沙利度胺治疗血管发育不良所致消化道出血的疗效观察  

The therapeutic effect of thalidomide on gastrointestinal bleeding of angiodysplasia： an observational study

作　　者：徐春红[1] 戈之铮[1] 刘文忠[1] 陈海英[1] 高云杰[1] 陈慧敏[1] 胡运彪[1] 萧树东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科上海市消化疾病研究所,200001

出　　处：《中华消化杂志》2008年第8期547-550,共4页Chinese Journal of Digestion

基　　金：上海市重点学科资助项目（Y0205）

摘　　要：目的观察和研究沙利度胺治疗血管发育不良所致消化道出血的临床疗效及其机制。方法收集2004年11月2006年12月血管发育不良所致反复发作的消化道出血患者18例，给予沙利度胺片100mg／d口服，疗程4个月。中位随访时间16．7个月，观察治疗前、后患者临床疗效和血清血管内皮生长因子（VEGF）和肿瘤坏死因子-α（TNF-α）水平变化。结果患者临床疗效总评分由治疗前的（15．000±3．630）分降至治疗后的（5．330±3．325）分，差异有统计学意义（P〈0．01）。随访期间，18例患者平均出血次数为（1．000±1．237）次，输血量为（100．000±240．098）ml，均比治疗前显著减少[（11．220±6．404）次和（1422．220±1556．601）ml，P值均〈0．01]；血红蛋白含量为（9．533±2．278）g／ml，比治疗前显著上升[（5．950±1．656）g／ml，P〈0．01]。5例患者服药前血清中VEGF浓度为180pg／ml、TNF-α浓度为58Pg／ml，治疗后VEGF和TNF-α浓度明显降低（116和34pg／ml，P值均〈0．01）。结论 沙利度胺能明显抑制血管发育不良消化道出血患者的血清VEGF、TNF-α水平，对血管发育不良所致的消化道出血疗效显著。Objective To observe and investigate the therapeutic effect of thalidomide on gastrointestinal bleeding of angiodysplasia. Methods Eighteen patients with recurrent gastrointestinal bleeding of angiodysplasia were treated with thalidomide 100 mg daily for 4 months. Median follow-up time was 16.7 months. The changes of clinical setting and serum vascular endothelial growth factor （VEGF） and tumor necrosis factor-α（TNF-α） level between pre-therapy and post-therapy were compared. Results The clinical setting of patients in post therapy was significantly better than that in pre-therapy. The overall symptom score, the median bleeding frequency and median transfusion volume of patients after therapy was significantly lower than those before the therapy [（15.000±3. 630）vs （5. 330±93. 325）, （11. 220±6. 404） vs （1. 000± 1. 237）, （1422.22± 1556. 601） ml vs （100.00±240.098）mh respectively, all P〈0.01], while median hemoglobin was obviously higher than that before the therapy F（5. 950 ±1. 656） g/ml vs （9. 533± 2. 278） g/ml, P〈 0.01]. Serum VEGF and TNF-α levels decreased obviously after the therapy （118 pg/ml vs 58 pg/mh 116 pg/ml vs 34 pg/ml, P〈0.01 ）. Conclusions Thalidomide can suppress the serum VEGF and TNF-α levels of the patients with recurrent gastrointestinal bleeding of angiodysplasia, then play a significantly role in preventing the rebleeding in patients with recurrent gastrointestinal bleeding of angiodysplasia.

关 键 词：消化道出血 沙利度胺 血管发育不良 治疗 

分 类 号：R686[医药卫生—骨科学]