二甲双胍联合内镜治疗家族性腺瘤性息肉病的疗效观察

The effect of metformin combined with endoscopy in the treatment of familial adenomatous polyposis

[目的]观察二甲双胍联合内镜治疗家族性腺瘤性息肉病的疗效。[方法]根据家族史并经结肠镜和组织病理学检查确诊的家族性腺瘤性息肉病患者45例,随机分为二甲双胍联合内镜治疗组(A组)、单纯内镜治疗组(B组)、塞来昔布联合内镜治疗组(C组),每组15例。对3组患者全肠道直径>1 cm的息肉以及距肛缘15 cm区域内的所有息肉行内镜下切除,并记录腺瘤的数目、大小。A组患者行内镜下息肉切除后即口服二甲双胍500 mg,2次/d;B组患者只行结肠镜下息肉切除;C组患者行内镜下息肉切除后即口服塞来昔布200 mg,2次/d。3组患者治疗后6个月、12个月各返院复查结肠镜1次,观察腺瘤的数目、大小并检测其病理类型。[结果]3组在治疗前及治疗后6、12个月直径>1 cm全肠道息肉数目均较前下降(A组中位数:治疗前、治疗6月后、治疗12个月后分别为16.00、8.00、5.00;B组中位数:治疗前、治疗6月后、治疗12个月后分别为13.00、10.00、10.00;C组中位数:治疗前、治疗6月后、治疗12个月后分别为13.50、8.50、6.00),A组、C组下降更为显著,与B组比较均差异有统计学意义(P<0.01)。3组在治疗前及治疗6、12个月后距肛缘15 cm区域息肉数目均有所下降(A组中位数:治疗前、治疗6个月后、治疗12个月后分别为17.00、8.00、6.00,治疗后与治疗前P<0.01;B组中位数:治疗前、治疗6个月后、治疗12个月后分别为17.00、12.00、8.00,治疗后与治疗前P<0.05;C组中位数:治疗前、治疗6个月后、治疗12个月后分别为13.50、5.50、5.00,治疗后与治疗前P<0.05),A组较治疗前减少更为显著。[结论]二甲双胍联合内镜治疗家族性腺瘤性息肉病的疗效优于单纯内镜治疗,且安全性较高。

[Objective]To explore the treatment effect of oral metformin combined with endoscopy in familial adenomatous polyposis.[Methods]Forty-five patients diagnosed as familial adenomatous polyposis by colonoscopic,histopathological examinations and family history were randomly divided into 3groups:metformin+endoscopy group(group A),endoscopy group(group B),celecoxib+endoscopy group(group C).The polyps were resected every 6months in the first year when the polyps were more than 1cm in the whole colon or 15cm away from anal verge,the number and size were recorded meanwhile.In addition,group A took metformin(500mg,bid)after endoscopic therapy,while group B just accepted endoscopic therapy,group C took celecoxib(200mg,bid)after endoscopic therapy.The changes of polyp number,histopathology were compared before and after the treatment among these three groups.[Results]Forty-five patients were enrolled in the study,of whom,1patients dropped out later for allergy.1patients was found diarrhea in group A,4patients was found abdominal pain,diarrhea,tightness,allergy for each complication in group C.The median number of polyps more than 1cm all decreased later(group A 16.00before treatment vs 8.00after 6months vs 5.00after 12months;group B 13.00before treatment vs 10.00after 6months vs 10.00after 12months;group C 13.50before treatment vs 8.50after 6months vs 6.00after 12months),group A and group C decreased more signifacantly,P<0.001for the former and P=0.014for the latter.The median number of polyps 15cm away from anal verge all decreased among three groups(group A 17.00before treatment vs 8.00after 6months vs 6.00after 12.00months,P<0.001;group B 17.00before treatment vs 12.00after 6months vs 8.00after 12.00months,P=0.014;group C 13.50before treatment vs 5.50after 6months vs 5.00after 12months,P=0.016),group A decreased more signifacantly.[Conclusions]The role of metformin combined with endoscopy on the treatment of familial adenomatous polyposis is more effective than that of endoscopy,and it is safe to use.