Zheng Minghua, Chen Yongping, Bai Jianling, Xin Yongning, Pan Xiazhen, Zhao Lu
Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
Pancreas. 2008 Oct;37(3):247-53. doi: 10.1097/MPA.0b013e31816857e3.
The aim of this study was to evaluate the effectiveness and the safety of allopurinol in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
: We used the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of allopurinol in the prevention of post-ERCP pancreatitis (PEP), including 6 RCTs conducted all over the world.
: Six RCTs totaling 1554 patients undergoing ERCP were included. When the RCTs were analyzed, odds ratios of allopurinol were 0.74 (95% confidence interval [CI], 0.37-1.48; P = 0.40) for PEP, 0.87 (95% CI, 0.33-2.28; P = 0.78) for severe PEP, 0.88 (95% CI, 0.37-2.11; P = 0.78) for post-ERCP hyperamylasemia, and 0.19 (95% CI, 0.01-3.91; P = 0.28) for case-fatality ratio of PEP, thus indicating no beneficial effects of allopurinol on acute pancreatitis, PEP death rate, and hyperamylasemia. No evidence of publication bias was found.
: Allopurinol cannot prevent the pancreatic injury after ERCP. Allopurinol is not recommended in the prophylaxis of PEP.
本研究旨在评估别嘌醇预防内镜逆行胰胆管造影术（ERCP）后胰腺炎的有效性和安全性。
我们采用Cochrane协作网推荐的方法，对全球范围内进行的6项关于别嘌醇预防ERCP术后胰腺炎（PEP）的随机对照试验（RCT）进行荟萃分析。
纳入了6项共1554例接受ERCP的RCT。对这些RCT进行分析时，别嘌醇预防PEP的比值比为0.74（95%置信区间[CI]，0.37 - 1.48；P = 0.40），预防严重PEP的比值比为0.87（95% CI，0.33 - 2.28；P = 0.78），预防ERCP术后高淀粉酶血症的比值比为0.88（95% CI，0.37 - 2.11；P = 0.78），PEP病死率的比值比为0.19（95% CI，0.01 - 3.91；P = 0.28），这表明别嘌醇对急性胰腺炎、PEP死亡率和高淀粉酶血症无有益作用。未发现发表偏倚的证据。
别嘌醇不能预防ERCP术后的胰腺损伤。不推荐使用别嘌醇预防PEP。
