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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 40 0mg/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瘤及平坦粘膜中增殖细胞核抗原 (prolif eratingcellnuclearantigen ,PCNA)和Bcl 2的表达。结果 用药后 3、6、9、12个月较用药前全结肠腺瘤数目及残存腺瘤平均直径均有显著性下降 ;用药前腺瘤PCNALI较正常对照及本组患者结肠平坦粘膜明显升高。用药后 3、6、9、12个月腺瘤及平坦粘膜PCNALI较服药前均无统计学意义的改变 ;用药前腺瘤Bcl 2表达阳性细胞率较正常对照明显升高 ,用药后 3、6、9、12个月较服药前有显著下降。结论舒林酸对FAP疗效显著 ,可使腺瘤明显消退。腺瘤的消退不是通过抑制细胞增殖 ,而是通过抑制Bcl 2在结肠腺瘤细胞中的表达 ,从而使腺瘤细胞凋亡增加所致 ,这可能是舒林酸逆转FAP患者大肠腺瘤的主要机制
Objective To observe the clinical efficacy of sulindac on familial adenomatous polyposis (FAP) and to explore its possible mechanism. Methods Total colon adenomas and colonic angiography were used to observe the changes of the number and size of total colonic adenomas at 3, 6, 9 and 12 months after taking sulindac 400 mg / d in 10 patients with FAP. Immunohistochemistry Adenoma and flat mucosa proliferating cell nuclear antigen (PCNA) and Bcl 2 expression. Results The numbers of total colonic adenomas and the average diameters of residual adenomas were significantly decreased at 3, 6, 9 and 12 months after treatment. The PCNALI of pre-treatment adenomas was significantly higher than that of the normal controls and the colonic mucosa of colon . 3, 6, 9, 12 months after treatment, adenomas and flat mucosa PCNALI than before treatment were no statistically significant changes; before treatment Bcl 2 positive cells were significantly higher than the normal control, after treatment 3,6 , 9,12 months than before medication significantly decreased. Conclusion Sulindac has a significant effect on FAP, which can obviously regress adenoma. Adenocarcinoma regression not by inhibiting cell proliferation, but by inhibiting the expression of Bcl 2 in colon adenoma cells, so that increased apoptosis of adenoma cells, which may be sulindac reversed FAP main colorectal adenoma mechanism