Jung Yoon Suk, Park Chan Hyuk, Eun Chang Soo, Park Dong Il, Han Dong Soo
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
J Gastroenterol Hepatol. 2017 May;32(5):957-965. doi: 10.1111/jgh.13639.
Although it is known that metformin can reduce risk of colorectal cancer, it is unclear whether it protects against colorectal adenoma.
This study conducted a systematic literature search on MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "colorectal," "colon," "rectal," "rectum," "adenoma," "polyp," "neoplasia," "neoplasm," "metformin," and "diabetes." Studies were included if they evaluated the association between metformin use and colorectal adenoma and reported odds ratios (ORs) or provided data from which these could be estimated.
Ten studies and a total of 8726 patients were evaluated. Across all studies, a median of 32.1% (range: 15.2-53.0%) of patients taking metformin also had adenoma; a median of 43.5% (range: 20.5-59.6%) of those not taking metformin had adenoma. In our meta-analysis, metformin use reduced the risk of adenoma (pooled OR = 0.76, 95% confidence interval [CI] = 0.63-0.92, I = 60%). Upon subgroup analyses, metformin use tended to reduce risk of adenoma in a high-risk population consisting of patients with a history of colorectal neoplasia (CRN) (pooled OR = 0.61, 95% CI = 0.34-1.10, I = 79%). In addition, metformin reduced the risk of adenoma in a high-risk population consisting of patients with diabetes mellitus (pooled OR = 0.75, 95% CI = 0.62-0.91, I = 57%).
Metformin use seemed to be associated with a reduced risk of colorectal adenoma, especially in high-risk populations consisting of patients with diabetes mellitus or a history of CRN, although statistical power was not achieved in patients with a history of CRN.
尽管已知二甲双胍可降低结直肠癌风险，但尚不清楚其是否能预防结直肠腺瘤。
本研究在MEDLINE、EMBASE和Cochrane图书馆进行了系统文献检索，使用的主要关键词有“结肠直肠”“结肠”“直肠”“直肠部”“腺瘤”“息肉”“瘤形成”“肿瘤”“二甲双胍”和“糖尿病”。如果研究评估了二甲双胍使用与结直肠腺瘤之间的关联，并报告了比值比（OR）或提供了可据此估算这些比值比的数据，则纳入该研究。
共评估了10项研究和8726例患者。在所有研究中，服用二甲双胍的患者中腺瘤患者的中位数为32.1%（范围：15.2% - 53.0%）；未服用二甲双胍的患者中腺瘤患者的中位数为43.5%（范围：20.5% - 59.6%）。在我们的荟萃分析中，使用二甲双胍可降低腺瘤风险（合并OR = 0.76，95%置信区间[CI] = 0.63 - 0.92，I² = 60%）。亚组分析显示，在有结直肠肿瘤（CRN）病史的高危人群中，使用二甲双胍倾向于降低腺瘤风险（合并OR = 0.61，95% CI = 0.34 - 1.10，I² = 79%）。此外，在糖尿病高危人群中，二甲双胍降低了腺瘤风险（合并OR = 0.75，95% CI = 0.62 - 0.91，I² = 57%）。
使用二甲双胍似乎与结直肠腺瘤风险降低有关，尤其是在糖尿病患者或有CRN病史的高危人群中，尽管在有CRN病史的患者中未达到统计学效力。
