熊去氧胆酸预防溃疡性结肠炎相关结直肠癌和上皮内瘤变的Meta分析

摘要

目的：系统评价熊去氧胆酸（UDCA）预防溃疡性结肠炎相关结直肠癌（UC-CRC）和上皮内瘤变（UC-Dys）的有效性，以为临床提供循证参考。方法：计算机检索Cochrane图书馆、EMBase、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库和万方数据库，收集UDCA（试验组）对比安慰剂（对照组）预防UC-CRC和UC-Dys有效性的随机对照试验（RCT）或队列研究，对符合纳入标准的研究进行资料提取，并采用Cochrane系统评价员手册5.1.0进行质量评价，采用Rev Man 5.3统计软件进行Meta分析。结果：共纳入7项研究，包括3项RCT和4项队列研究，合计672例患者。3项RCT的Meta分析结果显示，两组患者UC-CRC和UC-Dys发生率比较，差异均无统计学意义[OR＝0.95，95％CI（0.17，5.12），P＝0.95]；4项队列研究的Meta分析结果显示，两组患者UC-CRC和UC-Dys发生率比较，差异均无统计学差异[OR＝0.74，95％CI（0.30，1.84），P＝0.52]。亚组分析结果显示，试验组低剂量UDCA（＜15 mg/kg）UC-CRC和UC-Dys发生率均显著低于对照组，差异均有统计学意义[OR＝0.19，95％CI（0.08，0.49），P＜0.001]；两组高剂量UDCA（≥15 mg/kg）UC-CRC和UC-Dys发生率比较，差异均无统计学意义[OR＝1.97，95％CI（0.53，7.25），P＝0.31]。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：UDCA不能有效地降低UC-CRC和UC-Dys发病率，但低剂量UDCA有降低UC-CRC和UC-Dys癌变发生风险的趋势。%OBJECTIVE:To systematically review the efficacy of ursodeoxycholic acid(UDCA)in the prevention ofulcerative colitisassociated colorectal cancer (UC-CRC) and dysplasia (UC-Dys),and provide evidence-based reference for clinic. METH-ODS:Retrieved from Cochrane Library,EMBase,PubMed,CJFD,CBM,VIP and Wanfang Database,randomized controlled tri-als(RCT)or cohort studies about UDCA(test group)versus placebo(control group)in the prevention of UC-CRC and UC-Dys were collected. Meta-analysis was performed by using Rev Man 5.3 software after quality evaluation and data extraction by Co-chrane Manual 5.1.0. RESULTS:Totally 7 studies(3 randomized controlled trials and 4 cohort studies)were included in the analy-sis,involving 672 patients. Results of Meta-analysis of 3 RCT showed that there was no significant difference in the incidence of UC-CRC and UC-Dys between 2 groups [OR=0.95,95%CI(0.17,5.12),P=0.95];results of Meta-analysis of 4 cohort studiess-howed that there was no significant difference in the incidence of UC-CRC and UC-Dys between 2 groups[OR=0.74,95%CI(0.30, 1.84),P=0.52]. Results of subgroup analysis showed,the incidence of UC-CRC and UC-Dys in test group with low-dose UDCA (0.05). CONCLUSIONS:UDCA can not decease the incidence of UC-CRC and UC-Dys,it only prompts a possible trend toward decreased UC-CRC and UC-Dys risk in low-doseUDCA.