Mohta Srikant, Singh Namrata, Gunjan Deepak, Kumar Amit, Saraya Anoop
Department of Gastroenterology and Human Nutrition Unit All India Institute of Medical Sciences New Delhi India.
Department of Neurology All India Institute of Medical Sciences New Delhi India.
JGH Open. 2020 Oct 24;5(3):329-336. doi: 10.1002/jgh3.12433. eCollection 2021 Mar.
Chronic pancreatitis (CP) is an irreversible disease with increased oxidative stress. The therapeutic role of antioxidants for pain reduction in CP is debatable. A systematic review of articles in PubMed and Embase until February 2020 was performed. Only randomized controlled trials conducted on humans to evaluate the therapeutic effects of antioxidants for pain in CP were included. Studies of other design, nonhuman studies, and those that did not objectively assess pain were excluded. Twelve articles and four articles were eligible for qualitative and quantitative analysis, respectively. The four included studies had a total of 352 participants. Pain reduction as measured by a visual analog scale was not significantly different in the antioxidant group compared to placebo (standardized mean difference = -0.14 [95% confidence interval [CI] = -0.44 to 0.17]; = 0.38). Number of pain-free participants was also similar (odds ratio [OR] = 1.59 [0.97-2.59]; = 0.06). There was no difference in outcome when comparing different etiologies of CP or age group. The reduction in the number of analgesics used did not differ between both groups. Antioxidants were not associated with increased adverse events (OR = 2.59 [CI = 0.77-8.69]; = 0.12). A qualitative analysis on the effect on quality of life did not suggest any significant improvement with antioxidants. There was no significant pain reduction or change in quality of life in CP patients with use of antioxidants. This makes their routine use in the management of CP questionable. However, further studies may identify a subgroup where they are more useful.
慢性胰腺炎（CP）是一种伴有氧化应激增加的不可逆疾病。抗氧化剂在减轻CP疼痛方面的治疗作用存在争议。我们对截至2020年2月在PubMed和Embase上发表的文章进行了系统综述。仅纳入了针对人类进行的评估抗氧化剂对CP疼痛治疗效果的随机对照试验。排除了其他设计的研究、非人类研究以及未客观评估疼痛的研究。分别有12篇和4篇文章符合定性和定量分析的标准。纳入的4项研究共有352名参与者。与安慰剂相比，抗氧化剂组通过视觉模拟量表测量的疼痛减轻无显著差异（标准化平均差=-0.14[95%置信区间（CI）=-0.44至0.17]；P=0.38）。无痛参与者的数量也相似（优势比[OR]=1.59[0.97 - 2.59]；P=0.06）。比较CP不同病因或年龄组时，结果无差异。两组在使用镇痛药数量的减少方面没有差异。抗氧化剂与不良事件增加无关（OR=2.59[CI=0.77 - 8.69]；P=0.12）。对抗氧化剂对生活质量影响的定性分析未显示其有任何显著改善。CP患者使用抗氧化剂后疼痛无显著减轻，生活质量也无变化。这使得它们在CP管理中的常规使用存在疑问。然而，进一步的研究可能会确定一个更适用它们的亚组。
