舒林酸对家族性腺瘤性息肉病的疗效及作用机制的探讨  

Effects of sulindac on familial adenomatous polyposis and the mechanism

作　　者：安燕芳 吕愈敏[1] 叶嗣懋[1] 

机构地区：[1]北京医科大学第三医院消化科,100083

出　　处：《中华消化杂志》2000年第4期243-245,共3页Chinese Journal of Digestion

摘　　要：目的　观察舒林酸对家族性腺瘤息肉病 (FAP)的临床疗效 ,并探讨其可能的作用机制。方法　通过全结肠镜及结肠造影观察 10例FAP患者服用舒林酸 40 0mg/d后 3、6、9、12个月全结肠腺瘤的数目、大小的变化 ,并用免疫组织化学方法检测用药前后腺瘤及平坦粘膜中增殖细胞核抗原 (prolif eratingcellnuclearantigen ,PCNA)和Bcl 2的表达。结果　用药后 3、6、9、12个月较用药前全结肠腺瘤数目及残存腺瘤平均直径均有显著性下降 ;用药前腺瘤PCNALI较正常对照及本组患者结肠平坦粘膜明显升高。用药后 3、6、9、12个月腺瘤及平坦粘膜PCNALI较服药前均无统计学意义的改变 ;用药前腺瘤Bcl 2表达阳性细胞率较正常对照明显升高 ,用药后 3、6、9、12个月较服药前有显著下降。结论舒林酸对FAP疗效显著 ,可使腺瘤明显消退。腺瘤的消退不是通过抑制细胞增殖 ,而是通过抑制Bcl 2在结肠腺瘤细胞中的表达 ,从而使腺瘤细胞凋亡增加所致 。Objective To assess the clinical efficacy of sulindac on familial adenomatous polyposis (FAP) and its possible mechanism. Methods The number and size of colonic adenomas in ten patients of FAP were observed by colonscopy and barium enema after the patients received sulindac 400 mg/d at 3,6,9,12 months. Expression of proliferating cell nuclear antigen (PCNA) and Bcl 2 of adenoma and flat mucosa in these ten patients pre and post therapy were examined by immunohistochemical staining. Results The number of adenoma and size of remaining adenomas in the colon were significantly decreased at 3,6,9,12 months, respectively after treatment. PCNA LI of adenomas were significantly higher compared with that of healthy controls and colonic flat mucosa in patients prior to the treatment. There was no significant difference in PCNA LI between adenoma and flat mucosa after treatment with sulindac at 3,6,9 and 12 months. Bcl 2 immunoreactivity was more frequent in adenomas than that of healthy controls prior to the treatment, which decreased significantly after treatment at 3,6,9 and 12 months. Conclusions The efficacy of sulindac is significant in regressing colonic adenomas of patients with FAP. This study showed that regression of colonic adenomas is not the results of the inhibition of cell proliferation but the inhibition of Bcl 2 expression in adenomatous cells and result in increase of apoptosis. This may be the main mechanism of sulindac in reversion of colonic adenomas in FAP.

关 键 词：舒林酸 家族性腺瘤性息肉瘤 大肠腺瘤 药物疗法 

分 类 号：R96[医药卫生—药理学]