糖皮质激素预防ERCP术后胰腺炎的Meta分析  

The effect of glucocorticosteroids in prevention of post-ERCP pancreatitis:a meta-analysis

作　　者：袁文明[1] 李静[1] 徐琳[1] 张小利[1] 

机构地区：[1]四川大学华西医院循证医学与临床流行病学教研室,成都610041

出　　处：《解放军医学杂志》2007年第8期805-807,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评价糖皮质激素预防内窥镜逆行胰胆管造影术(ERCP)后胰腺炎(PEP)的疗效和安全性。方法计算机检索Cochrane图书馆(issue 4,2006)、Medline(1966～2007.1)、EMBASE(1986～2007.1)和中国生物医学文献数据库(1978～2007.1),手检消化内科相关杂志(2006.7～2007.1)和参考文献,纳入糖皮质激素预防ERCP术后胰腺炎的随机对照试验,由两人独立进行数据提取和文献评价。应用RevMan4.2.8进行统计分析。结果共纳入6篇文献,Meta分析显示两组ERCP术后胰腺炎发生率无统计学差异(RR=1.11,95%CI 0.89～1.39)。亚组分析显示两组术后轻中度和重度胰腺炎发生率均无统计学差异(轻中度RR=1.17,95%CI 0.91～1.51;重度RR=1.79,95%CI 0.69～4.65;纳入4篇文献)。两组治疗性ERCP术后胰腺炎的发生率无统计学差异(RR=1.24,95%CI 0.91～1.67;纳入3篇文献)。排除3篇中止试验后的Meta分析同样显示两组术后胰腺炎发生率无统计学差异(RR=0.73,95%CI 0.44～1.20)。结论当前研究显示,糖皮质激素不能减少ERCP术后胰腺炎的发生,需要进一步高质量的研究来揭示糖皮质激素与对预防ERCP术后胰腺炎的关系。Objective To evaluate the effect and safety of glucocorticosteroids in prevention of post-ERCP pancreatitis （post-endoscopic retrograde cholangiopancreatography pancreatitis, PEP）. Methods The database of Cochrane Library （issue 4, 2006）, Medline （1966-2007. 1）, EMBASE （1986-2007. 1） and CBM （1978-2007. 1） were searched. The cited literature of obtained articles and some core English and Chinese medical journals （July, 2006-Jan, 2007） relevant to gastro-enterology were also searched by hand. All randomized controlled trials （RCT） comparing glucocorticosteroids to placeboes in prevention of PEP were included. Data collection and literature evaluation were performed by two reviewers independently. RevMan 4.2. 8 was used for statistical analysis. Result Six RCTs were included in meta-analysis which showed no statistical difference for the incidence of overall PEP between the glucocorticosteroids group and placebo group （RR=1. 11, 95%CI 0. 89-1.39）. Stratified by severity of PEP, four trials were included. Meta-analysis showed no statistical difference for the incidence of mild to moderate PEP and severe PEP between the two groups （RR=1. 17, 95%CI 0. 91-1. 51 for mildmoderate PEP; RR=1. 79, 95%CI 0. 69-4. 65 for severe PEP）. Stratified by therapeutic ERCP, three RCTs were included. Meta-analysis showed no statistical difference for the incidence of PEP between the two groups （RR=1. 24, 95%CI 0. 91-1.67）. 3 trials as to interira-analysis were excluded by sensitive analysis. Meta-analysis also showed no statistical difference for the incidence of PEP between the two groups （RR=0. 73, 95%CI 0. 44-1.20）. Conclusion Based on current evidence, glucocorticosteroids is not beneficial in preventing the occurrence of PEP. Further high quality study is needed to disclose the efficacy of glucocorticosteroids in prevention of PEP.

关 键 词：糖皮质激素类 胰胆管造影术 内窥镜逆行 胰腺炎 META 

分 类 号：R195.1[医药卫生—卫生统计学]