De Palma G D, Catanzano C
Servizio Centralizzato Di Endoscopia Digestiva Operatoria, University of Naples Federico II, Italy.
Am J Gastroenterol. 1999 Apr;94(4):982-5. doi: 10.1111/j.1572-0241.1999.999_u.x.
The aim of this prospective controlled study was to determine whether prophylactic corticosteroids decrease the incidence of post-ERCP pancreatitis.
A double-blind comparison of hydrocortisone (100 mg by i.v. infusion immediately before endoscopy) with placebo (sodium chloride administered in the same fashion). A total of 535 patients (286 women and 249 men, with an average age of 58.6 yr) who were scheduled to undergo diagnostic or operative ERCP underwent randomization. Six patients were excluded from the final evaluation for various reasons. The remaining 529 patients, 263 in the hydrocortisone group and 266 in the placebo group, were analyzed. Patients were divided into subgroups with regard to high risk factors for acute pancreatitis after ERCP.
The overall incidence of acute pancreatitis was 5.3% (28 of 529 patients). Procedure-induced pancreatitis occurred in 15 of 263 (5.7%) patients treated with hydrocortisone and in 13 of 266 (4.9%) patients treated with placebo (p = NS). The results of analysis of risk factors for pancreatitis did not evidence any significant difference between the hydrocortisone group and the placebo group.
Hydrocortisone does not prevent acute pancreatitis after diagnostic or therapeutic ERCP.
这项前瞻性对照研究的目的是确定预防性使用皮质类固醇是否能降低内镜逆行胰胆管造影术（ERCP）后胰腺炎的发生率。
对氢化可的松（内镜检查前立即静脉输注100毫克）与安慰剂（以相同方式给予氯化钠）进行双盲比较。共有535例计划接受诊断性或手术性ERCP的患者（286例女性和249例男性，平均年龄58.6岁）进行了随机分组。6例患者因各种原因被排除在最终评估之外。对其余529例患者进行了分析，其中氢化可的松组263例，安慰剂组266例。根据ERCP后急性胰腺炎的高危因素将患者分为亚组。
急性胰腺炎的总体发生率为5.3%（529例患者中的28例）。接受氢化可的松治疗的263例患者中有15例（5.7%）发生了手术诱发的胰腺炎，接受安慰剂治疗的266例患者中有13例（4.9%）发生了手术诱发的胰腺炎（p=无显著性差异）。胰腺炎危险因素的分析结果表明氢化可的松组和安慰剂组之间没有任何显著差异。
氢化可的松不能预防诊断性或治疗性ERCP后的急性胰腺炎。
