直肠非甾体抗炎药预防非选择性患者内镜逆行胰胆管造影术后胰腺炎：系统评价和荟萃分析
Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis.
作者信息
Shen Chongrong, Shi Yanqiang, Liang Tianyu, Su Peizhu
机构信息
The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.
Department of Gastroenterology, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan City, China.
出版信息
Dig Endosc. 2017 May;29(3):281-290. doi: 10.1111/den.12816. Epub 2017 Mar 9.
BACKGROUND AND AIM
Efficacy of rectal non-steroidal anti-inflammatory drugs (NSAIDs) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in unselected patients remained controversial. The aim of the present study was to evaluate the efficacy of rectal NSAIDs in the prevention of PEP in unselected patients.
METHODS
An electronic literature search in the Cochrane Library, Embase, and PubMed was carried out for randomized controlled trials comparing rectal indomethacin or diclofenac with placebo in the prevention of PEP in unselected patients. Cochrane risk of bias tool was used to evaluate methodological quality. The data were carried out in forest plots using fixed-effect methods, and random-effect methods were used when heterogeneity was significant.
RESULTS
A total of nine trials were included in our final analysis. Rectal NSAIDs were effective to reduce the incidence of PEP in unselected patients (RR, 0.61; 95% CI, 0.46-0.79), especially for moderate-to-severe PEP (RR, 0.37; 95% CI, 0.17-0.79). Both indomethacin (RR, 0.67; 95% CI, 0.50-0.88) and diclofenac (RR, 0.29; 95% CI, 0.12-0.69) were significantly efficacious. Rectal NSAIDs given pre-ERCP showed significant efficacy (RR, 0.53; 95% CI, 0.39-0.71), whether when given within 30 min pre-ERCP (RR, 0.62; 95% CI, 0.42-0.92) or not (RR, 0.43; 95% CI, 0.28-0.67).
CONCLUSION
Rectal NSAIDs are effective in the prevention of PEP in unselected patients.
背景与目的
在未经过挑选的患者中，直肠非甾体抗炎药（NSAIDs）预防内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的疗效仍存在争议。本研究的目的是评估直肠NSAIDs在未经过挑选的患者中预防PEP的疗效。
方法
在Cochrane图书馆、Embase和PubMed中进行电子文献检索，以查找比较直肠吲哚美辛或双氯芬酸与安慰剂在未经过挑选的患者中预防PEP的随机对照试验。使用Cochrane偏倚风险工具评估方法学质量。数据采用固定效应方法在森林图中进行分析，当异质性显著时采用随机效应方法。
结果
最终分析共纳入9项试验。直肠NSAIDs可有效降低未经过挑选的患者中PEP的发生率（RR，0.61；95%CI，0.46 - 0.79），尤其是对中重度PEP（RR，0.37；95%CI，0.17 - 0.79）。吲哚美辛（RR，0.67；95%CI，0.50 - 0.88）和双氯芬酸（RR，0.29；95%CI，0.12 - 0.69）均具有显著疗效。ERCP前给予直肠NSAIDs显示出显著疗效（RR，0.53；95%CI，0.39 - 0.71），无论是否在ERCP前30分钟内给予（RR，0.62；95%CI，0.42 - 0.92）或不在30分钟内给予（RR，0.43；95%CI，0.28 - 0.67）。
结论
直肠NSAIDs在未经过挑选的患者中预防PEP有效。
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