硝酸甘油预防经内镜逆行胰胆管造影术后胰腺炎的Meta分析

发布时间：2018-04-25 11:59

  本文选题：经内镜胰胆管造影术 + 硝酸甘油　； 参考：《遵义医学院》2017年硕士论文

【摘要】：目的:评估硝酸甘油是否可预防经内镜逆行胰胆管造影术后胰腺炎(post-endoscopic retrograde cholangiopancreatography pancreatitis,PEP),为临床预防经内镜逆行胰胆管造影术后胰腺炎的发生提供一定参考。方法:基于研究主题制定检索策略,由两名研究人员独立通过计算机在以下数据库中检索有关硝酸甘油预防PEP的临床文献:Pubmed、Embase、the Cochrane library、SCI、Web of science、中国生物医学文献数据库(CBM)、中国知网数据库(CNKI)及万方数据库,文种限定中英文,检索时限均从建库至2016年11月30日。按照纳入标准及排除标准筛选文献,对最终纳入的文献进行数据提取,通过Cochrane协作网的偏倚风险评价表进行质量评价,采用Rev Man 5.3软件进行数据整合分析。因纳入的各项研究间硝酸甘油的给药途径、剂量及PEP严重程度、研究地域不同,为探讨临床异质性行亚组分析。为验证结局的稳定性及可靠性,行发表偏倚及敏感性分析。结果:纳入13篇共计2695例行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)患者(硝酸甘油组1339例,对照组1356例)的临床文献,荟萃分析示硝酸甘油可降低ERCP术后胰腺炎的发生率[RR=0.62,95%CI(0.48-0.80,P=0.0002]。亚组分析结果示(1)ERCP术后胰腺炎严重程度分型。轻度胰腺炎组:纳入6项研究,共1809例行ERCP患者(硝酸甘油组899例,对照组910例),分析结果示硝酸甘油降低轻度ERCP术后胰腺炎的发生无统计学意义[RR=0.77,95%CI(0.52-1.15),P=0.20]。中重度胰腺炎组:纳入5项,共1621例行ERCP患者(硝酸甘油组805例,对照组816例),分析结果示硝酸甘油降低中重度ERCP术后胰腺炎的发生无统计学意义[RR=0.70,95%CI(0.42-1.15),P=0.16];(2)按给药途径分型:舌下含服可降低PEP的发生[RR=0.40,95%CI(0.25-0.63),P0.0001]。透皮贴剂、局部喷洒组预防PEP的发生无统计学意义([RR1=0.78,95%CI1(0.55-1.10),P1=0.16];[RR_2=1.00,95%CI2(0.28-3.53),P2=1.00]);(3)用药剂量分型:小于5mg组可降低PEP的发生[RR=0.50,95%CI(0.33-0.78),P=0.002]。5-10mg组及15mg组降低ERCP术后胰腺炎的发生无统计学意义([RR1=0.73,95%CI1(0.48-1.11),P1=0.14];[RR_2=0.64,95%CI2(0.41-1.02),P2=0.06]);(4)地域分型:硝酸甘油降低PEP发生率在亚欧地区有统计学意义([RR1=0.52,95%CI1(0.33-0.79),P1=0.003;RR_2=0.56,95%CI2(0.39-0.81),P2=0.002])。结论:硝酸甘油可预防经内镜逆行胰胆管造影术后胰腺炎的发生,本研究最佳给药途径为舌下含服,其主要副反应为低血压、头痛,经常规治疗后可好转。
[Abstract]:Objective: to evaluate whether nitroglycerin can prevent post-endoscopic retrograde cholangiopancreatography pancreatitis after endoscopic retrograde cholangiopancreatography. Methods: based on the research topic, the retrieval strategy was established. Two researchers independently searched the following databases: the clinical literature on nitroglycerin prevention of PEP:: Pubmed Embase, the Cochrane library of science, the Chinese biomedical literature database, CNKI) and Wanfang database, in English and Chinese, respectively. The time limit for retrieval is from the construction of the database to November 30, 2016. According to the inclusion criteria and exclusion criteria, the data were extracted and evaluated by the bias risk evaluation table of Cochrane cooperation network, and the data integration analysis was carried out by Rev Man 5.3 software. Subgroup analysis was carried out to explore clinical heterogeneity due to the study of the route, dosage and PEP severity of m-nitroglycerin in different study areas. To verify the stability and reliability of the outcome, publication bias and sensitivity analysis were performed. Results: a total of 2695 patients (1339 patients in nitroglycerin group and 1356 patients in control group) underwent endoscopic retrograde cholangiopancreatography (ERCP). The meta-analysis showed that nitroglycerin could reduce the incidence of pancreatitis after ERCP [RRN 0.62N 95 CI 0.48-0.80P0.0002]. The results of subgroup analysis showed the severity of pancreatitis after ERCP. Mild pancreatitis group: a total of 1809 ERCP patients (nitroglycerin group, 899 cases, control group, 910 cases) were included in 6 studies. The results showed that nitroglycerin decreased the incidence of pancreatitis after mild ERCP. In the moderate and severe pancreatitis group, 1621 patients with ERCP were included in 5 items (805 patients in nitroglycerin group). In the control group (816 cases), the results showed that nitroglycerin decreased the incidence of pancreatitis after moderate and severe ERCP. There was no significant difference in the incidence of pancreatitis after operation [RRN 0.70 ~ 95 CI: 0.42-1.15 ~ (0.16) P ~ (0. 16)] according to the way of administration: sublingual administration could reduce the incidence of PEP [RRN 0.4025 ~ (0.63) P 0.0001]. Transdermal patch, 灞，

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