背景:碘溶液食管染色内镜对早期食管癌的检测具有重要意义。Lugol’s碘溶液对轻度染色病变的常规治疗效果有限,在常规饮食中添加天然物质变得越来越普遍。如先前的研究报道的,醋具有抗肿瘤作用。
目的:评价食醋是否能改善食管轻度病变患者的预后。
方法:这项前瞻性单中心试验纳入了2020年6月至2022年4月期间出现轻度染色病变的连续患者。实验组的患者在6个月内接受了更多的醋。该研究的主要结果是临床治疗效果。还详细记录了与食醋有关的并发症和不良事件。
结果:共有166例患者纳入最终分析。两组的基线资料无明显差别。意向治疗(ITT)分析表明,实验组的内镜特征改善率为33.72%,常规组为20.00%(P=0.007);活检病理改善率为19.77%和8.75%。分别为(P=0.011)。额外食用食醋对内镜特征改善率具有统计学保护作用[风险比(HR)ITT=2.183,95CI:1.183-4.028;HRper-方案(PP)=2.307,95CI:1.202-4.426]和活检病理改善(HRITT=2.931,95CI:1.212-7.089;HRPP=3.320,95CI:1.295-8.507)。未观察到增加食醋用量对预防高级别上皮内瘤变或早期癌症的统计学显着影响(HRITT=0.382,95CI:0.079-1.846;HRPP=0.382,95CI:0.079-1.846)。亚组分析表明,在年龄较大(年龄>60岁)的男性小病灶(病灶大小≤0.5cm)患者中,内镜特征和活检病理的总体治疗改善更为明显。实验组中的三名患者报告酸反流和胃灼热。随访期间未发现胃镜检查期间的不良事件。
结论:适度增加食醋摄入不能直接降低黏膜异型增生人群患食管癌的风险,但在一定程度上改善了内镜特点,改善了活检病理。需要进一步的研究来验证营养干预对食管癌前病变的影响。
BACKGROUND: Esophageal chromoendoscopy with iodine solution is important for detecting early esophageal cancer. The effect of routine treatment for lesions lightly stained with Lugol\'s iodine solution is limited, and the addition of natural substances to a regular diet is becoming increasingly common.
Vinegar has antitumor effects as reported in previous studies.
OBJECTIVE: To evaluate whether
vinegar supplementation could improve the prognosis of patients with lightly stained esophageal lesions.
METHODS: This prospective single-centre trial included consecutive patients with lightly stained lesions between June 2020 and April 2022. Patients in the experimental group received increased amounts of
vinegar for 6 months. The primary outcome of the study was the clinical therapeutic effect. Complications related to
vinegar ingestion and adverse events were also recorded in detail.
RESULTS: A total of 166 patients were included in the final analysis. There was no significant difference in the baseline data between the two groups. Intention-to-treat (ITT) analysis demonstrated that the rates at which endoscopic characteristics improved were 33.72% in the experimental group and 20.00% in the conventional group (P = 0.007); and the rates at which biopsy pathology improved were 19.77% and 8.75%, respectively (P = 0.011). Additional
vinegar consumption had a statistically protective effect on the rate at which endoscopic characteristics improved [hazard ratio (HR) ITT = 2.183, 95%CI: 1.183-4.028; HRper-protocol (PP) = 2.307, 95%CI: 1.202-4.426] and biopsy pathology improved (HRITT = 2.931, 95%CI: 1.212-7.089; HRPP = 3.320, 95%CI: 1.295-8.507). No statistically significant effect of increased vinegar consumption on preventing high-grade intraepithelial neoplasia or early cancer was observed (HRITT = 0.382, 95%CI: 0.079-1.846; HRPP = 0.382, 95%CI: 0.079-1.846). The subgroup analyses indicated that the overall therapeutic improvement of endoscopic characteristics and biopsy pathology seemed more obvious in older (age > 60) male patients with small lesions (lesion size ≤ 0.5 cm). Three patients in the experimental group reported acid regurgitation and heartburn. No adverse event during gastroscopy were recorded during follow-up.
CONCLUSIONS: A moderately increased ingestion of vinegar could not directly reduce the risk of esophageal cancer in the mucosa dysplasia population, but it improved the endoscopic characteristics and ameliorated the biopsy pathology to a certain extent. Further research is needed to verify the effect of nutritional intervention on precancerous esophageal lesions.