非甾体类抗炎药预防内镜下逆行胰胆管造影术后胰腺炎的荟萃分析  

The role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis： a meta- analysis

作　　者：牟国华[1] 

机构地区：[1]青岛大学医学院附属医院海阳分院消化内科,山东省海阳市265100

出　　处：《中国综合临床》2012年第8期853-859,共7页Clinical Medicine of China

摘　　要：目的通过荟萃分析方法来评价预防性使用非甾体类抗炎药（NSAIDs）是否具有降低内镜下逆行胰胆管造影术（ERCP）后胰腺炎的发病率和疾病严重程度的效用，为临床实践提供证据，并为术后胰腺炎的药物预防提出进一步展开临床研究的思路。方法全面检索MEDLINE（1966年1月至2011年1月），EMBASE（1966年1月至2011年1月）和Cochrane图书馆临床对照试验数据库（2011年第一期）。英文关键词“endoscopic retrograde cholangiopancreatography”或“ERCP”，“NSAIDs”或“nonsteroidal anti-inflammatory drugs”，“pancreatitis”，“indomethacin”和“diclofenac”。评价术后胰腺炎发生率、NSAIDs相关不良反应和病死率。统计学处理采用Cochrane协作网提供的Revman 4．3．2软件，计算比数比及其95％可信区间。结果共有5项随机对照临床试验包括1119例患者纳入荟萃分析研究。安慰剂组558例，均为安慰剂治疗，治疗剂量、时间与治疗组相同。治疗组561例，其中265例（23．68％）接受双氯芬酸治疗，296例（26．45％）接受吲哚美辛治疗。治疗组术后胰腺炎发生率6．60％低于安慰剂组13．26％（OR=0．45；P=0．0002），差异有统计学意义。其中轻症术后胰腺炎治疗组发生率5．53％低于安慰剂组10．75％（OR=0．48；P=0．002），差异有统计学意义。中、重症术后胰腺炎治疗组发生率1．07％低于安慰剂组2．51％（OR=0．44；P=0．08），差异无统计学意义。结论荟萃分析表明预防性使用NSAIDs能降低ERCP后胰腺炎发生率。Objective To evaluate the efficacy of NSAIDs in the prevention and alleviation of post- ERCP pancreatitis and to provide theoretical basis for clinical practice and enhance the improvement of clinical studies on post-ERCP pancreatitis medication. Methods We performed extensive literature search from computerized databases MEDLINE （Jan. 1966 - Jan. 2011 ） , EMBASE （Jan. 1966 - Jan. 2011 ） and the Cochrane Central Register of Controlled Trials （Issue 1,2011 ）using the key words ＂ endoscopic retrograde cholangiopancreatography＂ or ＂ERCP＂ ,＂ NSAIDs＂ or ＂nonsteroidal anti-inflammatory drugs＂,＂ pancreatitis＂ ,＂ indomethacin＂ and ＂ diclofenac＂. The following primary outcomes were assessed： （1）Incidence of PEP; （2） Mortality of PEP; （ 3 ） Adverse events. Pooled odds ratio and 95% confidence interval were computed using Revman version 4. 3.2 from Cochrane. org web. Results Five multinational RCTs were included in our meta- analysis. There were in total 1119 patients involved in this meta-analysis, including 561 individuals in the treatment group and 558 participants in the placebo group. Among the patients in the treatment group,265 were treated by diclofenac and 296 were treated by indomethacin. The placebo group had same duration and dose of treatment with the treatment group. The prevalence of post-ERCP pancreatitis was significantly lower in the treatment group than in the placebo group （6. 60% vs. 13.26% ;OR = 0.45 ;P 〈 0. 001 ）. The pooled odds ratio for NSAIDs with mild PEP was 0. 48 （ 95 % CI： 0. 31 - 0. 76 ; P = 0. 002 ） and the pooled odds ratio for NSAIDs with moderate to severe PEP was 0. 44 （ P = 0. 08 ） . Conclusion Based on the findings from the present systematic review of 5 RCTs, NSAIDs are effective and well tolerated in the prevention of PEP.

关 键 词：内镜下逆行胰胆管造影术 胰腺炎 非甾体类抗炎药 系统评价 META-分析 

分 类 号：R576[医药卫生—消化系统]