甲磺酸萘莫司他预防内镜逆行胰胆管造影术后胰腺炎：前瞻性随机对照试验的荟萃分析

Nafamostat mesilate for prevention of post-ERCP pancreatitis: a meta-analysis of prospective, randomized, controlled trials.

作者信息

Yu Ge, Li Shuang, Wan Rong, Wang Xingpeng, Hu Guoyong

机构信息

From the *Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine; and †Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.

出版信息

Pancreas. 2015 May;44(4):561-9. doi: 10.1097/MPA.0000000000000310.

DOI:10.1097/MPA.0000000000000310

PMID:25822153

Abstract

OBJECTIVES

We aimed to evaluate the efficacy of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS

Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched until April 18, 2014.

RESULTS

Seven randomized controlled trials and 2956 patients met the search criteria. When compared with nonnafamostat, the incidence of PEP was reduced to 53% in the patients who received nafamostat (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.34-0.63). Further analyses were conducted based on the different risk classifications (n = 641 in patients with high risks: RR, 0.54; 95% CI, 0.30-0.96 and n = 944 with low risks: RR, 0.31; 95% CI, 0.17-0.56), PEP severities (n = 1654: RR, 0.38; 95% CI, 0.25-0.59 for mild; RR, 0.37; 95% CI, 0.15-0.96 for moderate; RR, 0.92; 95% CI, 0.13-6.38 for severe), and nafamostat doses (n = 1902: RR, 0.42; 95% CI, 0.28-0.63 for 20 mg; n = 1150: RR, 0.40; 95% CI, 0.25-0.63 for 50 mg). However, there was no reduction of the incidence of post-ERCP hyperamylasemia (n = 1585; 95% CI, 0.68-1.45) or cannulation difficulty (n = 1585; 95% CI, 0.91-1.23).

CONCLUSIONS

Pooled analyses from current randomized controlled trials support the effectiveness of nafamostat for prophylaxis of PEP.

摘要

目的

我们旨在评估那法莫司他预防内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的疗效。

方法

检索了Medline、Embase、Cochrane对照试验中央注册库和Web of Science，检索截至2014年4月18日。

结果

七项随机对照试验及2956例患者符合检索标准。与未使用那法莫司他相比，接受那法莫司他治疗的患者中PEP发生率降至53%（风险比[RR]，0.47；95%置信区间[CI]，0.34 - 0.63）。基于不同风险分类（高风险患者641例：RR，0.54；95% CI，0.30 - 0.96；低风险患者944例：RR，0.31；95% CI，0.17 - 0.56）、PEP严重程度（1654例：轻度RR，0.38；95% CI，0.25 - 0.59；中度RR，0.37；95% CI，0.15 - 0.96；重度RR，0.92；95% CI，0.13 - 6.38）和那法莫司他剂量（1902例：20 mg时RR，0.42；95% CI，0.28 - 0.63；1150例：50 mg时RR，0.40；95% CI，0.25 - 0.63）进行了进一步分析。然而，ERCP后高淀粉酶血症发生率（1585例；95% CI，0.68 - 1.45）或插管困难发生率（1585例；95% CI，0.91 - 1.23）并未降低。