Aspirin and folic acid for the prevention of recurrent colorectal adenomas
Aspirin and folic acid for the prevention of recurrent colorectal adenomas
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DOI：
10.1053/j.gastro.2007.10.014
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发表时间：
2008-01-01
期刊：
影响因子：
29.4
通讯作者：
Muir, Kenneth R.
中科院分区：
文献类型：
--
作者：
Logan, Richard F. A.;Grainge, Matfhew J.;Muir, Kenneth R.
背景和目标：虽然观察性研究发现，定期服用阿司匹林与结直肠肿瘤风险降低有关，但使用阿司匹林的随机试验结果并不一致。在观察性研究中，膳食叶酸摄入也被发现与结肠直肠肿瘤风险降低有关。研究方法：采用2 × 2析因设计进行了一项阿司匹林（300 mg/d）和叶酸补充剂（0.5 mg/d）预防结直肠腺瘤复发的多中心、随机、双盲试验。所有患者在招募前6个月内切除了腺瘤（>= 0.5 cm），并在约3年后以4个月的间隔进行第二次结肠镜检查。主要结果指标是基线后诊断的结直肠腺瘤。结果：共有945例患者被纳入研究，其中853例（90.3%）接受了第二次结肠镜检查。总的来说，434例接受阿司匹林治疗的患者中有99例（22.8%）复发腺瘤，而419例接受安慰剂治疗的患者中有121例（28.9%）复发腺瘤（相对风险为0.79; 95%置信区间[CI]为0.63-0.99）。共有104例患者发生了晚期结直肠腺瘤;其中41例（9.4%）在阿司匹林组，63例（15.0%）在安慰剂组（相对风险，0.63; 95%CI，0.43-0.91）。补充叶酸对腺瘤复发没有影响（相对危险度，1.07; 95%CI，0.85-1.34）。结论：阿司匹林（300 mg/天）而不是叶酸（0.5 mg/天）的使用被发现可以降低结直肠腺瘤复发的风险，有证据表明阿司匹林在预防晚期病变的发展方面具有重要作用。
Background& Aims: Although observational studies have found regular aspirin use to be associated with a reduced risk of colorectal neoplasia, results from randomized trials using aspirin have been inconsistent. Dietary folate intake also has bee n found to be associated with a reduced risk of colorectal neoplasms in observational studies. Methods: A multicenter, randomized, double-blind trial of aspirin (300 mg/day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 2 X 2 factorial design. All patients had an adenoma ( >= 0.5 cm) removed in the 6 months before recruitment and were followed-up at 4-month intervals with a second colonoscopy after approximately 3 years. The primary outcome measure was a colorectal adenoma diagnosed after baseline. Results: A total of 945 patients were recruited into the study, of whom 853 (90.3%) underwent a second colonoscopy. In total, 99 (22.8%) of 434 patients receiving aspirin had a recurrent adenoma compared with 121 (28.9%) of 419 patients receiving placebo (relative risk, 0.79; 95% confidence interval [CI], 0.63-0.99). A total of 104 patients developed an advanced colorectal adenoma; 41 (9.4%) of these were in the aspirin group and 63 (15.0%) were in the placebo group (relative risk, 0.63; 95% CI, 0.43-0.91). Folate supplementation was found to have no effect on adenoma recurrence (relative risk, 1.07; 95% Cl, 0.85-1.34). Conclusions: Aspirin (300 mg/day) but not folate (0.5 mg/day) use was found to reduce the risk of colorectal adenoma recurrence, with evidence that aspirin could have a significant role in preventing the development of advanced lesions.