胃腸道血管發(fā)育不良的治療進(jìn)展

摘要 胃腸道血管發(fā)育不良（GIA）或稱胃腸道血管畸形（GIVM），是一種可累及整個(gè)消化道的疾病，其病灶隱匿、多發(fā)且易于再生，導(dǎo)致反復(fù)隱匿性消化道出血，老年患者尤為多見。該病癥的主要臨床特征為慢性消化道出血和難治性貧血。此前，針對(duì)GIA的治療缺乏公認(rèn)有效、安全的方法和藥物干預(yù)措施。近年來，有觀察性研究和病例報(bào)道指出生長(zhǎng)抑素類似物可能對(duì)GIA出血的治療有效，但缺乏隨機(jī)對(duì)照雙盲研究支持。傳統(tǒng)的有創(chuàng)治療方法如血管造影栓塞、內(nèi)鏡下局部治療、手術(shù)切除等對(duì)GIA的治療作用有限。新近多中心隨機(jī)對(duì)照雙盲試驗(yàn)證實(shí)沙利度胺在降低GIA的再出血發(fā)生率、減少輸血量等方面顯示出顯著療效。本文旨在總結(jié)GIA的治療進(jìn)展，以期為臨床醫(yī)師提供參考。

關(guān)鍵詞 胃腸出血； 血管發(fā)育不良； 沙利度胺； 生長(zhǎng)抑素

Progress in Treatment of Gastrointestinal Angiodysplasia CHEN Huimin， GE Zhizheng. Division of Gastroenterology and Hepatology， Renji Hospital， School of Medicine， Shanghai Jiao Tong University， Shanghai （200001）

Correspondence to： GE Zhizheng， Email： zhizhengge@aliyun.com

Abstract 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.

Key words Gastrointestinal Hemorrhage; Angiodysplasia; Thalidomide; Somatostatin

胃腸道血管發(fā)育不良（gastrointestinal angiodys?plasia， GIA）或稱胃腸道血管畸形（gastrointestinal vascular malformation， GIVM），是一種與皮膚病變、全身性血管疾病或家族綜合征無(wú)關(guān)的胃腸道黏膜血管病變，占消化道出血病因的3%～5%。GIA可累及整個(gè)消化道，以右半結(jié)腸和小腸多見，40%～75%的病變?yōu)槎喟l(fā)性。主要由血管發(fā)育不良所致的復(fù)發(fā)性小腸出血占所有消化道出血的5%～10%，以老年患者居多[1]。GIA病灶往往隱匿、多發(fā)且易于再生，加之癥狀的非特異性（如可表現(xiàn)為隱匿性消化道出血），診斷上存在較大困難。

GIA是一種明顯的血管異常，其組織學(xué)特征為黏膜和黏膜下層壁薄、缺乏平滑肌層，伴有未成熟的異常血管生長(zhǎng)以及毛細(xì)血管局灶性聚集和擴(kuò)張[2]。……