加贝酯预防内镜逆行胰胆管造影术后胰腺炎的meta分析

发布时间：2018-07-28 10:51

【摘要】：目的急性胰腺炎是内镜逆行胰胆管造影术（endoscopic retrogradecholangiopancreatography, ERCP）术后最常见的并发症。加贝酯作为一种蛋白酶抑制剂，被用于ERCP术后胰腺炎（post-endoscopic retrogradecholangiopancreatography pancreatitis, PEP）的预防研究中。此前的临床研究得出不同的结论，本文旨在用meta分析的方法来评价加贝酯在预防PEP发生中的有效性及安全性。 方法采用Cochrane系统评价方法，使用计算机从Cochrane图书馆、EMBASE、PubMed、中文期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBM）、万方数据库等数据库中检索文献，并辅以手工检索其他来源文献。对于符合入选标准的文献，2名研究者独立提取出文献中的数据，并依据Jadad量表评价并交叉核对纳入研究的质量。用Cochrane协作网提供的统计软件RevMan5.2完成meta分析。 结果根据制定的检索策略和文献纳入、排除标准，共有10篇文献，总共3235例病例被纳入研究中。10篇均为随机对照临床试验（randomized controlled trial, RCT）。meta分析结果显示：加贝酯组与对照组相比，PEP发生率差异有统计学意义（OR=0.56，95%CI为0.34~0.93， P=0.02）， ERCP术后高淀粉酶血症（post-ERCPhyperamylasemia, PEHA）发生率差异也有统计学意义（OR=0.82，95%CI为0.67~0.99，P=0.04）；而ERCP术后重症急性胰腺炎（severe acutepancreatitis, SAP）发生率差异无统计学意义（OR=0.81，95%CI为0.29~2.25，P=0.69），ERCP术后腹痛发生率差异也无统计学意义（OR=0.93，95%CI为0.64~1.36，P=0.70）。亚组分析显示加贝酯大剂量(≥1g)长时程(≥12h)使用对PEP有预防作用（OR=0.44，95%CI为0.24~0.78，P=0.005），也可预防ERCP术后腹痛的发生（OR=0.43，95%CI为0.25~0.77，P=0.004）和预防PEHA的发生（OR=0.7，95%CI为0.50~0.96，P=0.03）。 结论加贝酯可预防的PEHA的发生；加贝酯不能预防ERCP术后SAP的发生；大剂量长时程应用加贝酯可预防PEP、PEHA、ERCP术后腹痛的发生；加贝酯的应用是安全的；尚需更多高质量且样本量大的随机对照试验来验证加贝酯的预防作用。
[Abstract]:Objective Acute pancreatitis is the most common complication after endoscopic retrograde cholangiopancreatography (endoscopic retrogradecholangiopancreatography, ERCP). Gabelle, as a protease inhibitor, has been used in the preventive study of postoperative pancreatitis (post-endoscopic retrogradecholangiopancreatography pancreatitis, PEP) after ERCP. Different conclusions have been drawn from previous clinical studies. The purpose of this study is to evaluate the efficacy and safety of Gabexate in the prevention of PEP by meta analysis. Methods the Cochrane system was used to retrieve the literature from the Cochrane library EMBASE PubMedand the Chinese Journal Full-text Database (CNKI), the Chinese Biomedical Literature Database (CBM), Wanfang), and the Chinese Journal of Science and Technology Database (VIP),). Other sources of literature were retrieved by hand. Two researchers who met the inclusion criteria extracted the data from the literature independently and evaluated and cross-checked the quality of the study according to the Jadad scale. The meta analysis is completed with the statistical software RevMan5.2 provided by the Cochrane Cooperative Network. Results according to the retrieval strategy and literature inclusion and exclusion criteria, there were 10 articles. A total of 3235 cases were included in the study. 10 were randomized controlled clinical trials. The results of (randomized controlled trial, RCT) .meta analysis showed that there was a significant difference in the incidence of (randomized controlled trial, RCT) between the Gabexate group and the control group (CI = 0.34695 CI = 0.340.93). There was also significant difference in the incidence of post-ERCP hyperamylasemia (PEHA) (OR 0.8295 CI was 0.67 卤0.99P0. 04). However, there was no significant difference in the incidence of severe acute pancreatitis (severe acutepancreatitis, SAP) after ERCP (CI = 0.29 卤2.25, P = 0.69). There was also no significant difference in the incidence of abdominal pain after ERCP (OR0.93 95 CI = 0.64 卤1.36 P = 0.70). Subgroup analysis showed that high dose (鈮，

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