维生素 D 和钙对结直肠腺瘤发病、恶变和进展的相加保护作用：系统评价和荟萃分析。
Additively protective effects of vitamin D and calcium against colorectal adenoma incidence, malignant transformation and progression: A systematic review and meta-analysis.
机构信息
Department of Pathology and Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Disease Proteomics of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China; Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Department of Pathology and Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Disease Proteomics of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China.
出版信息
Clin Nutr. 2020 Aug;39(8):2525-2538. doi: 10.1016/j.clnu.2019.11.012. Epub 2019 Nov 16.
BACKGROUND
Colorectal cancer (CRC) exhibits a linear progression from normal colonic epithelium, adenoma initiation, carcinoma transformation and even to metastasis. Diet changes might influence carcinogenesis and prognosis. We aimed to determine the effects of vitamin D and calcium on colorectal adenoma incidence, malignancy development and prognosis.
METHODS
Systematic literature searches (PubMed, Embase, and Cochrane Library databases) and hand searches were performed by September 30, 2019. A random-effects model was adopted to pool relative ratios (RRs) for colorectal tumour incidence or hazard ratios (HRs) for CRC mortality. Stratified analyses were performed by gender, tumour location, calcium intake level and ethnic group.
RESULTS
Total 854,195 cases from 166 studies were included. The colorectal adenoma incidence was inversely correlated with the circulating 25-hydroxyvitamin D [25(OH)D] level (RR: 0.80, 95% CI: 0.71-0.89), vitamin D intake (RR: 0.87, 95% CI: 0.82-0.92) and calcium intake (RR: 0.86, 95% CI: 0.81-0.91). The CRC incidence was decreased by circulating 25(OH)D (RR: 0.67, 95% CI: 0.59-0.77), vitamin D intake (RR: 0.85, 95% CI: 0.78-0.93) and calcium intake (RR: 0.75, 95% CI: 0.70-0.79). High-level circulating 25(OH)D triggered better overall survival (HR: 0.67, 95% CI: 0.57-0.79) and CRC-specific survival (HR: 0.63, 95% CI: 0.53-0.74). Stratified analyses showed that vitamin D and calcium significantly suppressed colorectal tumour incidence among women. Left-sided CRC risk was reversely related to circulating 25(OH)D (RR: 0.60, 95% CI: 0.41-0.88) and vitamin D intake (RR: 0.73, 95% CI: 0.57-0.93). Circulating 25(OH)D decreased colorectal adenoma (RR: 0.63, 95% CI: 0.48-0.82) and CRC (RR: 0.69, 95% CI: 0.56-0.86) risk in populations with higher calcium intake. European and American populations benefited more from vitamin D intake against colorectal tumour. A significant dose-response relationship was observed between intake of vitamin D or calcium and colorectal tumour incidence.
CONCLUSIONS
Vitamin D and calcium play additively chemopreventive roles in colorectal adenoma incidence, malignant transformation and progression, especially for women and left-sided CRC patients.
背景
结直肠癌（CRC）从正常结肠上皮、腺瘤起始、癌转化甚至转移呈线性进展。饮食变化可能会影响致癌作用和预后。我们旨在确定维生素 D 和钙对结直肠腺瘤发病、恶性发展和预后的影响。
方法
系统检索（PubMed、Embase 和 Cochrane 图书馆数据库）和手工检索截至 2019 年 9 月 30 日。采用随机效应模型对结直肠肿瘤发病率的相对比值（RR）或结直肠癌死亡率的风险比（HR）进行汇总。按性别、肿瘤位置、钙摄入量水平和种族进行分层分析。
结果
共纳入 166 项研究中的 854195 例病例。结直肠腺瘤的发病率与循环 25-羟维生素 D [25（OH）D]水平呈负相关（RR：0.80，95%CI：0.71-0.89）、维生素 D 摄入量（RR：0.87，95%CI：0.82-0.92）和钙摄入量（RR：0.86，95%CI：0.81-0.91）。循环 25（OH）D（RR：0.67，95%CI：0.59-0.77）、维生素 D 摄入量（RR：0.85，95%CI：0.78-0.93）和钙摄入量（RR：0.75，95%CI：0.70-0.79）降低了 CRC 发病率。高循环 25（OH）D 水平可改善总体生存率（HR：0.67，95%CI：0.57-0.79）和结直肠癌特异性生存率（HR：0.63，95%CI：0.53-0.74）。分层分析表明，维生素 D 和钙可显著降低女性结直肠肿瘤的发病率。左半结肠癌的发病风险与循环 25（OH）D（RR：0.60，95%CI：0.41-0.88）和维生素 D 摄入量（RR：0.73，95%CI：0.57-0.93）呈负相关。循环 25（OH）D 可降低结直肠腺瘤（RR：0.63，95%CI：0.48-0.82）和 CRC（RR：0.69，95%CI：0.56-0.86）的风险，特别是在钙摄入量较高的人群中。欧洲和美洲人群从维生素 D 摄入中获益更多，可预防结直肠肿瘤。维生素 D 或钙的摄入量与结直肠肿瘤发病率之间存在显著的剂量-反应关系。
结论
维生素 D 和钙在结直肠腺瘤的发生、恶性转化和进展中具有协同化学预防作用，尤其是对女性和左半结肠癌患者。
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