药物治疗前后Barrett食管Cox-2与Ki-67的表达

Changes of the expression of Cox-2 and Ki-67 in Barrett's esophagus before and after treatment

目的:研究不同方法治疗Barrett食管患者的疗效,探索各种治疗方法产生效果的可能机制,为Barret食管的治疗提供理论支持及指导。方法:经胃镜及活检确诊的Barret食管惠者55例,随机分为4组进行治疗,(1)A组:未给予治疗;(2)B组:口服奥美拉唑20 mg,2次／d;(3)C组:口服铝碳酸镁1000 mg,3次／d;(4)D组:口服奥美拉唑20 mg, 2次/d,铝碳酸镁1000mg,3次／d。治疗前、治疗后1个月及3个月后观察临床症状及内镜下表现,取得食管黏膜组织标本行病理学检查,采用SABC免疲组化染色检测食管上皮中(Cox-2、Ki-67)的表达情况,并进行组间及治疗前后比较。结果:在缓解临床症状方面,备治疗组的症状均较治疗前明显改善,与对照组相比差异均有统计学意义(P<0.05);各治疗组相比,症状缓解率差异无统计学意义(P>0．05)。对照组和药物治疗组的Barret食管黏膜均来见明显缩小。各治疗组的食管标本中,Cox-2、Ki-67的表达均显著降低,与对照组相比差异有统计学意义(P=<0．05)。结论:押酸药和／或胆汁吸附刺不能使Barret食管逆转,但可消除临床症状并可改变BE食管Cox-2与Ki-67的表达。

Objective To investigate the effect of different treatment on Barrett＇s esophagus and to explore the mechanism of therapeutic regimen in order to select the most effective one. Methods Fifty-five patients with Barrett＇s esophagus were diagnosed by endoscopy and biopsy. All patients were randomly divided into four groups： group A （control group）, group B （Omeprazole 20 mg, twice a day）, group C （Hydrotalcite 1000 mg, three times a day）, group D （Omeprazole 20 mg, twice a day and Hydrotalcite 1000 mg, three times a day）. All patients were treated for three months. Specimens of esophageal tissue were collected and clinical effect was observed with endoscopy before and 1 month, 3 months after treatment. Expression of Cox-2 and Ki-67 in Barrett esophagus were investigated with immunohistochemistry and the differences were analyzed among groups. Results The symptoms of patients in treatment groups were significantly less than group A after treament （P〈0.05）. There was no statistic difference in relieving clinical symptom in group B, C and D （P〉0.05）. Barrett＇s esophagus was not changed significantly in group B, C, and D with endoscopy. There was a statistic difference in the expression of Cox-2 and Ki-67 in group B, C and D compared to group A（P〈0.05）. The expression of Cox-2 was significantly different .in group D compared to group B and C（P〈0.05）. Conclusion Omeprazole or/and Hydrotalcite cann＇t eradicate Barrett＇s esophagus, but can relieve clinical symptom and influence the expression of Cox-2 and Ki-67.