转换酶抑制剂（ACEI）并接受新辅助/辅助激素治疗联合根治性放射治疗的患者是否具有较低的放射性直肠炎发生率、严重程度和持续时间。
对 2009 年至 2013 年期间进行的一项队列研究中的 817 例接受新辅助或辅助激素治疗作为一线治疗的患者进行了倾向评分分析。患者分为以下三组：第 1 组为服用 ACEI 的高血压患者（作为研究组）；第 2 组为未服用 ACEI 的非高血压患者；第 3 组为未服用 ACEI 的高血压患者（均为对照组）。直肠炎的发生率、严重程度和持续时间为主要结局。采用 χ(2)检验、Mann-Whitney U 检验、方差分析、风险比（RR）、置信区间（CI）、Kaplan-Meier 图和对数秩检验进行分析。
参与者的平均年龄为 68.91 岁，随访时间为 3.38 年。基于疾病和年龄匹配比较，3 组之间直肠炎分级存在统计学显著差异：χ(2)（8，n=308）=72.52，P<.001。Mann-Whitney U 检验表明，服用 ACEI 的高血压患者的直肠炎分级明显低于未服用 ACEI 的非高血压患者和未服用 ACEI 的高血压患者（P<.001）。服用 ACEI 的高血压患者发生直肠炎的风险比（RR）明显低于未服用 ACEI 的高血压患者（RR 0.40，95%CI 0.30-0.53，P<.001）和未服用 ACEI 的非高血压患者（RR 0.58，95%CI 0.44-0.77，P<.001）。时间事件分析显示，服用 ACEI 的高血压患者与对照组有显著差异（P<.0001）。此外，服用 ACEI 的高血压患者的直肠炎缓解速度明显更快（P<.0001）。
接受新辅助或辅助激素治疗联合根治性放射治疗的患者服用 ACEI 后发生中重度直肠炎的可能性显著降低（P<.001）。ACEI 的摄入与降低放射性直肠炎的风险显著相关，并且还加速了其缓解。
