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目的系统评价血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEIs/ARBs)与消化系统肿瘤发生或预后之间的关系。方法计算机检索Pub Med、EMbase、The Cochrane Library、CNKI、Wan Fang Data、VIP和CBM数据库,搜集关于ACEIs/ARBs与消化系统肿瘤发生或预后关系的研究,检索时限为建库至2017年2月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入21篇文献的32个研究。Meta分析结果显示:(1)ACEIs/ARBs可降低结直肠癌的发病风险[OR=0.92,95%CI(0.86,0.99),P=0.023],但ACEIs/ARBs与肝癌、胃癌的发病风险无明显相关性。(2)ACEIs/ARBs可改善结直肠癌患者的生存期[HR=0.79,95%CI(0.63,0.98),P=0.031],但ACEIs/ARBs与胰腺癌患者的生存期无明显相关性[HR=0.75,95%CI(0.50,1.13),P=0.165]。结论 ACEIs/ARBs可降低结直肠癌的发病风险,改善结直肠癌患者的预后,但其可能与消化系统其他肿瘤的发生或预后没有相关性。受纳入研究的数量及质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the relationship between angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACEIs / ARBs) and the occurrence or prognosis of digestive system tumors. Methods The databases of PubMed, EMbase, The Cochrane Library, CNKI, Wan Fang Data, VIP and CBM were searched by computer. The relationship between ACEIs / ARBs and tumorigenesis and prognosis of digestive system was collected. The search period was from February to February 2017. Two researchers independently screened the literature, extracted the data, and assessed the risk of being included in the study after the Meta-analysis using Stata 12.0 software. Results A total of 32 studies were included in 21 articles. Meta analysis showed that: (1) ACEIs / ARBs could reduce the risk of colorectal cancer [OR = 0.92,95% CI (0.86,0.99), P = 0.023] Clearly relevant. (2) ACEIs / ARBs could improve the survival of patients with colorectal cancer [HR = 0.79,95% CI (0.63,0.98), P = 0.031], but there was no significant correlation between ACEIs / ARBs and the survival of patients with pancreatic cancer [ HR = 0.75, 95% CI (0.50, 1.13), P = 0.165]. Conclusion ACEIs / ARBs can reduce the risk of colorectal cancer and improve the prognosis of patients with colorectal cancer, but may not be associated with the occurrence or prognosis of other cancers in the digestive system. Due to the quantity and quality limitations of the included studies, more conclusions need to be drawn to more high-quality studies.