Differences in risk factor-colorectal adenoma associations according to non-steroidal anti-inflammatory drug use.
Differences in risk factor-colorectal adenoma associations according to non-steroidal anti-inflammatory drug use.
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DOI：
10.1097/meg.0000000000001252
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发表时间：
2018-11
影响因子：
2.1
通讯作者：
Bostick RM
中科院分区：
文献类型：
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作者：
Mujtaba S;Bostick RM
由于多项观察性研究和大型随机对照试验表明，非甾体抗炎药（NSAID）可显著降低结直肠肿瘤的风险，因此我们研究了NSAID的使用是否掩盖了各种其他风险因素与结直肠肿瘤的相关性。使用来自三项偶发散发性结直肠腺瘤病例对照研究的汇总数据（汇总n = 789例，2,035例无息肉对照），使用多变量logistic回归，我们研究了各种风险因素与结直肠腺瘤的关联，并按NSAID使用分层。多变量调整的比值比（OR）示例按常规非阿司匹林NSAID未使用/使用列出的暴露量最高相对于最低四分位数的患者（95%置信区间[CI]）分别为1.57（CI 0.96，2.55）与1.14（0.37，3.49）总脂肪，1.37（CI 0.86，2.18）与0.70（CI 0.23，2.25）饱和脂肪，0.93（CI 0.68，1.28）与1.30（CI 0.61，2.75）钙，0.89水果和蔬菜总量分别为1.38（CI 0.65，2.94）和0.85（CI 0.65，1.11），体力活动分别为0.94（CI 0.52，1.71）和0.85（CI 0.65，1.11）。对于目前吸烟者与从不吸烟者，非NSAID常规使用者/非使用者的OR（95% CI）分别为2.91（CI 2.22，3.82）vs. 1.75（CI 0.90，3.41），肥胖者与正常体重者的OR（95% CI）分别为1.67（CI 1.28，2.17）vs. 1.19（CI 0.69，2.04）。我们的研究结果表明，除了简单的混杂因素，定期使用非阿司匹林NSAID可能会掩盖主要危险因素与结直肠腺瘤的相关性，并支持定期评估此类相关性，并按定期使用非阿司匹林NSAID进行分层。
Because multiple observational studies and large, randomized controlled trials indicate that non-steroidal anti-inflammatory drugs (NSAIDs) strongly reduce risk for colorectal neoplasms, we investigated whether NSAID use masks associations of various other risk factors with colorectal neoplasms. Using pooled data from three case-control studies of incident, sporadic colorectal adenoma (pooled n = 789 cases, 2,035 polyp-free controls), using multivariable logistic regression, we investigated various risk factor-colorectal adenoma associations stratified by NSAID use. Example multivariable-adjusted odds ratios (OR) (95% confidence intervals [CI]) for those in the highest relative to the lowest quartiles of exposure, by regular non-aspirin NSAID non-use/use, respectively, were 1.57 (CI 0.96, 2.55) vs. 1.14 (0.37, 3.49) for total fat, 1.37 (CI 0.86, 2.18) vs. 0.70 (CI 0.23, 2.25) for saturated fat, 0.93 (CI 0.68, 1.28) vs. 1.30 (CI 0.61, 2.75) for calcium, 0.89 (CI 0.64, 1.23) vs. 1.38 (CI 0.65, 2.94) for total fruits and vegetables, and 0.85 (CI 0.65, 1.11) vs. 0.94 (CI 0.52,1.71) for physical activity. For current versus never smokers, the ORs (95% CIs) among regular non-NSAID users/non-users were 2.91 (CI 2.22, 3.82) vs. 1.75 (CI 0.90, 3.41), and for those who were obese versus those who were normal weight, they were 1.67 (CI 1.28, 2.17) vs. 1.19 (CI 0.69, 2.04). Our findings suggest that regular non-aspirin NSAID use may mask, beyond simple confounding, associations of major risk factors with colorectal adenoma, and support routinely assessing such associations stratified by regular non-aspirin NSAID use.