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目的研究Barrett食管病例氩离子凝固术(APC)联合药物治疗及单纯药物治疗前、后食管黏膜中环氧化酶-2(COX-2)的基因表达变化。判断Battett食管治疗的临床疗效及可能机制。方法经胃镜及病理诊断的Barrett食管66例,分为3组,A组为阳性对照组(不治疗组),B组为APC联合抑酸剂治疗组,C组为抑酸剂药物治疗组。治疗前、后观察患者症状缓解状况,胃镜下Barrett食管上皮消融情况,取食管黏膜组织标本,采用实时荧光定量聚合酶联反应(PCR)技术检测,Barrett食管黏膜及对照组食管黏膜中COX-2mRNA表达情况,进行组间及治疗前、后比较。结果 B组、C组均可有效地缓解症状,与A组相比差异有统计学意义,B、C组症状缓解率相比差异无统计学意义。A组与C组随访胃镜下Barrett食管上皮未见明显缩小,而B组Barrett食管黏膜消融,代之以淡红色食管黏膜覆盖。胃镜联合药物治疗后COX-2mRNA的表达明显降低至正常食管水平,而C组COX-2mRNA的表达降低,但与治疗前对比差异无统计学意义。结论单纯抑酸治疗与APC联合抑酸剂治疗相比,作用差,APC联合抑酸剂治疗后可以有效地缓解症状,消融Barrett食管上皮,是治疗Barrett食管的一种安全、有效的方法。
Objective To study the gene expression of cyclooxygenase-2 (COX-2) in esophageal mucosa of Barrett’s esophagus combined with argon plasma coagulation (APC) and drug treatment before and after drug treatment. To determine the clinical efficacy and possible mechanism of Battett’s esophagus therapy. Methods 66 cases of Barrett ’s esophagus diagnosed by endoscopy and pathology were divided into 3 groups: group A was positive control group (no treatment group), group B was APC combined antacid therapy group and group C was antacid drug treatment group. Before and after treatment, the patients’ symptom relief, barrett esophageal epithelium ablation under gastroscope and esophageal mucosa were examined by real-time fluorescence quantitative polymerase chain reaction (PCR). The expressions of COX-2 mRNA in Barrett’s esophageal mucosa and control group Express the situation, before and after the treatment group, compare. Results The symptoms of group B and group C were relieved effectively. The difference was statistically significant compared with group A, while there was no significant difference between groups B and C. In group A and group C, Barrett’s esophageal epithelium was not significantly reduced under endoscopy, while group B was ablated by Barrett’s esophageal mucosa and replaced by light red esophageal mucosa. The expression of COX-2mRNA decreased significantly to the level of normal esophagus after gastroscope combined with drug treatment, while the expression of COX-2mRNA decreased in group C, but there was no significant difference between before and after treatment. Conclusions Compared with APC combined with acid-suppressing agent, APC combined with acid-suppressing agent can effectively relieve symptoms and ablate Barrett’s esophageal epithelium, which is a safe and effective method for treating Barrett’s esophagus.