【摘要】 目的 評價舒林酸治療結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數據庫。按Cochrane系統評價的方法評價納入研究質量，并進行Meta分析。 結果 共納入7個隨機對照試驗（RCT），共235例患者。Meta分析結果顯示舒林酸治療腺瘤性息肉病（FAP）在有效率、息肉消失率方面與安慰劑比較，差異無統計學意義（Pgt;0.05）；治療散發性結腸腺瘤性息肉病（SCAP）在有效率、息肉消失率、腺瘤直徑變化方面與安慰劑比較，差異有統計學意義（Plt;0.05）；舒林酸的不良反應多為消化道癥狀，與安慰劑比較差異有統計學意義（Plt;0.05）。 結論 系統評價結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。【關鍵詞】結直腸息肉；舒林酸；有效性；不良反應；系統評價【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 (Pgt;0.05). There were significant differences in the effective rate, polyps disappearance rate and size of adenomas between the two groups (Plt;0.05); the most common adverse event was the symptoms of digestive tract which differed much from that in the placebo group (Plt;0.05). Conclusion The therapeutic effect of sulindac on FAP is not sure, but it is effective on SCAP.
【摘要】 目的 采用循證醫學的方法評價硫唑嘌呤（aiathioprine，AZA）治療潰瘍性結腸炎（ulcerative colitis，UC）的有效性和安全性。 方法 計算機檢索PubMed、Cochrane library、Embase、CNKI、維普和CBM數據庫收集國內外關于AZA診療UC的隨機對照試驗（ramdomized controllel trial，RCT）。按Cochrane系統評價的方法評價納入研究質量，并進行Meta分析。 結果 共納入5個RCT，共262例UC患者。Meta分析結果顯示，AZA治療UC在緩解率方面與安慰劑比較，差異無統計學意義[P=1.19，95%CI（0.94，1.49），P=0.14]；在復發率方面，兩者比較差異有統計學意義[P=0.72，95%CI（0.54，0.95），P=0.02]；全部不良反應方面和嚴重不良反應方面，兩者比較差異無統計學意義，Meta分析結果分別為[P=2.52，95%CI（0.82，7.74），P=0.11]和[P=4.03，95%CI（0.88，18.53），P=0.07]。 結論 系統評價結果為AZA在療效方面優于安慰劑，在不良反應發生率方面差異無統計學意義。但由于納入的5個研究中沒有高質量的RCT，且有1個可能產生高度偏倚，使得這一結論受到影響，有必要開展更多設計嚴謹，大樣本、多中心的RCT。【Abstract】 Objective To assess the efficacy and safety of azathio-prine in the treatment of ulcerative colitis through an evidence-based method. Methods We searched the literature from databases like PubMed, Cochrane library, CNKI, VIP, and CBM, and evaluated the quality of studies according to Cochrane systematic review. Finally, Meta-analysis was performed. Results Five randomized controlled trials (RCT) were included in this study with a total of 262 patients. Meta-analysis showed that there was no significant difference in the rate of remission between azathio-prine and placebo in treating ulcerative colitis [P=1.19, 95%CI (0.94, 1.49),P=0.14]. There was significant difference in the relapse rate between the two treating methods [P=0.72, 95%CI (0.54, 0.95),P=0.02]. In addition, there was no statistical difference in all adverse effects [P=2.52, 95%CI (0.82, 7.74),P=0.11] and serious adverse effects [P=4.03, 95%CI (0.88, 18.53),P=0.07] between the two treating methods. Conclusion In the treatment of ulcerative colitis, azathio-prine has a significant advantage in efficacy than placebo, but there is no significant difference in the rate of adverse events between the two groups. However, none of the 5 RCT included in this review has a high quality and one of them even probably has a high bias, which has a big influence on our conclusion. Consequently, multi-center large-scale randomized controlled trials of higher quality are needed to make confirmation.
