直肠给药途径应用NSAIDS类抗炎药预防ERCP术后急性胰腺炎疗效与安全的Meta分析

发布时间：2018-03-06 10:24

本文选题：内镜下逆行胰胆管造影术后急性胰腺炎　切入点：胰胆管造影术　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:内镜下逆行胰胆管造影术(Endoscopic Retrograte Cholang-iopancreatography,ERCP)是一门广泛使用的进行诊断和治疗胆道与胰腺相关性疾病的技术,包括胆总管结石、良性或恶性胰胆管狭窄等。ERCP术后急性胰腺炎(post-ERCP pancreatitis,PEP)是ERCP术后最常见的并发症,发病率约为2-10%。轻度PEP可以延长住院时间,然而重度PEP可以引起出血性胰腺炎,胰腺坏死,多器官功能衰竭甚至死亡。ERCP术后诱发的全身炎症反应是引起PEP的病理生理性事件;然而截至目前,确切的发病机制尚不能完全阐明。目前研究表明:磷脂酶A2(phospholipase A2,PLA2)是参与急性胰腺炎炎症级联反应的重要因子;作为一种有效的PLA2抑制剂,直肠途径应用非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDS)在临床上已经被广泛应用于预防PEP。一些相关的Meta分析研究表明:直肠途径应用NSAIDS对于预防PEP是安全有效的;然而最新的随机对照试验(randomized controlled trial,RCT)研究表明:单次剂量的吲哚美辛(100mg)相比安慰剂并不能有效预防PEP;不同国家之间的指南对于直肠途径应用NSAIDS预防PEP的有效性和安全性仍存在争议。目的:采用Meta分析方法,评估直肠途径应用NSAIDS预防PEP的安全性及有效性,并提供最新的研究结果来揭示何种类型NSAIDS和给药时间将更加有效。方法:计算机检索万方数据库(wanfangdata)、中国生物医学文献数据库(cbm)、维普(vip)、中国知网(cnki)、cochranelibrary、pubmed、embase、ovid和webofscience等国内外数据库,获取已检索研究资料的参考文献,收集直肠给药途径应用nsaids预防pep的随机对照试验(rct)研究,应用cochrane协作网提供的“偏倚风险评估”工具和“改良jadad量表”,对收集的文献进行偏倚风险和质量评估,提取文献数据,并应用cochrane协作网推荐的revman5.3软件进行meta分析。本研究的主要终点是评估直肠给药途径应用nsaids对于预防pep的有效性;并对不同类型的nsaids、普通和高危患者以及不同给药时间进行亚组分析,评估其降低风险值。结果:本研究最终纳入12篇随机对照试验(rct)文献,共3989例患者(nsaids组2016例,安慰剂组1973例)进行meta分析,结果表明:1)在高危组和普通组患者中直肠途径应用nsaids相比安慰剂明显降低了pep发病率(rr=0.52,95%ci(0.43,0.64),p0.01);2)直肠给药途径应用nsaids相比安慰剂明显降低了中重度pep发病率(rr=0.44,95%ci(0.28,0.69),p=0.01);3)直肠给药途径应用吲哚美辛和双氯芬酸钠以及nsaids的不同给药时间(ercp术前或术后)均不会对其疗效造成影响。结论:直肠给药途径应用nsaids在高危组和普通组患者中对于预防pep均是安全有效的;并且nsaids预防pep的有效性并不受给药时间(ercp术前或术后)和药物种类(双氯芬酸钠或吲哚美辛)的影响。
[Abstract]:Background: Endoscopic Retrograte Cholang-iopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary tract and pancreatic related diseases, including choledocholithiasis. Acute pancreatitis after ERCP is the most common complication, the incidence of which is about 2-10. Mild PEP can prolong hospital stay, but severe PEP can cause hemorrhagic pancreatitis and pancreatic necrosis. The systemic inflammatory response induced by multiple organ failure or even death after ERCP is the pathophysiological event of PEP. The exact pathogenesis has not been fully elucidated. At present, studies have shown that phospholipase A _ 2 / phospholipase A _ 2 / PLA _ 2 is an important factor involved in inflammatory cascade reaction in acute pancreatitis, and is an effective inhibitor of PLA2. The application of non-steroidal anti-inflammatory drug NSAIDSs in rectum pathway has been widely used in the prevention of PEP.A number of related Meta analysis studies have shown that the application of NSAIDS in rectal pathway is safe and effective for the prevention of PEP. However, the latest randomized controlled trial randomized controlled trialcitrate study showed that a single dose of indomethacin 100mg was not effective in preventing PEPs compared with placebos; guidelines for the use of NSAIDS in different countries were effective and safe for the rectal approach to the prevention of PEP. Sex is still controversial. Objective: to use Meta analysis method, To evaluate the safety and efficacy of rectal NSAIDS in the prevention of PEP. The latest research results were also provided to reveal which types of NSAIDS and administration time would be more effective. Methods: the database of Wanfang, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, and the domestic and foreign databases, such as the Chinese Medical Literature Database, the Chinese Biomedical document Database, the Chinese Biomedical document Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, and the Chinese Biomedical Literature Database, etc., were searched by computer and compared with the other domestic and foreign databases. A randomized controlled trial of rectal administration with nsaids to prevent pep was conducted. Using the "bias risk assessment" tool provided by cochrane cooperation network and the modified jadad scale, the bias risk and quality of the collected literature were evaluated, and the literature data were extracted. The main end point of this study was to evaluate the efficacy of rectal administration of nsaids in the prevention of pep. The subgroup analysis of different types of nsaids, common and high risk patients, and different administration time were carried out to evaluate the risk reduction value. Results: this study included 12 randomized controlled trials (RCT) literature, including 3 989 patients with nsaids (2016 cases). Meta analysis was performed in the placebo group (1973 cases). The results showed that nsaids significantly decreased the incidence of pep in high risk group and general group compared with placebo. Rectal administration of nsaids significantly decreased the incidence of moderate and severe pep compared with placebo. The effect of indomethacin, diclofenac sodium and different time of administration of nsaids before or after operation was not affected. Conclusion: rectal administration of nsaids is effective in preventing pep in high risk group and normal group. Are safe and effective; The efficacy of nsaids in the prevention of pep was not affected by the time of administration before or after operation and the type of drug (diclofenac sodium or indomethacin).
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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