柳汝明 1,2 , 吳斌 1,2 , 唐堯 1
  • 四川大學(xué)（成都，610041）1 華西醫(yī)院藥劑科，2 華西藥學(xué)院;

【摘要】　目的　 評價舒林酸治療結(jié)直腸息肉的有效性和安全性。　方法　 計算機檢索PubMed、Cochrane Iibrary、Embase、SCI、CNKI、萬方、維普、CBM數(shù)據(jù)庫。按Cochrane系統(tǒng)評價的方法評價納入研究質(zhì)量，并進(jìn)行Meta分析。　結(jié)果　 共納入7個隨機對照試驗（RCT），共235例患者。Meta分析結(jié)果顯示舒林酸治療腺瘤性息肉?。‵AP）在有效率、息肉消失率方面與安慰劑比較，差異無統(tǒng)計學(xué)意義（P gt;0.05）；治療散發(fā)性結(jié)腸腺瘤性息肉?。⊿CAP）在有效率、息肉消失率、腺瘤直徑變化方面與安慰劑比較，差異有統(tǒng)計學(xué)意義（P lt;0.05）；舒林酸的不良反應(yīng)多為消化道癥狀，與安慰劑比較差異有統(tǒng)計學(xué)意義（P lt;0.05）。　結(jié)論　 系統(tǒng)評價結(jié)果顯示舒林酸對于家族性FAP的療效尚不確切，而對SCAP有一定的療效。
【關(guān)鍵詞】結(jié)直腸息肉；舒林酸；有效性；不良反應(yīng)；系統(tǒng)評價
【Abstract】　Objective　 To assess the efficacy and safety of sulindac on colorectal polyps.　Methods　 The literatures were searched from several databases including PubMed,Cochrane Iibrary,SCI,CNKI,Wanfang,VIP,and CBM. The quality of the researches was evaluated according to Cochrane systematic reviews, and the Meta analysis was performed.　Results　 Seven RCT were enrolled with a total of 235 patients. Meta analysis showed that there was no significant difference in the effective rate and polyps disappearance rate of FAP between the two groups (P gt;0.05). There were significant differences in the effective rate, polyps disappearance rate and size of adenomas between the two groups (P lt;0.05); the most common adverse event was the symptoms of digestive tract which differed much from that in the placebo group (P lt;0.05).　Conclusion　 The therapeutic effect of sulindac on FAP is not sure, but it is effective on SCAP.

引用本文： 柳汝明,吳斌,唐堯. 舒林酸治療結(jié)直腸息肉有效性及安全性的系統(tǒng)評價. 華西醫(yī)學(xué), 2011, 26(1): 81-84. doi: 復(fù)制

