舒林酸对家族性腺瘤性息肉病的疗效及作用机制的探讨

目的观察舒林酸对家族性腺瘤息肉病（ＦＡＰ）的临床疗效。并探讨其可能的作用机制。方法通过全结肠镜及结肠造影观察１０例ＦＡＰ患者服用舒林酸４００ｍｇ／ｄ后３、６、９、１２个月全结肠腺瘤的数目、大小的变化，并用免疫组织化学方法检测用药前后腺及平坦粘膜中增殖细胞核抗原（ｐｒｏｌｉｆ－ｅｒａｔｉｎｇ ｃｅｌｌ ｎｕｃｌｅａｒ ａｎｔｉｇｅｎ，ＰＣＮＡ）和Ｂｃｌ－２的表达。结果用药后３、６、９、１２个月较用药

Effects of sulindac on familial adenomatopis polyposis and the mechanism

Objective To assess the clinical efficacy of sulindac on familial adenomatous polyposis (FAP) and its possible mechanism. Methods The number and size of colonic adenomas in ten patients of FAP were observed by colonscopy and barium enema after the patients received sulindac 400 mg/d at 3,6,9,12 months. Expression of proliferating cell nuclear antigen (PCNA) and Bcl 2 of adenoma and flat mucosa in these ten patients pre and post therapy were examined by immunohistochemical staining. Results The number of adenoma and size of remaining adenomas in the colon were significantly decreased at 3,6,9,12 months, respectively after treatment. PCNA LI of adenomas were significantly higher compared with that of healthy controls and colonic flat mucosa in patients prior to the treatment. There was no significant difference in PCNA LI between adenoma and flat mucosa after treatment with sulindac at 3,6,9 and 12 months. Bcl 2 immunoreactivity was more frequent in adenomas than that of healthy controls prior to the treatment, which decreased significantly after treatment at 3,6,9 and 12 months. Conclusions The efficacy of sulindac is significant in regressing colonic adenomas of patients with FAP. This study showed that regression of colonic adenomas is not the results of the inhibition of cell proliferation but the inhibition of Bcl 2 expression in adenomatous cells and result in increase of apoptosis. This may be the main mechanism of sulindac in reversion of colonic adenomas in FAP.