Di Francesco Vincenzo, Mariani Alberto, Angelini Giampaolo, Masci Enzo, Frulloni Luca, Talamini Giorgio, Passaretti Sandro, Testoni Pieralberto, Cavallini Giorgio
Department of Biomedical and Surgical Sciences, University of Verona, Italy.
Dig Dis Sci. 2002 Apr;47(4):741-5. doi: 10.1023/a:1014775513616.
Gabexate mesilate is an antiprotease drug, which reduced the severity of pancreatitis and frequency of post-ERCP pancreatitis. In dogs gabexate inhibits sphincter of Oddi motility but no data are available in humans. The aim of this study was to verify by manometry the action of gabexate on human sphincter of Oddi motility. We enrolled 12 patients with idiopathic recurrent pancreatitis (eight males, five females, mean age 46 +/- 8 years). Standard preendoscopic sphincter of Oddi manometry was done in basal conditions and during infusion of gabexate 20 mg/min: basal pressure, amplitude and frequency of phasic contractions, and motility index (amplitude per frequency) were calculated before and after gabexate injection. Statistical analysis was performed by using Wilcoxon rank test for paired data. Six patients had a manometric diagnosis of stenosis (basal pressure greater than 40 mm Hg); six had normal findings. Phasic activity was not evaluable in five patients with stenosis. Basal pressure was unaffected by drug infusion, while gabexate caused a significant reduction of phasic activity, both in terms of frequency (4.5 +/- 1 vs 3.6 +/- 1; P < 0.05) and amplitude (157.4 +/- 44 vs 80.0 +/- 32; P < 0.05) of contractions. Motility index was reduced on average by 49%. In conclusion, this pilot study confirms, in patients with acute recurrent pancreatitis, the inhibitory action of gabexate on sphincter of Oddi motility already described in dogs. This action needs to be revaluated at therapeutic dosages. On the other hand, prophylactic use of the drug should be avoided during sphincter of Oddi manometry, in order to avoid false negative results.
甲磺酸加贝酯是一种抗蛋白酶药物，可减轻胰腺炎的严重程度并降低内镜逆行胰胆管造影术后胰腺炎的发生率。在犬类中，加贝酯可抑制Oddi括约肌的运动，但尚无关于人类的相关数据。本研究的目的是通过测压法验证加贝酯对人类Oddi括约肌运动的作用。我们纳入了12例特发性复发性胰腺炎患者（8例男性，5例女性，平均年龄46±8岁）。在基础状态下以及以20mg/min的速度输注加贝酯期间，进行标准的内镜下Oddi括约肌测压：计算加贝酯注射前后的基础压力、相性收缩的幅度和频率以及运动指数（幅度除以频率）。采用配对数据的Wilcoxon秩和检验进行统计分析。6例患者测压诊断为狭窄（基础压力大于40mmHg）；6例结果正常。5例狭窄患者无法评估相性活动。基础压力不受药物输注的影响，而加贝酯使相性活动显著降低，无论是收缩频率（4.5±1对3.6±1；P<0.05）还是幅度（157.4±44对80.0±32；P<0.05）。运动指数平均降低了49%。总之，这项初步研究证实，在急性复发性胰腺炎患者中，加贝酯对Oddi括约肌运动具有抑制作用，这在犬类中已有描述。这种作用需要在治疗剂量下重新评估。另一方面，在Oddi括约肌测压期间应避免预防性使用该药物，以避免出现假阴性结果。
