舒林酸长期治疗家族性腺瘤性息肉病的临床研究  

The long-term effects of sulindac on familial adenomatous polyposis

作　　者：李军[1] 吕愈敏[1] 顾芳[1] 安燕芳 钱跃清[1] 

机构地区：[1]北京大学第三医院消化科,100083

出　　处：《中华消化杂志》2005年第3期153-156,共4页Chinese Journal of Digestion

摘　　要：目的观察长期服用舒林酸对家族性腺瘤性息肉病(FAP)患者结直肠腺瘤消退的作用及其安全性。方法FAP患者口服舒林酸400mg/d,12个月内每3个月结肠镜复查一次,观察结直肠息肉的变化。对有效者,继续服用舒林酸维持治疗,维持剂量按300mg/d到200mg/d到150mg/d依次减少。减药中如果腺瘤数目增加,则将药量增至上一剂量。结果18例FAP患者在治疗12个月后结直肠内息肉显著减少,平均维持治疗时间为(35.5±17.7)个月。最后一次复查时息肉数目均较治疗前明显减少[从治疗前的(854±920)个降到(13±20)个](P<0.01)。舒林酸的有效维持量为150～300mg/d,平均剂量为(262.5±56.9)mg/d。治疗期间肠道中出现微小扁平隆起和红斑。活检病理显示治疗后管状腺瘤比例增加,腺瘤异型程度下降(P<0.01)。5例患者停药后腺瘤复发,2例再次服药后腺瘤再次消退。长期服用舒林酸的常见不良反应是结肠黏膜糜烂,没有发现严重的不良反应。结论舒林酸长期维持治疗可使FAP患者结直肠腺瘤保持长期显著消退状态。最小有效维持量150mg/d～300mg/d不等,有个体差异。长期用药安全性好。初步提示停用舒林酸后腺瘤有复发倾向,但再次用药仍有效。Objective To evaluate the long-term effect and safety of sulindac in attempting to maintain the regression of colorectal adenomas in patients with familial adenomatous polyposis(FAP). Methods Eighteen FAP patients were treated with sulindac 400 mg/d. The change of colorectal polyps was assessed by colonoscopy every 3 months in the first year. After the significant regression of ~colorectal polyps was achieved, the dosage of sulindac was tapered from 300 mg to 200 mg, and then to 150 mg to maintain the treatment effects.If there was recurrence of colorectal polyps on subsequent endoscopic examinations, the dosage of sulindac was resumed to the prior one again. Results All the patients who received sulindac were significantly responsive to the treatment in the first 12 months. The average period of treatment was 35.5±17.7 months. Compared with baseline data, the average number of polyps ~reduced significantly at last follow-up colonoscopy (from 854±920 to 13±20) (P<0.01). The average minimal effective dosage of sulindac was (262.5±56.9) mg/d(range 150 mg/d～300 mg/d). The lesions of minor flat elevation and erythema were found on the surface of colorectal tract during the treatment. The pathological examination showed that the percentage of tubular adenoma increased and the grade of dysplasia in the adenomas reduced after treatment (P<0.01). Coloreactal polyps in 5 patients recurred after withdrawal of treatment. Two of them got similar regression when they took sulindac ~again . The most common side effect identified in this study was colorectal mucosal erosions. No severe adverse event was found during the treatment. Conclusions Long-term treatment of sulindac is effective in maintaining the regression of colorectal adenoma in FAP patients. The minimal effective dosages of sulindac range from 150 mg/d to 300 mg/d, and those dosages seem to be safe for the patients in this long-term follow-up study. However colorectal polyps tend to recur after withdrawal, and can be regressed by the ~administration of sulind

关 键 词：舒林酸 治疗 家族性腺瘤性息肉病 临床研究 

分 类 号：R735.3[医药卫生—肿瘤]