不同时段给药对吲哚美辛栓剂预防ERCP术后胰腺炎的作用分析

Rectal Indomethacin for Prevention of Post-ERCP Pancreatitis

关键词:  吲哚美辛  ERCP术后胰腺炎  meta分析

Key words:  indomethacin  post-ERCP pancreatitis  meta analysis

摘要:

目的 对吲哚美辛栓剂预防ERCP术后胰腺炎(post-ERCP pancreatitis，PEP)的作用，及不同给药时段对药物作用的影响进行系统性评估。方法 对2000年1月—2012年12月发表的文献进行检索，纳入关于吲哚美辛栓剂预防PEP的随机对照研究(RCT)，Jadad评分评估文献质量，Revman 5.0软件行数据统计分析。结果 按检索策略入选8个临床研究，吲哚美辛组的PEP发生相对风险率为对照组的43%(RR=0.43，95%CI：0.32~0.58，P<0.01)；按不同时段给药时间的亚组分析中，T1组(术前0.5~2 h)和T3组(术后)中PEP发生相对风险率分别为对照组的34%(RR=0.34，95%CI：0.20~0.58)和51%(RR=0.51，95%CI：0.34~0.75)。T2组(术前0~30 min)中与对照组的PEP发生率无明显差异；吲哚美辛栓剂组中、重症PEP发生率亦明显降低(RR=0.38，95%CI：0.21~0.68)。结论 吲哚美辛栓剂能有效预防PEP，术前0.5~2 h和术后给药能明显降低PEP的发生率，术前30 min内给药的结果尚不肯定，吲哚美辛栓剂可以有效预防术后高淀粉酶血症，减少中重症PEP发生率。

Abstract:

OBJECTIVE To evaluate the effect of rectal indomethacin for prevention of post-ERCP pancreatitis(PEP) by Meta analysis. METHODS The papers focused on the indomethacin prevention of PEP in Jan 2000-Dec 2012 with RCT were enrolled, qualify the trials by Jadad score, and analyse data by Renman 5.0. RESULTS Eight trials were enrolled. Meta analysis results were as follows: the incidence of PEP in rectal indomethacin group versus placebo group showed a relative risk of 43%(RR=0.43, 95%CI: 0.32-0.58], P<0.01); as for subgroups of different medication time, the incidence of PEP in subgroup T1(0.5-2 h prior to ERCP) and subgroup T3(post-ERCP) relatively showed a significant 34%(RR=0.34, 95%CI: 0.20-0.58)and 51%(RR=0.51, 95%CI: 0.34-0.75); there was no obvious difference in subgroup T2(within 30 min prior to ERCP); the incidences of hyperamylasemia and mild-severe pancreatitis were both lower in indomethacin group than in control group. CONCLUSION Rectal indomethacin is effective for prevention PEP. Administration of indomethacin at 0.5-2 h prior to ERCP or post-ERCP shows a significant lower incidence of PEP, but the effect is still unsure when taken within 30 min prior to ERCP. Indomethacin also decreases the risk of hyperamylasemia and mild-severe pancreatitis.