Kuan Yi-Chun, Huang Kuang-Wei, Lin Cheng-Li, Luo Jiing-Chyuan, Kao Chia-Hung
Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan.
Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan.
Cancers (Basel). 2019 Sep 29;11(10):1468. doi: 10.3390/cancers11101468.
The effect of clopidogrel, whose mechanism of action differs from that of aspirin, on CRC risk remains unknown. We investigated the effects of clopidogrel and aspirin, either as monotherapy or combined, on colorectal cancer (CRC) risk in patients with Type 2 diabetes mellitus (T2DM). We conducted a cohort study using Taiwan National Health Insurance Research Database. Four groups comprising 218,903 patients using aspirin monotherapy, 20,158 patients using clopidogrel monotherapy, 42,779 patients using dual antiplatelet therapy, and 281,840 nonuser matched controls were created using propensity score matching. Cox proportional hazards regression was used to evaluate the CRC risk during follow-up. During the 13-year follow-up period, we found 9431 cases of CRC over 3,409,522 person-years. The overall incidence rates of CRC were 2.04, 3.45, 1.55, and 3.52 per 1000 person-years in the aspirin, clopidogrel, dual antiplatelet, and nonuser cohorts, respectively. The adjusted hazard ratios (aHRs) were 0.59 (95% confidence interval [CI], 0.56-0.61), 0.77 (95% CI, 0.68-0.87), and 0.37 (95% CI, 0.33-0.40) for the aspirin, clopidogrel, and dual antiplatelet cohorts, respectively. Dose- and duration-dependent chemopreventive effects were observed in the three cohorts.
氯吡格雷的作用机制与阿司匹林不同，其对结直肠癌风险的影响尚不清楚。我们研究了氯吡格雷和阿司匹林单药治疗或联合治疗对2型糖尿病（T2DM）患者结直肠癌（CRC）风险的影响。我们使用台湾国民健康保险研究数据库进行了一项队列研究。通过倾向得分匹配创建了四组，分别为218,903例使用阿司匹林单药治疗的患者、20,158例使用氯吡格雷单药治疗的患者、42,779例使用双联抗血小板治疗的患者以及281,840例未用药的匹配对照。使用Cox比例风险回归评估随访期间的CRC风险。在13年的随访期内，在3,409,522人年中我们发现了9431例CRC病例。阿司匹林、氯吡格雷、双联抗血小板和未用药队列中CRC的总体发病率分别为每1000人年2.04、3.45、1.55和3.52例。阿司匹林、氯吡格雷和双联抗血小板队列的调整后风险比（aHR）分别为0.59（95%置信区间[CI]，0.56 - 0.61）、0.77（95%CI，0.68 - 0.87）和0.37（95%CI，0.33 - 0.40）。在这三个队列中观察到了剂量和持续时间依赖性的化学预防作用。
