RANDOMIZED CONTROLLED TRIAL OF THE EFFECT OF SULINDAC ON DUODENAL AND RECTAL POLYPOSIS AND CELL-PROLIFERATION IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS
RANDOMIZED CONTROLLED TRIAL OF THE EFFECT OF SULINDAC ON DUODENAL AND RECTAL POLYPOSIS AND CELL-PROLIFERATION IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS
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DOI：
10.1002/bjs.1800801244
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发表时间：
1993-12-01
影响因子：
9.6
通讯作者：
PHILLIPS, RKS
中科院分区：
文献类型：
--
作者：
NUGENT, KP;FARMER, KCR;PHILLIPS, RKS
24例家族性腺瘤性息肉病患者既往接受过预防性结肠切除术，并患有晚期十二指肠息肉病，进入一项随机试验，以评估非甾体抗炎药舒林酸对十二指肠和直肠息肉的影响。在入组时和治疗6个月后，通过录像膀胱镜检查（14例患者和直肠镜检查）评估息肉的大小和数量;由两名不知道随机化和记录的混乱时间顺序的评估者比较录像带。通过体外掺入5-溴-2 '-脱氧尿苷来测量粘液细胞增殖。舒林酸治疗与十二指肠上皮细胞增殖减少（中位标记指数（LI）15.8%对14.4%，P = 0.003）和十二指肠息肉消退趋势（P = 0.12）相关。在直肠，细胞增殖显示出显着减少（中位数LI 8.5对7.4%，P = 0.018），并观察到显着（P = 0.01）息肉消退。直肠息肉病的严重程度低于十二指肠息肉病，且反应更为显著。对于直肠息肉在回肠直肠吻合术后未能显示显著消退且不适合袋式手术的患者，舒林酸是一种可能的治疗方法;它可能适用于早期十二指肠息肉病或作为十二指肠清除术后的辅助治疗。
Twenty-four patients with familial adenomatous polyposis who had previously undergone prophylactic colectomy and had advanced duodenal polyposis were entered into a randomized trial to assess the effect of the non-steroidal anti-inflammatory drug sulindac on duodenal and rectal polyps. Polyp size and number were assessed by videotaped duodenoscopy (and rectoscopy in 14 patients) at entry and after 6 months of treatment; the tapes were compared by two assessors who were unaware of the randomization and the shuffled chronological order of the recordings. Mucosal cell proliferation was measured by in vitro incorporation of 5-bromo-2'-deoxyuridine. Sulindac therapy was associated with a reduction in epithelial cell proliferation in the duodenum (median labelling index (LI) 15.8 versus 14.4 per cent, P = 0.003) and a trend towards duodenal polyp regression (P = 0.12). In the rectum, cell proliferation showed a marked reduction (median LI 8.5 versus 7.4 per cent, P = 0.018), and significant (P = 0.01) polyp regression was seen. Rectal polyposis was less severe than that in the duodenum and responded more dramatically. Sulindac is a possible treatment for patients in whom rectal polyps have failed to show significant regression after ileorectal anastomosis and who are unsuitable for pouch surgery; it may be useful in early duodenal polyposis or as an adjunct after duodenal clearance.