选择性环氧合酶-2抑制剂对结肠多发腺瘤防治作用的临床研究  

Effects of selective cyclooxygenase-2 inhibitor on treatment and prevention of multiple colorectal adenoma

作　　者：靖大道[1] 郑萍[1] 楼俪泓 周怡和[1] 周育德[1] 朱国清[1] 王兴鹏[1] 

机构地区：[1]上海交通大学附属第一人民医院消化科,200080

出　　处：《中华消化杂志》2006年第12期805-808,共4页Chinese Journal of Digestion

摘　　要：目的观察比较选择性环氧合酶-2(COX-2)抑制剂塞来昔布和非选择性COX抑制剂肠溶阿司匹林对结肠多发性腺瘤的防治作用及其不良反应。方法96例经结肠镜和病理组织学确诊的结肠多发性腺瘤患者,分为A、B、C三组,每组32例。各组患者均在内镜下行高频电凝电切息肉圈套切除术和(或)氩气刀治疗后分别给予塞来昔布200 mg,每天2次(A组)、肠溶阿司匹林50 mg,每天2次(B组)和空白对照(C组),疗程1年。期间每6个月复查结肠镜1次,以后每12个月复查肠镜1次,评价腺瘤复发情况,随访2年。结果A、B、C三组中分别有27、26、27例患者完成疗程和随访。疗程结束时按意图治疗分析/方案分析,A、B、C各组中结肠腺瘤的治愈率分别为84．4%/100%、78．1%/96．2%和75．O%/88．9%,各组间差异无统计学意义(P＞0．05)；疗程结束后第1年内,A、B、C三组中分别有1、1和6例复发,A、B两组患者肠腺瘤的复发率显著低于C组(x^2=4．866和4．410,P值均＜0．05)；在2年随访结束时,A、B、C三组中分别检出4、5和12例息肉,各组腺瘤的总再发率分别为14．8%、19．2%和46．2%,A组和B组腺瘤再发率显著低于C组(x^2=6．1 73和4．282,P值均＜0．05),A组腺瘤再发率略低于B组,但差异无统计学意义(P＞0．05)；而B组消化道并发症发生率显著高于A组(x^2=4．957,P＜0．05)。结论结直肠多发性腺瘤经内镜摘除术后,给予塞来昔布或肠溶阿司匹林服用均可显著降低腺瘤的再发率,但后者胃肠道不良反应的发生率显著高于前者。Objectives To investigate and evaluate the preventive and therapeutic effects of celecoxib, a selective cyclooxygenase-2 （COX -2） inhibitor, on multiple colorectal adenoma and compare it with aspirin. Methods Ninty-six patients with colorectal multiple adenoma were randomly divided into A, B and C groups. Adenomas in all patients were removed with high-frequency electrocoagulation, electroexcision or argon plasma coagulation（APC） under colonoscopy. Then, group A were administered celecoxib 200 mg twice daily, group B aspirin 50 mg twice daily, group C served as control. Colonoscopy was per formed every 6 months in the first year, and every year in order to observe and evaluate the recurrence rate of adenoma and the side effects after the treatment. Results Twenty-seven patients in group A, 26 patients in group B and 27 patients in group C had completed the treatment. At the end of the treatment, on PP/ITT analysis, the cure rate of the colorectal adenoma were 84.4 %/100 % , 78. 1%/96.2 % and 75.0%/88.9% in group A, B and C, respectively. During the first year of follow-up, there were 1, 1 and 6 cases which were found recurrences of the adenomas in group A, B and C, respectively. The recurrence rates of colorectal adenomas in group A（ 3.7 % ） and group B（4.0 % ） were significantly lower than that in group C（24.0%） （P 〈 0.05 and 〈 0.05, respectively）. At the end of follow-up, the total recurrence rate of colorectal adenomas in group A（ 14.8 % ） and group B（ 19.2 % ） were significantly lower than that in group C（46. 2% ） （P 〈0.05 and d0.05）. While the side-effective rate in group A （3.3%） was significantly lower than that in groupB（22. 5%） （P〈 0.05）. Conclusions After re section of the multiple colorectal adenomas, both the selective inhibitor of COX-2, celecoxib and the non- selective inhibitor of COX- 2, aspirin, may reduce its recurrence rate, but the former has a good tolerance and lower side-effects.

关 键 词：结直肠腺瘤 塞来昔布 阿司匹林 预防 治疗 

分 类 号：R735.35[医药卫生—肿瘤]