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2. 　Baron JA. Epidemiology of non-steroidal anti-inflammatory drugs and cancer [J]. Prog Exp Tumor Re, 2003, 37(1): 1-24.
3. 　Cerdan FJ, Torresmelero J, Martinez S, et al. Treatment of familiar adenomatous polyposis-coli with sulindac[J]. Revista Espanola De Enfermedades Digestivas, 1995, 87(8): 574-576.
4. 　Cruzcorrea M, Hylind LM, Romans KE, et al. Long-term treatment with sulindac in familial adenomatous polyposis: a prospective cohort study[J]. Gastroenterology, 2002, 122(3): 641-645.
5. 　Hixson LJ, Earnest DL, Fennerty MB, et al. NSAID effect on sporadic colon polyps[J]. Am J Gastroenterol, 1993, 88(10): 1652-1656.
6. 　Niv Y, Fraser GM. Adenocarcinoma in the rectal segment in familial polyposis coli is not prevented by sulindac therapy[J]. Gastroenterology, 1994, 107(3): 854-857.
7. 　Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 1 [updated September 2008]. The Cochrane Collaboration, 2008.
8. 　Giardiello FM, Hamilton SR, Krush AJ, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis[J]. N Engl J Med, 1993, 328(18): 1313-1316.
9. 　Nugent KP, Farmer KC, Spigelman AD, et al. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis[J]. Br J Surg, 1993, 80(12): 1618-1619.
10. 　Giardiello FM, Yang VW, Hylind LM, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac[J]. N Engl J Med, 2002, 346(14): 1054-1059.
11. 　Ladenheim J, Garcia G, Titzer D, et al. Effect of sulindac on sporadic colonic polyps[J]. Gastroenterology, 1995, 108(4): 1083-1087.
12. 　錢躍清, 呂愈敏, 葉嗣懋. 舒林酸治療散發(fā)性結(jié)直腸腺瘤的臨床研究[J]. 中華消化雜志, 2001, 21(12): 710-712.
13. 　賈道全, 武衛(wèi)國, 羅成福, 等. 舒林酸與內(nèi)鏡下高頻電切治療結(jié)直腸腺瘤的轉(zhuǎn)歸分析[J]. 中華消化內(nèi)鏡雜志, 2003, 20(2): 125-126.
14. 　陳和平, 韓盛璽, 徐剛, 等. 舒林酸治療散發(fā)性結(jié)腸腺瘤性息肉的機制研究[J]. 中國醫(yī)刊, 2008, 43(9): 51-53.
  1. 1. 　吳在德, 吳肇漢. 外科學(xué)[M]. 6版. 北京: 人民衛(wèi)生出版社, 2006: 510-515.
  2. 2. 　Baron JA. Epidemiology of non-steroidal anti-inflammatory drugs and cancer [J]. Prog Exp Tumor Re, 2003, 37(1): 1-24.
  3. 3. 　Cerdan FJ, Torresmelero J, Martinez S, et al. Treatment of familiar adenomatous polyposis-coli with sulindac[J]. Revista Espanola De Enfermedades Digestivas, 1995, 87(8): 574-576.
  4. 4. 　Cruzcorrea M, Hylind LM, Romans KE, et al. Long-term treatment with sulindac in familial adenomatous polyposis: a prospective cohort study[J]. Gastroenterology, 2002, 122(3): 641-645.
  5. 5. 　Hixson LJ, Earnest DL, Fennerty MB, et al. NSAID effect on sporadic colon polyps[J]. Am J Gastroenterol, 1993, 88(10): 1652-1656.
  6. 6. 　Niv Y, Fraser GM. Adenocarcinoma in the rectal segment in familial polyposis coli is not prevented by sulindac therapy[J]. Gastroenterology, 1994, 107(3): 854-857.
  7. 7. 　Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 1 [updated September 2008]. The Cochrane Collaboration, 2008.
  8. 8. 　Giardiello FM, Hamilton SR, Krush AJ, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis[J]. N Engl J Med, 1993, 328(18): 1313-1316.
  9. 9. 　Nugent KP, Farmer KC, Spigelman AD, et al. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis[J]. Br J Surg, 1993, 80(12): 1618-1619.
  10. 10. 　Giardiello FM, Yang VW, Hylind LM, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac[J]. N Engl J Med, 2002, 346(14): 1054-1059.
  11. 11. 　Ladenheim J, Garcia G, Titzer D, et al. Effect of sulindac on sporadic colonic polyps[J]. Gastroenterology, 1995, 108(4): 1083-1087.
  12. 12. 　錢躍清, 呂愈敏, 葉嗣懋. 舒林酸治療散發(fā)性結(jié)直腸腺瘤的臨床研究[J]. 中華消化雜志, 2001, 21(12): 710-712.
  13. 13. 　賈道全, 武衛(wèi)國, 羅成福, 等. 舒林酸與內(nèi)鏡下高頻電切治療結(jié)直腸腺瘤的轉(zhuǎn)歸分析[J]. 中華消化內(nèi)鏡雜志, 2003, 20(2): 125-126.
  14. 14. 　陳和平, 韓盛璽, 徐剛, 等. 舒林酸治療散發(fā)性結(jié)腸腺瘤性息肉的機制研究[J]. 中國醫(yī)刊, 2008, 43(9): 51-53.