Barrett食管的治疗研究及p53在治疗前后的表达

目的：研究不同方法治疗Barrett食管（BE）患者的疗效，并通过检测治疗前后食管中p53的表达改变．探索各种治疗方法产生效果的可能机制。方法：经胃镜及活检确诊的BE患者75例，随机分为5组进行治疗。（1）对照组（A组），不进行特殊治疗；（2）抑酸药组（B组），口服奥美拉唑20mg，每日2次。（3）胆汁吸附剂组（C组）．口服铝碳酸镁1000mg，每日3次。（4）抑酸药＋胆汁吸附剂组（D组），口服奥美拉唑及铝碳酸镁，用法用量同B、C组。（5）氩气凝固术（APC）＋抑酸药及胆汁吸附剂组（E组），在D组治疗基础上对BE患者行内镜下APC治疗。各组均治疗3个月。治疗前、治疗后1个月及3个月后观察并记录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．并采用SABC免疫组化染色检测食管上皮中p53的表达情况。结果：3个月后各治疗组的症状均较治疗前明显减轻，与A组相比均有统计学差异（P〈0．05）；各治疗组间相比，症状缓解率无明显差异（P〉0．05）。内镜检查发现。A、B、C、D组的BE黏膜均未见明显变化，而E组能使91％的患者BE黏膜消除。D、E组治疗后食管p53表达均较治疗前显著降低，与A组相比有统计学差异（P〈0．05），E组改变比D组更显著。各治疗组均未发现严重不良反应。结论：抑酸药和（或）胆汁吸附剂不能使BE逆转，但可消除临床症状并可改变BE中p53的表达。APC＋抑酸药及胆汁吸附剂方案可以消除症状。也可消除BE黏膜。安全性好，可降低p53的表达，是治疗BE的一种合理可行、有效实用的方法。p53的表达可作为判定治疗效果的可能指标。

The study of treating Barrett''''s esophagus patients and change of the expression of p53 before and after the treatment

Objective To investigate the effect of different treatment on Barrett's esophagus (BE) and to explore the mechanism of therapeutic regimen by detecting the change of the expression of p53 in the Barrett's epithelium before and after treatment. Methods Seventy-five patients with Barrett's esophagus were diagnosed by endoscopy and biopsy. All patients were randomly divided into five groups: Group A(control group), Group B(omeprazole 20 mg, bid, po), Group C(hydrotalcite 1 000 mg, tid, po), Group D(omeprazole 20 mg, bid, po and hydrotalcite 1 000 mg, tid, po) and Group E (omeprazole 20 mg, bid, po and hydrotalcite 1 000 mg, tid, po after argon plasma coagulation). All patients were treated for three months. Specimens of esophageal tissue were collected and clinical effect was observed by endoscopy before and 1 month,3 months after treatment. Expression of p53 in Barrett's esophagus were observed by immunohistochemistry. Results The symptoms of patients in treatment groups were significantly less than those in Group A(P < 0.05). There were no significant differences in relieving clinical symptom among Group B, C, D and E(P > 0.05). Barrett's esophagus didn't change significantly in Group B,C and D and was eliminated in 91% patients in Group E by endoscopy. There were significant differences in expression of p53 between Group D or Group E and Group A(P < 0.05). Conclusions Omeprazole and/or hydrotalcite can't eradicate BE,but they can relieve clinical symptom and down-regulate the expression of p53. Argon plasma coagulation combined with omeprazole and hydrotalcite is an effective, safe and promising therapeutic regimen against Barrett's esophagus. p53 may be a good indicator to assess the therapic effect of BE.