Yong Feng-Jiao, Mao Xuan-Yue, Deng Li-Hui, Zhang Ming-Ming, Xia Qing
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Hepatobiliary Pancreat Dis Int. 2015 Feb;14(1):10-7. doi: 10.1016/s1499-3872(14)60290-3.
Continuous regional arterial infusion (CRAI) is a drug delivery system, which dramatically increases the drug concentration in the pancreas. Previous clinical and basic studies have demonstrated the possible therapeutic efficacy of CRAI for severe acute pancreatitis (SAP). This meta-analysis of all published randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of CRAI for the treatment of SAP.
Up to August 10, 2014, RCTs comparing CRAI with intravenous infusion for SAP in PubMed, Embase, EBSCO, MEDLINE, Science Citation Index Expanded, Cochrane Library, China Academic Journals Full-Text Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database were selected by two independent reviewers. The relative risk (RR) and their 95% confidence intervals (CI) for duration of elevated serum amylase and urine amylase, duration of abdominal pain, infection rate, incidence of complication, overall mortality, curative rate, hospital stay and details of subgroup analysis were extracted. Meta-analyses were made using the software Review Manager (RevMan version 5.10).
Six RCTs with 390 patients meeting the inclusion criteria were included in the final analysis. Compared with intravenous infusion route, CRAI significantly shortened the duration of elevated urine amylase (MD=-2.40, 95% CI=-3.20, -1.60; P<0.00001) and the duration of abdominal pain (MD=-1.46, 95% CI=-1.94, -0.98; P<0.00001), decreased the incidence of complication (RR=0.35, 95% CI=0.15, 0.81; P=0.01) and overall mortality (RR=0.25, 95% CI=0.08, 0.78; P=0.02), shortened the duration of hospital stay (MD=-10.36, 95% CI=-17.05, -3.68; P=0.002), and increased the curative rate (RR=1.66, 95% CI=1.13, 2.46; P=0.01). No mortality and catheter-related infections due to CRAI administration was reported in these studies. Subgroup analysis showed that the combination of drug administration via CRAI did not significantly improve the outcomes.
CRAI is effective for the treatment of SAP, and the combination of drug administration via CRAI did not have a significant effect on the improvement of the outcomes.
持续区域性动脉灌注（CRAI）是一种给药系统，可显著提高胰腺中的药物浓度。既往临床和基础研究已证明CRAI对重症急性胰腺炎（SAP）可能具有治疗效果。本荟萃分析纳入了所有已发表的随机对照试验（RCT），以评估CRAI治疗SAP的疗效和安全性。
截至2014年8月10日，由两名独立评审员在PubMed、Embase、EBSCO、MEDLINE、科学引文索引扩展版、Cochrane图书馆、中国学术期刊全文数据库、中国生物医学文献数据库和中国科学期刊数据库中筛选比较CRAI与静脉输注治疗SAP的RCT。提取血清淀粉酶和尿淀粉酶升高持续时间、腹痛持续时间、感染率、并发症发生率、总死亡率、治愈率、住院时间的相对风险（RR）及其95%置信区间（CI），以及亚组分析的详细信息。使用Review Manager软件（RevMan 5.10版）进行荟萃分析。
最终分析纳入了6项RCT，共390例符合纳入标准的患者。与静脉输注途径相比，CRAI显著缩短了尿淀粉酶升高持续时间（MD=-2.40，95%CI=-3.20，-1.60；P<0.00001）和腹痛持续时间（MD=-1.46，95%CI=-1.94，-0.98；P<0.00001），降低了并发症发生率（RR=0.35，95%CI=0.15，0.81；P=0.01）和总死亡率（RR=0.25，95%CI=0.08，0.78；P=0.02），缩短了住院时间（MD=-10.36，95%CI=-17.05，-3.68；P=0.002），并提高了治愈率（RR=1.66，95%CI=1.13，2.46；P=0.01）。这些研究中未报告因CRAI给药导致的死亡和导管相关感染。亚组分析表明，通过CRAI联合给药并未显著改善治疗结果。
CRAI对SAP治疗有效，且通过CRAI联合给药对改善治疗结果无显著影响。
