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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (03) : 138 -144. doi: 10.3877/cma.j.issn.2095-7157.2022.03.005

综述

胃窦血管扩张症的治疗进展
陈德鑫1, 翟亚奇1,†(), 李明阳1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心消化内科医学部
  • 收稿日期:2022-05-22 出版日期:2022-08-15
  • 通信作者: 翟亚奇, 李明阳

Research progress of gastric antral vascular ectasia

Dexin Chen1, Yaqi Zhai1,†(), Mingyang Li1,†()   

  1. 1. Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2022-05-22 Published:2022-08-15
  • Corresponding author: Yaqi Zhai, Mingyang Li
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引用本文：

陈德鑫, 翟亚奇, 李明阳. 胃窦血管扩张症的治疗进展[J]. 中华胃肠内镜电子杂志, 2022, 09(03): 138-144.

Dexin Chen, Yaqi Zhai, Mingyang Li. Research progress of gastric antral vascular ectasia[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(03): 138-144.

胃窦血管扩张症(GAVE)是一种原因不明的、以胃窦黏膜条形或弥漫性毛细血管扩张为典型特征的血管畸形性疾病，约占非静脉曲张上消化道出血的4%。临床表现主要为缺铁性贫血和反复的消化道出血，胃镜多能确诊。GAVE的治疗方式主要包括药物、消化内镜和外科手术，目前尚无统一规范的治疗策略。近期，沙利度胺、贝伐珠单抗以及内镜下套扎术、射频术被用于GAVE的治疗，初步表现出令人满意的结果。因此，本文通过系统文献回顾，对GAVE的治疗进展作一综述。

关键词: 胃窦血管扩张症, 上消化道出血, 内窥镜, 治疗

Gastric antral vascular ectasia (GAVE) is a vascular malformation of unknown cause, characterized by strip or diffuse telangiectasia of gastric antral mucosa, which is usually diagnosed by gastroscopy. The main clinical manifestations are iron deficiency anemia and recurrent gastrointestinal bleeding. The major treatment of GAVE includes pharmacotherapy, endoscopy and surgery. Currently, no consensus has been reached on the management of GAVE. Recently, thalidomide and bevacizumab, as well as endoscopic ligation and radiofrequency ablation have been increasingly used in the management of GAVE, preliminarily showing promising results. Therefore, in this review, we reviewed the advances in the treatment of GAVE to provide authoritative clinical references for further treatment.

Key words: Gastric antral vascular ectasia, Upper gastrointestinal bleeding, Endoscopy
图1 线状条纹型GAVE
图2 弥漫点状型GAVE
表1 GAVE的药物治疗总结
药物 机制 用法用量 特点 不良反应
奥曲肽 减少内脏血流；抑制血管活性物质的分泌；降低胃肠道收缩性[53,74] 皮下注射，0.1 mg，2~3次/d或20 mg 1次/月[54]。 起效较快、副作用较少 恶心、腹痛、腹泻、轻度脂肪泻、腹胀[75]
环磷酰胺 抑制免疫[58] 每月750~ 1000 mg/m2，1次/月[58,76] 适用于合并SSc和/或大面积弥漫性GAVE患者[58] 感染，骨髓和膀胱毒性[77]
雌激素孕酮联合治疗 减少胃黏膜血管的数量及血流；增加血管紧张素和去甲肾上腺素的血管收缩作用；增加血管内皮的完整性[78,79,80] 30 u雌激素与1.5 mg孕酮长期维持治疗[81] 副作用少且较轻微；需长期维持 男性乳房发育、子宫出血等[79,82]
糖皮质激素 收缩血管，抑制血管生成，改善毛细血管脆性[66,83,84] 30 mg/d初始剂量，逐步减至10 mg/d维持[66] 适合合并自身免疫性疾病的GAVE患者[59] 免疫抑制、血糖升高、高脂血症、骨质疏松、股骨头坏死、消化道黏膜损伤和出血[85]
沙利度胺 抑制VEGF，抗血管生成[62] 100 mg/d，维持3个月以上[63] 作用缓慢；副作用轻微 便秘、疲劳、头晕、嗜睡、周围神经病变、水肿、皮疹以及深静脉血栓、胎儿畸型[62,63]
贝伐珠单抗 抑制VEGF，抗血管生成[64] 5 mg/kg[65] 抗血管生成作用强，用于难治性GAVE 高血压恶化、皮肤黏膜出血、动静脉血栓等[65]
氨甲环酸 抗纤溶药，治疗GAVE的具体机制不详 0.5~1 g，3次/d[70] 适用于合并明显活动性消化道出血的患者[86] 增加血栓风险，如心肌梗塞、肺栓塞及深静脉血栓[71]
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