【摘要】：目的急性胰腺炎是內(nèi)鏡逆行胰膽管造影術(shù)（endoscopic retrogradecholangiopancreatography, ERCP）術(shù)后最常見的并發(fā)癥。加貝酯作為一種蛋白酶抑制劑，被用于ERCP術(shù)后胰腺炎（post-endoscopic retrogradecholangiopancreatography pancreatitis, PEP）的預(yù)防研究中。此前的臨床研究得出不同的結(jié)論，本文旨在用meta分析的方法來評價(jià)加貝酯在預(yù)防PEP發(fā)生中的有效性及安全性。 方法采用Cochrane系統(tǒng)評價(jià)方法，使用計(jì)算機(jī)從Cochrane圖書館、EMBASE、PubMed、中文期刊全文數(shù)據(jù)庫（CNKI）、維普中文科技期刊數(shù)據(jù)庫（VIP）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、萬方數(shù)據(jù)庫等數(shù)據(jù)庫中檢索文獻(xiàn)，并輔以手工檢索其他來源文獻(xiàn)。對于符合入選標(biāo)準(zhǔn)的文獻(xiàn)，2名研究者獨(dú)立提取出文獻(xiàn)中的數(shù)據(jù)，并依據(jù)Jadad量表評價(jià)并交叉核對納入研究的質(zhì)量。用Cochrane協(xié)作網(wǎng)提供的統(tǒng)計(jì)軟件RevMan5.2完成meta分析。 結(jié)果根據(jù)制定的檢索策略和文獻(xiàn)納入、排除標(biāo)準(zhǔn)，共有10篇文獻(xiàn)，總共3235例病例被納入研究中。10篇均為隨機(jī)對照臨床試驗(yàn)（randomized controlled trial, RCT）。meta分析結(jié)果顯示：加貝酯組與對照組相比，PEP發(fā)生率差異有統(tǒng)計(jì)學(xué)意義（OR=0.56，95%CI為0.34~0.93， P=0.02）， ERCP術(shù)后高淀粉酶血癥（post-ERCPhyperamylasemia, PEHA）發(fā)生率差異也有統(tǒng)計(jì)學(xué)意義（OR=0.82，95%CI為0.67~0.99，P=0.04）；而ERCP術(shù)后重癥急性胰腺炎（severe acutepancreatitis, SAP）發(fā)生率差異無統(tǒng)計(jì)學(xué)意義（OR=0.81，95%CI為0.29~2.25，P=0.69），ERCP術(shù)后腹痛發(fā)生率差異也無統(tǒng)計(jì)學(xué)意義（OR=0.93，95%CI為0.64~1.36，P=0.70）。亞組分析顯示加貝酯大劑量(≥1g)長時(shí)程(≥12h)使用對PEP有預(yù)防作用（OR=0.44，95%CI為0.24~0.78，P=0.005），也可預(yù)防ERCP術(shù)后腹痛的發(fā)生（OR=0.43，95%CI為0.25~0.77，P=0.004）和預(yù)防PEHA的發(fā)生（OR=0.7，95%CI為0.50~0.96，P=0.03）。 結(jié)論加貝酯可預(yù)防的PEHA的發(fā)生；加貝酯不能預(yù)防ERCP術(shù)后SAP的發(fā)生；大劑量長時(shí)程應(yīng)用加貝酯可預(yù)防PEP、PEHA、ERCP術(shù)后腹痛的發(fā)生；加貝酯的應(yīng)用是安全的；尚需更多高質(zhì)量且樣本量大的隨機(jī)對照試驗(yàn)來驗(yàn)證加貝酯的預(yù)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 鹵0.99P0. 04). However, there was no significant difference in the incidence of severe acute pancreatitis (severe acutepancreatitis, SAP) after ERCP (CI = 0.29 鹵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 鹵1.36 P = 0.70). Subgroup analysis showed that high dose (鈮，

本文編號：2149869