吲哚美辛栓剂预防ERCP术后胰腺炎疗效的Meta分析  

Effect of indomethacin suppository on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography:a Meta-analysis

作　　者：蒲新霖 蒋昭友 PU Xinlin;JIANG Zhaoyou(Department of Gastroenterology,Chengdu Seventh People's Hospital,Chengdu 610041,China;Department of Oncology,Chengdu Seventh People's Hospital,Chengdu 610041,China)

机构地区：[1]成都市第七人民医院消化内科,成都610041 [2]成都市第七人民医院肿瘤科,成都610041

出　　处：《医学新知》2024年第12期1395-1407,共13页New Medicine

摘　　要：目的系统评价术前使用吲哚美辛栓剂预防内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术后胰腺炎(post-ERCP pancreatitis,PEP)的有效性。方法计算机检索中国知网、中国生物医学文献数据库、维普、万方、PubMed、Cochrane Central Register of Controlled Trials和Embase数据库,检索吲哚美辛栓剂预防急性PEP的随机对照试验,检索时间截止2024年4月20日。2名研究者独立筛选文献、提取数据、偏倚风险评价,采用RevMan 5.3软件进行Meta分析。结果共纳入20项研究,涉及4238例患者。Meta分析结果显示,吲哚美辛组急性PEP发生率[RR=0.47,95%CI(0.35,0.62)]和高淀粉酶血症发生率[RR=0.55,95%CI(0.44,0.69)]显著低于对照组,差异有统计学意义;但其在急性重症PEP发病率方面与对照组差异无统计学意义[RR=0.47,95%CI(0.20,1.11)]。吲哚美辛组在降低ERCP术后6 h淀粉酶水平[MD=-40.16,95%CI(-48.93,-31.39)]方面优于对照组,差异有统计学意义,但在ERCP术后3 h[MD=-26.82,95%CI(-162.46,108.82)]和24 h[MD=-83.75,95%CI(-179.56,12.05)]淀粉酶水平方面两组差异无统计学意义。结论ERCP术前使用吲哚美辛栓剂能降低急性PEP、高淀粉酶血症发生率,可降低ERCP术后6 h淀粉酶水平。Objective To systematically evaluate the efficacy of indomethacin suppository on the prevention of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Methods CNKI,CBM,VIP,WanFang,PubMed,CENTRAL and Embase were searched to collect randomized controlled trials of indomethacin suppository for the prevention of acute PEP.The search period was from inception to April 20,2024.Two authors screened the articles independently,extracted the target data and evaluated the risk of bias.Meta-analysis was conducted using software RevMan 5.3.Results A total of 20 studies with 4,238 patients were included.The results of Meta-analysis showed:the incidence of acute PEP[RR=0.47,95%CI(0.35,0.62)]and the incidence of hyperamylasemia[RR=0.55,95%CI(0.44,0.69)]in indomethacin group were significantly lower than the control group,the difference was statistically significant,but there was no statistically significant in acute severe PEP between indomethacin group and control group[RR=0.47,95%CI(0.20,1.11)].In the indomethacin group,the amylase level at 6 h[MD=-40.16,95%CI(-48.93,-31.39)]after ERCP was significantly lower than the control group.There were no significant difference in the amylase level at 3 h[MD=-26.82,95%CI(-162.46,108.82)]and 24 h[MD=-83.75,95%CI(-179.56,12.05)]after ERCP between the indomethacin group and the control group.Conclusion Indomethacin suppository can decrease the incidence of acute PEP and hyperamylasemia after ERCP,and can reduce the amylase level at 6 h after ERCP.

关 键 词：吲哚美辛 内镜下逆行胰胆管造影 胰腺炎 META分析 

分 类 号：R576[医药卫生—消化系统]