中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
8期
853-859
,共7页
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
內鏡下逆行胰膽管造影術%胰腺炎%非甾體類抗炎藥%繫統評價%Meta-分析
내경하역행이담관조영술%이선염%비치체류항염약%계통평개%Meta-분석
Post-endoscopic retrograde cholangiopancreatography%Pancreatitis%Nonsteroidal antiinflammatory drugs%Randomized controlled trial%Meta-analysis
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.
目的 通過薈萃分析方法來評價預防性使用非甾體類抗炎藥(NSAIDs)是否具有降低內鏡下逆行胰膽管造影術(ERCP)後胰腺炎的髮病率和疾病嚴重程度的效用,為臨床實踐提供證據,併為術後胰腺炎的藥物預防提齣進一步展開臨床研究的思路.方法 全麵檢索MEDLINE(1966年1月至2011年1月),EMBASE(1966年1月至2011年1月)和Cochrane圖書館臨床對照試驗數據庫(2011年第一期).英文關鍵詞“endoscopic retrograde cholangiopancreatography"或“ERCP”,“NSAIDs”或“nonsteroidal anti-inflammatory drugs”,“pancreatitis”,“indomethacin”和“diclofenac”.評價術後胰腺炎髮生率、NSAIDs.相關不良反應和病死率.統計學處理採用Cochrane協作網提供的Revman 4.3.2軟件,計算比數比及其95％可信區間.結果 共有5項隨機對照臨床試驗包括1119例患者納入薈萃分析研究.安慰劑組558例,均為安慰劑治療,治療劑量、時間與治療組相同.治療組561例,其中265例(23.68％)接受雙氯芬痠治療,296例(26.45％)接受吲哚美辛治療.治療組術後胰腺炎髮生率6.60％低于安慰劑組13.26％(OR =0.45；P =0.0002),差異有統計學意義.其中輕癥術後胰腺炎治療組髮生率5.53％低于安慰劑組10.75％(OR =0.48；P =0.002),差異有統計學意義.中、重癥術後胰腺炎治療組髮生率1.07％低于安慰劑組2.51％(OR =0.44;P =0.08),差異無統計學意義.結論 薈萃分析錶明預防性使用NSAIDs能降低ERCP後胰腺炎髮生率.
목적 통과회췌분석방법래평개예방성사용비치체류항염약(NSAIDs)시부구유강저내경하역행이담관조영술(ERCP)후이선염적발병솔화질병엄중정도적효용,위림상실천제공증거,병위술후이선염적약물예방제출진일보전개림상연구적사로.방법 전면검색MEDLINE(1966년1월지2011년1월),EMBASE(1966년1월지2011년1월)화Cochrane도서관림상대조시험수거고(2011년제일기).영문관건사“endoscopic retrograde cholangiopancreatography"혹“ERCP”,“NSAIDs”혹“nonsteroidal anti-inflammatory drugs”,“pancreatitis”,“indomethacin”화“diclofenac”.평개술후이선염발생솔、NSAIDs.상관불량반응화병사솔.통계학처리채용Cochrane협작망제공적Revman 4.3.2연건,계산비수비급기95％가신구간.결과 공유5항수궤대조림상시험포괄1119례환자납입회췌분석연구.안위제조558례,균위안위제치료,치료제량、시간여치료조상동.치료조561례,기중265례(23.68％)접수쌍록분산치료,296례(26.45％)접수신타미신치료.치료조술후이선염발생솔6.60％저우안위제조13.26％(OR =0.45；P =0.0002),차이유통계학의의.기중경증술후이선염치료조발생솔5.53％저우안위제조10.75％(OR =0.48；P =0.002),차이유통계학의의.중、중증술후이선염치료조발생솔1.07％저우안위제조2.51％(OR =0.44;P =0.08),차이무통계학의의.결론 회췌분석표명예방성사용NSAIDs능강저ERCP후이선염발생솔.
Objective To evaluate the efficacy of NSAIDs in the prevention and alleviation of postERCP 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 metaanalysis.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.
