摘要：目的 探讨选择性环氧合酶-2(COX-2)抑制剂塞来昔布联合叶酸预防食管癌的有效性.方法 将84例食管上皮轻、中重度不典型增生患者随机分为叶酸组(28例)、塞来昔布联合叶酸组(28例)以及安慰剂组(28例),连续服用12个月后,再行胃镜及病理复查.终点指标定义为食管上皮不典型增生的组织学分级有严重程度的改变,记录其逆转、稳定、进展变化,比较各治疗组疗效.结果 塞来昔布联合叶酸组的不典型增生的好转率为60.7%(17/28),显著高于对照组(P＜0.05).叶酸组对食管上皮各级不典型增生并未有显著影响.结论 塞来昔布和叶酸联合应用可能降低食管癌发病的危险,尚需进一步扩大样本量的研究. Abstract： Objective To determine the validity of celecoxib combined with folate for the prevention of esophageal carcinoma.Methods Eighty four subjects completed the trial. Subjects had histologically confirmed mild or moderate esophageal dysplasia at baseline. And they were randomly divided into three groups: folate group,celecoxib plus folate group and control group.Esophagogastroduodenoscopy was performed before and after a 12-month intervention. Per-subject change (regression, stable or progression) in the worst dysplasia grade was defined as the primary end point. Results were compared by agent group.Results The relative reverse rate of celecoxib plus folate group was 60.7%(17/28), significantly higher than that in placebo group (P＜0.05). Folate alone did not influence changes in dysplasia grade by baseline histology subgroup(P＞0.05).Conclusions Celecoxib and folate have better effects than celecoxib alone in the chemoprevention of esophageal carcinoma for high risk subjects. Further trials with larger numbers are needed to confirm these results.

关键词：叶酸 抑制剂塞来昔布 食管癌 化学预防作用 esophageal 

单位：济宁医学院附属滕州市中心人民医院消化内科 山东滕州 277500 济宁医学院附属医院病理科