胃肠道血管发育不良的治疗进展

Progress in Treatment of Gastrointestinal Angiodysplasia

胃肠道血管发育不良(GIA)或称胃肠道血管畸形(GIVM),是一种可累及整个消化道的疾病,其病灶隐匿、多发且易于再生,导致反复隐匿性消化道出血,老年患者尤为多见。该病症的主要临床特征为慢性消化道出血和难治性贫血。此前,针对GIA的治疗缺乏公认有效、安全的方法和药物干预措施。近年来,有观察性研究和病例报道指出生长抑素类似物可能对GIA出血的治疗有效,但缺乏随机对照双盲研究支持。传统的有创治疗方法如血管造影栓塞、内镜下局部治疗、手术切除等对GIA的治疗作用有限。新近多中心随机对照双盲试验证实沙利度胺在降低GIA的再出血发生率、减少输血量等方面显示出显著疗效。本文旨在总结GIA的治疗进展,以期为临床医师提供参考。

Gastrointestinal angiodysplasia(GIA)or gastrointestinal vascular malformation(GIVM)is a disease that affects the entire digestive tract with lesions which are insidious,multiple,and easy to regenerate.The lesions usually lead to repeated latent gastrointestinal bleeding,especially in elderly patients.The main clinical features of this disorder are chronic gastrointestinal bleeding and refractory anemia.Previously,there was a lack of recognized effective and safe methods and drug interventions for the treatment of GIA.In recent years,observational studies and case reports have suggested that somatostatin analogues may be effective in the treatment of GIA bleeding,but there is a lack of double⁃blind randomized controlled study support.Traditional invasive treatment methods,such as angiographic embolization,endoscopic local therapy,and surgical resection,have limited therapeutic use in GIA.Recently,multicenter,double⁃blind,randomized controlled trials have confirmed that thalidomide has certain efficacy in reducing the incidence of rebleeding and the requirements for blood transfusion in GIA.This paper aimed to summarize the progress in the treatment of GIA and provide reference for clinicians.