作　　者： (龙林竞）; (曹国丽）; (李玉婷）; (汤绍辉）;

机构地区： 暨南大学附属第一医院消化内科,广州510630

出　　处： 《中国循证医学杂志》 2017年第9期1051-1059,共9页

摘　　要： 目的系统评价血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEIs/ARBs)与消化系统肿瘤发生或预后之间的关系。方法计算机检索Pub Med、EMbase、The Cochrane Library、CNKI、Wan Fang Data、VIP和CBM数据库,搜集关于ACEIs/ARBs与消化系统肿瘤发生或预后关系的研究,检索时限为建库至2017年2月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入21篇文献的32个研究。Meta分析结果显示:(1)ACEIs/ARBs可降低结直肠癌的发病风险[OR=0.92,95%CI(0.86,0.99),P=0.023],但ACEIs/ARBs与肝癌、胃癌的发病风险无明显相关性。(2)ACEIs/ARBs可改善结直肠癌患者的生存期[HR=0.79,95%CI(0.63,0.98),P=0.031],但ACEIs/ARBs与胰腺癌患者的生存期无明显相关性[HR=0.75,95%CI(0.50,1.13),P=0.165]。结论 ACEIs/ARBs可降低结直肠癌的发病风险,改善结直肠癌患者的预后,但其可能与消化系统其他肿瘤的发生或预后没有相关性。受纳入研究的数量及质量限制,上述结论尚需开展更多高质量研究予以验证。 Objective To systematically review the association between angiotensin-converting enzyme inhibitors （ACEIs）/angiotensin receptor blockers （ARBs） therapy and digestive system neoplasms. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were searched from inception to February 2017 to collect studies about ACEIs/ARBs therapy and risk of digestive system neoplasms or survival of digestive system neoplasms patients. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, then meta-analysis was performed using Stata 12.0 software. Results A total of 21 articles including 32 studies were included. The results of meta-analysis showed that ACEIs/ARBs therapy could reduce the risk of colorectal cancer （OR=0.92, 95%CI 0.86 to 0.99, P=0.023）, but there were no relationships between ACEIs/ARBs therapy and the risk of liver cancer or gastric cancer. ACEIs/ARBs therapy could improve the survival of colorectal cancer patients （HR=0.79, 95%CI 0.63 to 0.98, P=0.031）, but there was no association between ACEIs/ARBs therapy and the survival of pancreatic cancer patients （HR=0.75, 95%CI 0.50 to 1.13, P=0.165）. Conclusion ACEIs/ARBs therapy may reduce the risk of colorectal cancer, as well as improve the survival of colorectal cancer patients, but there are no significant relationships between ACEIs/ARBs therapy and the risk or the survival of other digestive system neoplasms, such as liver cancer, gastric cancer and pancreatic cancer. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关 键 词： 消化系统肿瘤 结直肠癌 肝癌 胃癌 胰腺癌 分析