口服阿司匹林预防结直肠腺瘤行内镜切除术后复发的临床研究

摘要

Objective To investigate the preventive effect and safety of oral asipirin on reducing the recurrence of colorectal adenoma after resection by endoscopy. Methods This study was a single center, prospective, randomized, open, controlled study. One hundred and four eligible patients with sporadic colorectal adenomas removed under colonoscopy were enrolled and randomized into two groups by random number table. Cases in the experimental group received daily aspirin (100mg/day, n=52), and patients in the control group took daily vitamin C(100 mg/day,n=52) for two years. The primary outcome was adenoma recurrence rate assessed by colonoscopy within two years after removal. Secondary outcomes were total number, size and pathological features of recurrent colorectal adenomas, safety and adverse effects of taking asipirin. Results There were no significant differences in demographic and clinicopathological features between two groups(P>0.05). Lower recurrence rate was observed in the experimental group [7.7%(4/52) vs. 23.1%(12/52), χ2=4.727, P=0.030]. Moreover, no aspirin usage (95% CI: 1.072-1.647, P=0.009), smoking (95% CI: 1.242-1.618, P<0.001), high grade dysplasia (95% CI: 1.113-1.514, P=0.001) were independent factors of recurrence by multivariate logistic model analysis. Both groups had similar adverse effects rates (9.6%vs. 11.5%,P=0.750). The two groups did not differ significantly in terms of total number, size and pathological features of recurrent colorectal adenomas (all P>0.05). Conclusions Oral aspirin intake (100mg/day) can reduce 2-year recurrence rate of colorectal adenomas with optimal safety and little side effects.%目的：探讨口服阿司匹林对降低结直肠腺瘤在内镜切除术后复发的预防作用和安全性评价。方法本研究为单中心、前瞻性、随机、开放、病例对照研究。前瞻性将104例符合入组标准、已经在内镜下行散发性结直肠腺瘤切除的患者纳入研究，按随机数字表法分为2组：研究组患者每日口服100mg阿司匹林（共52例），对照组每日口服维生素C（共52例），两组均进行连续2年的药物治疗。首要研究终点为术后2年内结直肠腺瘤的复发率，次要研究目标为分析复发的结直肠腺瘤的数目、大小和病理学指标，评估阿司匹林的安全性及不良反应。结果两组患者在流行病学及临床病理特征无显著的差异（P＞0．05）。研究组的结直肠腺瘤复发率明显低于对照组[7．7％（4／52） vs．23．1％（12／52），χ2＝4．727，P＝0．030]。多因素Logistic 模型分析显示不使用阿司匹林（95％ CI：1．072～1．647，P＝0．009）、吸烟（95％ CI：1．242～1．618，P＜0．001）以及高度不典型增生（95％ CI：1．113～1．514，P＝0．001）是结直肠腺瘤复发的高危因素。研究组和对照组具有相似的不良反应（9．6％ vs 11．5％，P＝0．750）。两组患者在复发结直肠腺瘤的数目、大小和病理学指标方面未见显著的统计学差异（均P＞0．05）。结论口服阿司匹林100 mg／d能够降低结直肠腺瘤2年复发率，并且低剂量的阿司匹林安全性较好，不良反应率低。