關(guān)于口服雙膦酸鹽（BP）的攝入量與結(jié)直腸癌（CRC）風(fēng)險之間的關(guān)聯(lián)，最近幾項研究得到了比較沖突的結(jié)果。為此，本研究收集已發(fā)表的一些研究中的證據(jù)，進(jìn)行一個明確的劑量-反應(yīng)的薈萃分析，研究結(jié)果在線發(fā)表于JCO 。

　　2012年1月15日，通過搜索MEDLINE和EMBASE數(shù)據(jù)庫納入相關(guān)研究。我們納入研究報道了口服雙膦酸鹽和CRC風(fēng)險之間關(guān)聯(lián)的95%置信區(qū)間的效果估計。

　　3個病例對照研究，共16998例CRC和108197對照人群；一個隊列研究納入94405人接受口服雙膦酸鹽和283181人未接受雙膦酸鹽被納入這項薈萃分析。

　　隨機效應(yīng)模型的薈萃分析結(jié)果表明：接受口服雙膦酸鹽的CRC患者的合并風(fēng)險比（OR）為0.87（95％CI，0.78-0.97）。劑量為10劑及以上與CRC呈顯著的負(fù)相關(guān)，合并OR值為0.71（95％CI，0.58-0.87）。同樣，分析表明使用1至3年和超過3年的雙膦酸鹽使用都呈顯著的負(fù)相關(guān)關(guān)系，合并OR值分別為0.76（95％CI，0.68-0.85）和0.78（95％CI，0.61-0.99）。

　　該薈萃分析表明，在10個或更多的處方劑量使用口服雙膦酸鹽或1年或以上的持續(xù)時間的使用都與CRC的風(fēng)險降低相關(guān)。當(dāng)然還需要進(jìn)一步的隨機對照試驗來證明這種關(guān)聯(lián)。

　　Reduced Risk of Colorectal Cancer With Use of Oral Bisphosphonates: A Systematic Review and Meta-Analysis

　　Purpose The association between oral bisphosphonate (BP) intake and colorectal cancer (CRC) risk has been investigated in several recent studies with conflicting results. We summarized the evidence from the published studies in a categorical, dose-response meta-analysis.

　　Methods Relevant studies were identified by a search of MEDLINE and EMBASE databases through January 15, 2012. We included studies that reported effect size estimates with 95% CIs for the association between exposure to oral BPs and risk of CRC.

　　Results Three case-control studies with a total of 16,998 CRC cases and 108,197 controls and one cohort study with 94,405 individuals exposed to BPs and 283,181 unexposed to BPs were included in meta-analysis. The random effect model meta-analysis suggested reduced risk of CRC with exposure to oral BPs with pooled odds ratio (OR) of 0.87 (95% CI, 0.78 to 0.97). Significant inverse relationship was noted for 10 or more presc**tions categories, with pooled ORs of 0.71 (95% CI, 0.58 to 0.87). Similarly, the analysis for 1 to 3 years of use and more than 3 years of use of BPs suggested a significant inverse relationship, with pooled ORs of 0.76 (95% CI, 0.68 to 0.85) and 0.78 (95% CI, 0.61 to 0.99), respectively.

　　Conclusion This meta-analysis suggests that the use of oral BPs at a dose of 10 or more presc**tions or 1 or more years of duration is associated with reduced risk of CRC. Further randomized controlled trials are needed to prove this association.