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目的系统性评价选择性环氧合酶(COX)-2抑制剂预防结直肠腺瘤的有效性和安全性。方法检索 Medline(1966至2006年)数据库,OVID(1996至2007年)数据库,EMBASE(1980至2007年1月)数据库,Cochrane 图书馆(至2007年1月)以及中国生物医学文献数据库(CBM disk,1997至2007年1月)并鉴定随机对照研究(RCT)的质量。按 Jadad 质量评分进行评定。用RevMan4.2软件进行荟萃分析。结果 6项随机临床实验中共5708例患者满足纳入标准。选择性COX-2抑制剂与安慰剂比较,能显著降低腺瘤检出率(RR:0.70,95%CI:0.55～0.88,P=0.0003)以及晚期腺瘤检出率(RR:0.69,95%CI:0.53～0.89,P=0.005)。两者发生不良反应事件的危险度差异无统计学意义(RR:1.07,95%CI:0.98～1.17,P=0.11),但并发心血管等严重事件的危险度差异有统计学意义(RR:1.21,95%CI:1.09～1.33,P=0.0002)。结论选择性 COX-2抑制剂可以有效消退结直肠腺瘤性息肉,可用于结直肠肿瘤的化学预防。但因为其潜在的心血管疾病等风险,尚不可作为常规用药。
Objective To systematically evaluate the effectiveness and safety of selective cyclooxygenase (COX) -2 inhibitors in preventing colorectal adenoma. Methods The databases of Medline (1966-2006), OVID (1996-2007) database, EMBASE database (January 1980), Cochrane Library (January 2007) and CBM disk , 1997 to January 2007) and to identify the quality of randomized controlled studies (RCTs). Rated by Jadad Quality Score. Meta-analysis with RevMan 4.2 software. Results A total of 5708 patients in 6 randomized clinical trials met the inclusion criteria. Selective COX-2 inhibitors significantly reduced adenoma detection rates (RR: 0.70, 95% CI: 0.55-0.88, P = 0.0003) and late adenoma detection rates (RR: 0.69, 95 vs. placebo) % CI: 0.53-0.89, P = 0.005). There were no significant differences in the risk of adverse events between the two groups (RR: 1.07, 95% CI: 0.98 to 1.17, P = 0.11), but there were significant differences in the risk of cardiovascular events (RR: 1.21, 95% CI: 1.09-1.33, P = 0.0002). Conclusions Selective COX-2 inhibitors can effectively eliminate colorectal adenomatous polyps and can be used for chemoprevention of colorectal tumors. However, because of its potential risk of cardiovascular disease, not yet used as a routine medication.