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选择性环氧合酶2抑制剂对食管不典型增生的干预治疗研究
靳西凤，杜荣莲，柴同海，孙庆燕，张晶靳西凤、杜荣莲、柴同海、张晶，山东省 济宁医学院附属滕州市中心人民医院消化内科，277500；孙庆燕，济宁医学院附属医院检验科
摘 要:目的 探讨选择性环氧合酶2（COX-2）抑制剂塞来昔布（celecoxib）预防食管上皮不典型增生的有效性，并探索其可能机制。方法 将54例食管上皮轻、中、重度不典型增生患者随机分为塞来昔布组（28例）及安慰剂组（26例）。12个月后再行胃镜及病理复查。终点指标定义为食管上皮不典型增生的组织学分级有严重程度的改变，记录其逆转、稳定、进展变化，比较其疗效。采用酶联免疫吸附试验（ELISA）检测血管内皮生长因子（VEGF）含量，并进行组间及治疗前后比较。结果 塞来昔布组不典型增生的好转率为46.4%，和对照组23.1%相比，差异无统计学意义（P＞0.05）。治疗组中VEGF表达显著降低，与对照组相比，差异有统计学意义（P＜0.05）。在缓解临床症状方面，塞来昔布治疗组的症状与对照组相比，差异有统计学意义（P＜0.05）。结论 塞来昔布可消除临床症状并可降低VEGF表达，使食管上皮不典型增生比例降低，可能降低食管癌发病的危险，尚需进一步扩大样本量的研究。
关键词:环氧化酶2抑制剂； 食管肿瘤； 增生； 塞来昔布
Selective cyclooxygenase 2 inhibitors for the prevention of esophageal atypical hyperplasia
JIN Xi-feng，DU Rong-lian，CHAI Tong-hai，SUN Qing-yan，ZHANG Jing.Department of Gastroenterology，Tengzhou Central People′s Hospital of Jining Medical College，Jining 277500，China
Abstract:Objective To determine the validity of celecoxib for the prevention of esophageal atypical hyperplasia and to explore the possible mechanism of therapeutic regimen. Methods Fifty four subjects had histologically confirmed mild or moderate to severe esophageal dysplasia at baseline. And they were randomly divided into two groups：celecoxib group，normal control group. Esophagogastroduodenoscopy was performed before and after a 12-month intervention. Per-subject change（regression，stable，or progression）in the worst dysplasia grade was defined as the primary end point were compared by agent group. The expression of vascular endothelial growth factor（VEGF）was detected by enzyme-linked immunosorbent assay（ELISA）and the differences were analyzed among groups. Results Celecoxib resulted in a trend toward decreased dysplasia progression，and the relative reverse rate of celecoxib group was 46.4%（P＞0.05）. And the expression of VEGF was significantly different in celecoxib group compared to the placebo group（P＜0.05）. Statistical difference was observed in relieving clinical symptom between the two groups（P＜0.05）. Conclusions Celecoxib can relieve clinical symptom and reduce the expression of VEGF. celecoxib appears to be associated with a decreased incidence of esophageal cancer. Further trials with larger numbers are needed to confirm these results.
Key words:Cyclooxygenase 2 inhibitors； Esophageal neoplasms； Hyperplasia； Celecoxib
文献标引:靳西凤，杜荣莲，柴同海，孙庆燕，张晶.选择性环氧合酶2抑制剂对食管不典型增生的干预治疗研究[J/CD].中华临床医师杂志：电子版,2009,3(12):1978-1984.
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