一篇关于 NSAIDs 在动物研究和临床试验中治疗急性胰腺炎的系统评价。
A systematic review of NSAIDs treatment for acute pancreatitis in animal studies and clinical trials.
机构信息
Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, PA, USA.
出版信息
Clin Res Hepatol Gastroenterol. 2020 Jan-Jun;44S:100002. doi: 10.1016/j.clirex.2019.100002. Epub 2019 Sep 10.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently given to patients with acute pancreatitis (AP) for controlling pain, but their efficacy in treating AP, particularly in reducing systemic complications, remains unclear.
AIM
The aim of our study was to evaluate the efficacy of NSAIDs in treating AP and its systematic complications.
METHODS
Two independent reviewers screened articles from MEDLINE, Embase and Cochrane and scored the quality of each study according to the CAMARADES 10-item quality checklist or the Jadad scale. Five endpoints were chosen to evaluate the effect of NSAIDs in animal studies: amylase and lipase levels, proinflammatory cytokines, oxidative damage, histopathological changes, and mortality rate. Meanwhile, in clinical studies, endpoints, such as proinflammatory cytokines, pain relief, systematic complications, mortality, and adverse events were used.
RESULTS
A total of 36 studies out of 17,845 were identified and included. Of these 36 studies, only 5 were clinical trials involving 580 patients, and the remaining 31 were animal studies with 1623 rats or mice. 24 studies focused on the treatment of AP with NSAIDs and 12 on AP-associated systematic complications. Both preclinical and clinical studies showed that NSAIDs may have beneficial effects against AP-related injuries. 9 of the 14 preclinical studies stated that NSAIDs reduced the serum amylase level significantly, and 6 of 7 showed that NSAIDs lowered the lipase level markedly. 17 experimental studies all demonstrated that NSAIDs reduced the inflammation. Histopathological examinations indicated that NSAIDs significantly improved the histopathological damages. Similarly, clinical evidence showed that NSAIDs are effective in suppressing proinflammatory cytokines, relieving pain, ameliorating systematic complications and reducing mortality. In the included 5 clinical studies, serious adverse events associated with NSAIDs were rarely reported.
CONCLUSION
This systematic review shows that NSAIDs are a potential treatment for AP-related injuries based on the current preclinical and clinical evidences.
背景
非甾体抗炎药（NSAIDs）常被用于治疗急性胰腺炎（AP）患者以控制疼痛，但它们在治疗 AP 方面的疗效，特别是在减少全身并发症方面，尚不清楚。
目的
本研究旨在评估 NSAIDs 治疗 AP 及其系统性并发症的疗效。
方法
两名独立评审员从 MEDLINE、Embase 和 Cochrane 筛选文章，并根据 CAMARADES 10 项质量检查表或 Jadad 量表对每项研究的质量进行评分。选择了 5 个终点来评估 NSAIDs 在动物研究中的作用：淀粉酶和脂肪酶水平、促炎细胞因子、氧化损伤、组织病理学变化和死亡率。同时，在临床研究中，使用了促炎细胞因子、疼痛缓解、系统并发症、死亡率和不良事件等终点。
结果
从 17845 篇文章中筛选出 36 篇进行了分析，其中只有 5 项是包含 580 例患者的临床试验，其余 31 项是涉及 1623 只大鼠或小鼠的动物研究。24 项研究关注 NSAIDs 治疗 AP，12 项研究关注 AP 相关系统性并发症。临床前和临床研究均表明 NSAIDs 可能对 AP 相关损伤具有有益作用。14 项临床前研究中有 9 项表明 NSAIDs 显著降低了血清淀粉酶水平，7 项研究表明 NSAIDs 显著降低了脂肪酶水平。17 项实验研究均表明 NSAIDs 减轻了炎症。组织病理学检查表明 NSAIDs 显著改善了组织病理学损伤。同样，临床证据表明 NSAIDs 可有效抑制促炎细胞因子、缓解疼痛、改善系统性并发症并降低死亡率。在纳入的 5 项临床研究中，很少有报道 NSAIDs 相关的严重不良事件。
结论
基于目前的临床前和临床证据，本系统评价表明 NSAIDs 是一种治疗 AP 相关损伤的潜在方法。
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