CAJ | 학술논문

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100 mg/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)和肿瘤坏死因子一a(TNF-a)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180 pg/ml、TNF-α浓度为58 Pg/ml,治疗后VEGF和TNF-α浓度明显降低(116和34 pg/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.
목적 관찰화연구사리도알치료혈관발육불량소치소화도출혈적림상료효급기궤제.방법 수집2004년11월-2006년12월혈관발육불량소치반복발작적소화도출혈환자18례,급여사리도알편100 mg/d구복,료정4개월.중위수방시간16.7개월,관찰치료전、후환자림상료효화혈청혈관내피생장인자(vEGF)화종류배사인자일a(TNF-a)수평변화.결과 환자림상료효총평분유치료전적(15.000±3.630)분강지치료후적(5.330±3.325)분,차이유통계학의의(P＜0.01).수방기간,18례환자평균출혈차수위(1.000±1.237)차,수혈량위(100.000±240.098)ml,균비치료전현저감소[(11.220±6.404)차화(1422.220±1556.601)ml,P치균＜0.01];혈홍단백함량위(9.533±2.278)g/ml,비치료전현저상승[(5.950±1.656)g/ml,P＜0.01].5례환자복약전혈청중VEGF농도위180 pg/ml、TNF-α농도위58 Pg/ml,치료후VEGF화TNF-α농도명현강저(116화34 pg/ml,P치균＜0.01).결론 사리도알능명현억제혈관발육불량소화도출혈환자적혈청VEGF、TNF-α수평,대혈관발육불량소치적소화도출혈료효현저.
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 faetor-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±3.325),(11.220±6.404)vs(1.000±1.237),(1422.22±1556.601)ml vs(100.00±240.098)ml,respectively,all P＜0.01],while median hemoglobin was obviously higher than that before the therapy[(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/ml,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.