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姜黄素在溃疡性结肠炎中的应用:它已准备好进入黄金时代了吗?一项临床试验的系统评价和荟萃分析。

Curcumin use in ulcerative colitis: is it ready for prime time? A systematic review and meta-analysis of clinical trials.

作者信息

Chandan Saurabh, Mohan Babu P, Chandan Ojasvini C, Ahmad Rizwan, Challa Abhishek, Tummala Hemachand, Singh Shailender, Dhawan Punita, Ponnada Suresh, Singh Amar B, Adler Douglas G

机构信息

Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Saurabh Chandan, Abhishek Challa, Shailender Singh).

Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona (Babu P. Mohan).

出版信息

Ann Gastroenterol. 2020 Jan-Feb;33(1):53-58. doi: 10.20524/aog.2019.0439. Epub 2019 Nov 29.

Abstract

BACKGROUND

Curcumin, an active ingredient of the Indian herb turmeric (Curcuma longa), has shown promising anti-inflammatory properties. Studies of its potential benefits in treating patients with ulcerative colitis (UC) are limited. We performed a systematic review and meta-analysis of human randomized placebo controlled trials to evaluate the efficacy of adjunctive therapy with curcumin in treating patients with UC.

METHODS

We conducted a search of several databases (from January 2000 to September 2018). A random-effects model was used for analysis. We assessed heterogeneity between study-specific estimates using the Cochran Q statistical test, 95% prediction interval (PI) and I statistics. The outcomes assessed were the pooled odds of clinical response and remission as well as the endoscopic response.

RESULTS

A total of 7 studies with 380 patients (curcumin n=188; placebo n=190) were included in the final analysis. The pooled odds ratio for clinical remission with curcumin use was 2.9 (95%CI 1.5-5.5, I=45, P=0.002), clinical response was 2.6 (95%CI 1.5-4.5, I=74%, P=0.001), and endoscopic response/remission was 2.3 (95%CI 1.2-4.6, I=35.5%, P=0.01).

CONCLUSIONS

Based on our study, combined mesalamine and curcumin therapy was associated with roughly threefold better odds of a clinical response compared to placebo, with minimal side effects. This response was statistically significant, albeit with heterogeneity, probably due to the different severity scoring indices, curcumin dosages and routes of drug delivery used.

摘要

背景

姜黄素是印度草药姜黄(Curcuma longa)的一种活性成分,已显示出有前景的抗炎特性。关于其在治疗溃疡性结肠炎(UC)患者中的潜在益处的研究有限。我们进行了一项系统评价和荟萃分析,纳入人类随机安慰剂对照试验,以评估姜黄素辅助治疗UC患者的疗效。

方法

我们检索了多个数据库(2000年1月至2018年9月)。采用随机效应模型进行分析。我们使用Cochran Q统计检验、95%预测区间(PI)和I统计量评估各研究特异性估计值之间的异质性。评估的结局包括临床缓解和应答的合并比值比以及内镜应答。

结果

最终分析纳入了7项研究,共380例患者(姜黄素组n = 188;安慰剂组n = 190)。使用姜黄素实现临床缓解的合并比值比为2.9(95%CI 1.5 - 5.5,I = 45,P = 0.002),临床应答为2.6(95%CI 1.5 - 4.5,I = 74%,P = 0.001),内镜应答/缓解为2.3(95%CI 1.2 - 4.6,I = 35.5%,P = 0.01)。

结论

基于我们的研究,与安慰剂相比,美沙拉嗪联合姜黄素治疗使临床应答的几率提高了约三倍,且副作用最小。尽管存在异质性,但这种应答具有统计学意义,可能是由于使用了不同的严重程度评分指数、姜黄素剂量和给药途径。

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