Mahamid Mahmud, Watad Abdulla, Bragazzi Nicola L, Wengrower Dov, Wolff Julie, Livovsky Dan, Amital Howard, Adawi Mohammad, Goldin Eran
Disgestive Diseases Institute Sharee Zedek Medical Center, Jerusalem, Israel.
Endoscopy Unit, Faculty of Medicine, Nazareth Hospital EMMS Bar-Ilan University, Safed, Israel.
Front Pharmacol. 2018 Jun 29;9:704. doi: 10.3389/fphar.2018.00704. eCollection 2018.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the major complications of ERCP. Thus, several non-invasive as well as invasive strategies have been investigated as preventative therapies for PEP with various efficacy. We enrolled any patients who underwent ERCP both at the Shaare Zedek Medical Center in Jerusalem and EMMS Nazareth hospital. Association between use of statins and different variables were assessed with univariate tests (chi-squared for categorical variables). Predictors of incidence of PEP and severity of pancreatitis were computed using conditional logistic regression, correcting for potential confounding factors. 958 subjects were analyzed. Average age was 62.04 ± 21.18 years (median 68 years). Most of the patients were female ( = 558, 58.2%), Jewish ( = 827, 86.3%), and inpatients ( = 631, 65.9%). Only few ERCPs were performed emergently ( = 40, 4.2%). Twenty-Seven patients repeated the exam. Overall incidence of PEP/hyperamylasemia was 16.8% ( = 161); with a 5.6% ( = 54) incidence of hyperamylasemia and a 11.2% ( = 107) incidence of pancreatitis. Overall, 6 cases of severe pancreatitis were identified. The logistic regression analysis demonstrated that chronic use of statins is a protective factor in preventing development of PEP/hyperamylasemia [OR 0.436 [95%CI 0.303-0.627], < 0.001]; Particularly, the PEP OR was of 0.318 [95%CI 0.169-0.597], < 0.001 and the hyperamylasemia OR was of 0.565 [95%CI 0.372-0.859], = 0.008. No significant predictor could be found for the risk of developing severe PEP. Our data support the possibility of exploiting statins as preventive agents for PEP. However, further studies, mainly RCTs, are warranted in order to replicate our findings.
内镜逆行胰胆管造影术(ERCP)后胰腺炎(PEP)是ERCP的主要并发症之一。因此,人们已经研究了多种非侵入性和侵入性策略作为PEP的预防性治疗方法,其疗效各不相同。我们纳入了在耶路撒冷的沙雷兹德克医疗中心和拿撒勒EMMS医院接受ERCP的所有患者。使用单变量检验(分类变量采用卡方检验)评估他汀类药物的使用与不同变量之间的关联。使用条件逻辑回归计算PEP发生率和胰腺炎严重程度的预测因素,并对潜在的混杂因素进行校正。对958名受试者进行了分析。平均年龄为62.04±21.18岁(中位数68岁)。大多数患者为女性(n = 558,58.2%)、犹太裔(n = 827,86.3%)且为住院患者(n = 631,65.9%)。仅少数ERCP是急诊进行的(n = 40,4.2%)。27名患者重复了该项检查。PEP/高淀粉酶血症的总体发生率为16.8%(n = 161);高淀粉酶血症的发生率为5.6%(n = 54),胰腺炎的发生率为11.2%(n = 107)。总体上,共确诊6例重症胰腺炎。逻辑回归分析表明,长期使用他汀类药物是预防PEP/高淀粉酶血症发生的保护因素[比值比(OR)为0.436,95%置信区间(CI)为0.303 - 0.627,P < 0.001];特别是,PEP的OR为0.318(95%CI为0.169 - 0.597,P < 0.001),高淀粉酶血症的OR为0.565(95%CI为0.372 - 0.859,P = 0.008)。未发现与发生重症PEP风险相关的显著预测因素。我们的数据支持将他汀类药物用作PEP预防药物的可能性。然而,需要进一步开展研究,主要是随机对照试验(RCT),以验证我们的研究结果。