High-Dose Ursodeoxycholic Acid Is Associated With the Development of Colorectal Neoplasia in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis
High-Dose Ursodeoxycholic Acid Is Associated With the Development of Colorectal Neoplasia in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis
复制标题
DOI：
10.1038/ajg.2011.156
复制
发表时间：
2011-09-01
影响因子：
9.8
通讯作者：
Lindor, Keith D.
中科院分区：
文献类型：
--
作者：
Eaton, John E.;Silveira, Marina G.;Lindor, Keith D.
目的：已有研究表明熊去氧胆酸(UDCA)对溃疡性结肠炎(UC)和原发性硬化性胆管炎(PSC)患者大肠肿瘤的发生具有化学预防作用。我们研究了大剂量(28-30 mg/kg/天)UDCA对UC和PSC患者大肠肿瘤发生的影响。方法：在先前的大剂量UDCA多中心随机安慰剂对照试验中，对UC和PSC患者大肠肿瘤的发生进行了评估。接受UDCA治疗的UC和PSC患者与接受安慰剂治疗的患者进行比较。我们回顾了低度或高度不典型增生或结直肠癌的病理和结肠镜检查报告。结果：共对56名受试者进行了235年的随访。两组的基线特征(包括PSC和UC的持续时间、药物、患者年龄、结直肠癌家族史和吸烟状况)相似。在研究期间，接受大剂量UDCA的患者发生结直肠肿瘤(异型增生和癌症)的风险显著高于接受安慰剂的患者(风险比：4.44，95%可信区间：1.30-20.10，P=0.02)。结论：长期使用大剂量UDCA与UC和PSC患者发生结直肠肿瘤的风险增加有关。
OBJECTIVES: Some studies have suggested that ursodeoxycholic acid (UDCA) may have a chemopreventive effect on the development of colorectal neoplasia in patients with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). We examined the effects of high-dose (28-30 mg/kg/day) UDCA on the development of colorectal neoplasia in patients with UC and PSC.METHODS: Patients with UC and PSC enrolled in a prior, multicenter randomized placebo-controlled trial of high-dose UDCA were evaluated for the development of colorectal neoplasia. Patients with UC and PSC who received UDCA were compared with those who received placebo. We reviewed the pathology and colonoscopy reports for the development of low-grade or high-grade dysplasia or colorectal cancer.RESULTS: Fifty-six subjects were followed for a total of 235 patient years. Baseline characteristics (including duration of PSC and UC, medications, patient age, family history of colorectal cancer, and smoking status) were similar for both the groups. Patients who received high-dose UDCA had a significantly higher risk of developing colorectal neoplasia (dysplasia and cancer) during the study compared with those who received placebo (hazard ratio: 4.44, 95% confidence interval: 1.30-20.10, P=0.02).CONCLUSIONS: Long-term use of high-dose UDCA is associated with an increased risk of colorectal neoplasia in patients with UC and PSC.