奥曲肽预防胰腺移植术后并发症有效性和安全性的Meta分析  

Efficacy and Safety of Octreotide in Preventing Complications after Pancreas Transplantation: A Meta-Analysis of Randomized Trials

作　　者：李璐璐[1] 李永胜[1] 庞丽丽[1] 赵娜[1] 冯莉[1] 李胜富[1] 龙丹[1] 李幼平[1,2] 

机构地区：[1]四川大学华西医院卫生部移植免疫实验室,成都610041 [2]四川大学华西医院中国循证医学中心

出　　处：《中国循证医学杂志》2008年第4期267-272,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家973计划自然科学基金项目(2003CB15504);国家教育部创新研究团队发展计划资助

摘　　要：目的系统评价奥曲肽预防胰腺移植术后并发症的有效性和安全性。方法计算机检索EMbase(1974～2008.1)、PubMed(1970～2008.1)、Cochrane图书馆(2008年第1期),中国生物医学文献数据库(1978～2008.1)查找有关奥曲肽预防胰腺移植术后并发症的临床试验研究。由两名评价者独立选择试验、提取资料和评估方法学质量,而后采用Cochrane协作网RevMan4.2.8软件进行统计分析。结果最终纳入3个RCT共82例胰腺移植受者。在移植术后第5天,奥曲肽组与空白对照组相比可降低尿淀粉酶,其差异有统计学意义[SMD=–784.86,95%CI(–1464.24,–105.49),P=0.02],但两组血淀粉酶的差异无统计学意义[SMD=–12.26,95%CI(–56.53,32.06),P=0.59]。奥曲肽组与空白对照组相比,术后各种并发症发生率的差异无统计学意义。奥曲肽组在胰腺移植90天存活和受者6个月生存率与空白对照组比较,其差异亦均无统计学意义[RR=0.96,95%CI(0.83,1.11),P=0.56;RR=1.17,95%CI(0.86,1.58),P=0.3]。在安全性方面,未报道奥曲肽对CsA和FK506吸收的影响,也无其他不良反应的报道。结论现有研究结果显示,与空白对照相比,奥曲肽不能明显降低胰腺移植术后胰腺炎、胰瘘及急性排斥反应的发生,对移植物和受者近期存活率也无明显影响。本系统评价纳入的RCT质量虽较高,但例数不多,上述结论尚需大样本、长期随访的高质量随机对照研究证实。Objective To evaluate after pancreas transplantation. Methods the efficacy and safety of prophylactic octreotide for preventing complications We searched The Cochrane Library （Issue 1, 2008）, PubMed （1970 to January 2008）, EMbase （1974 to January 2008） and CBM （1978 to January 2008）. Six studies concerning prophylactic octreotide in preventing complications after pancreas transplantation were retrieved. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently. Meta-analyses were done using The Cochrane Collaboration＇s RevMan 4.2.10 software. Results Three RCTs, involving a total of 82 patients were included in the review. On the fifth postoperative day, the urinary amylase was significantly lower in patients in the octreotide group compared to the control group （SMD=-784.86, 95%CI -1464.24 to -105.49, P=0.02）, and no significant difference was observed between the two groups in serum amylase （SMD=-12.26, 95%CI -56.53 to 32.06, P=0.59）. No significant difference in the incidence of complications was noted between the two groups. The differences between the two groups in graft survival rate （90 days after operation） and patients＇ 6-month survival rate were not statistically significant （RR= 0.96, 95%CI 0.83 to 1.11, P=0.56; RR= 1.17, 95%CI 0.86 to 1.58, P=0.32, respectively）. As for safety, there were no reports of adverse effects of octreotide on CsA or FK506 absorption and no reports of other adverse reactions. Conclusion The evidence currently available shows that prophylactic octreotide is not capable of reducing dramatically the occurrence of pancreatitis, fistula, thrombosis and rejection after pancreas transplantation. And there is no obvious influence on graft survival rate and patient survival rate. Because the RCTs available for this systematic review are too small, further highquality large-scale RCTs with long-term follow up are required to provide more reliable evidence.

关 键 词：胰腺移植 并发症 预防 奥曲肽 系统评价 

分 类 号：R657.5[医药卫生—外科学]