Calcium supplements for the prevention of colorectal adenomas
Calcium supplements for the prevention of colorectal adenomas
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DOI：
10.1056/nejm199901143400204
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发表时间：
1999-01-14
影响因子：
158.5
通讯作者：
Greenberg, ER
中科院分区：
文献类型：
--
作者：
Baron, JA;Beach, M;Greenberg, ER
背景和方法实验室、临床和流行病学证据表明钙可能有助于预防结直肠腺瘤。我们进行了一项随机、双盲试验，研究补充碳酸钙对结直肠腺瘤复发的影响。我们随机分配 930 名近期有结直肠腺瘤病史的受试者（平均年龄 61 岁；72% 为男性）接受碳酸钙（3 克[1200 毫克元素钙]乳制品）或安慰剂，并在合格检查一年和四年后进行后续结肠镜检查。主要终点是在第一次随访内窥镜检查后直至（并包括）第二次随访检查时检测到至少一个腺瘤的受试者比例。根据年龄、性别、研究前终生腺瘤数量、临床中心和监测期长度调整腺瘤复发的风险比。结果钙组受试者腺瘤复发的风险较低。在接受至少一项研究结肠镜检查的 913 名受试者中，与安慰剂相比，钙治疗腺瘤复发的调整后风险比为 0.85（95% 置信区间，0.74 至 0.98；P=0.03）。主要分析基于完成两项后续检查的 832 名受试者（钙组 409 名，安慰剂组 423 名）。钙剂组 127 名受试者（31%）和安慰剂组 159 名受试者（38%）在第一次和第二次随访内窥镜检查之间至少诊断出一个腺瘤；调整后的风险比为 0.81（95% 置信区间，0.67 至 0.99；P=0.04）。钙剂组与安慰剂组腺瘤平均数量的调整后比率为 0.76（95% 置信区间，0.60 至 0.96；P=0.02）。钙的作用与初始膳食脂肪和钙的摄入量无关。结论 钙补充剂可显着（尽管适度）降低结直肠腺瘤复发的风险。 (N Engl J Med 1999;340:101-7) (C) 1999，马萨诸塞州医学会。
Background and Methods Laboratory, clinical, and epidemiologic evidence suggests that calcium may help prevent colorectal adenomas. We conducted a randomized, double-blind trial of the effect of supplementation with calcium carbonate on the recurrence of colorectal adenomas. We randomly assigned 930 subjects (mean age, 61 years; 72 percent men) with a recent history of colorectal adenomas to receive either calcium carbonate (3 g [1200 mg of elemental calcium] dairy) or placebo, with follow-up colonoscopies one and four years after the qualifying examination. The primary end point was the proportion of subjects in whom at least one adenoma was detected after the first follow-up endoscopy but up to (and including) the second follow-up examination. Risk ratios for the recurrence of adenomas were adjusted for age, sex, lifetime number of adenomas before the study, clinical center, and length of the surveillance period.Results The subjects in the calcium group had a lower risk of recurrent adenomas. Among the 913 subjects who underwent at least one study colonoscopy, the adjusted risk ratio for any recurrence of adenoma with calcium as compared with placebo was 0.85 (95 percent confidence interval, 0.74 to 0.98; P=0.03). The main analysis was based on the 832 subjects (409 in the calcium group and 423 in the placebo group) who completed both follow-up examinations. At least one adenoma was diagnosed between the first and second follow-up endoscopies in 127 subjects in the calcium group (31 percent) and 159 subjects in the placebo group (38 percent); the adjusted risk ratio was 0.81 (95 percent confidence interval, 0.67 to 0.99; P=0.04). The adjusted ratio of the average number of adenomas in the calcium group to that in the placebo group was 0.76 (95 percent confidence interval, 0.60 to 0.96; P=0.02). The effect of calcium was independent of initial dietary fat and calcium intake.Conclusions Calcium supplementation is associated with a significant - though moderate - reduction in the risk of recurrent colorectal adenomas. (N Engl J Med 1999;340:101-7) (C) 1999, Massachusetts Medical Society.