内镜逆行胰胆管造影术后胰腺炎（post-ERCP pancreatitis，PEP）时应用甲磺酸萘莫司他输注的效果。
The effect of nafamostat mesilate infusion after ERCP for post-ERCP pancreatitis.
机构信息
Division of Gastroenterology, Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang-si, 10326, Republic of Korea.
出版信息
BMC Gastroenterol. 2022 May 31;22(1):271. doi: 10.1186/s12876-022-02345-3.
BACKGROUND
Nafamostat mesilate decreases the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, no studies have administered nafamostat mesilate after ERCP. So we investigated if the infusion of nafamostat mesilate after ERCP can affect the post-ERCP pancreatitis (PEP) in high-risk patients.
METHODS
In a tertiary hospital, 350 high-risk patients of PEP were reviewed retrospectively. Among them, 201 patients received nafamostat mesilate after ERCP. Patient-related and procedure-related risk factors for PEP were collected. We performed a propensity score matching to adjust for the significant different baseline characteristics. The incidence and severity of PEP were evaluated according to the infusion of nafamostat mesilate. The risk factors of PEP were also analyzed by multivariate logistic regression.
RESULTS
The baseline characteristics were not different after the matching. The PEP rate (17.4% vs. 10.3%, P = 0.141) was insignificant. Among the PEP patients, mild PEP was significantly higher in the nafamostat mesilate group (85.7% vs. 45.5%, P = 0.021). Only one patient in the nafamostat mesilate group developed severe PEP. Although young age (odds ratio [OR] 3.60, 95% CI 1.09-11.85, P = 0.035) was a risk factor, nafamostat mesilate (odds ratio [OR] 0.30, 95% CI 0.09-0.98, P = 0.047) was a protective factor for moderate to severe PEP.
CONCLUSIONS
The administration of nafamostat mesilate after ERCP in high-risk patients was not effective in preventing PEP, but may attenuate the severity of PEP.
背景
甲磺酸萘莫司他可降低内镜逆行胰胆管造影（ERCP）后胰腺炎的发生率。然而，尚无研究在 ERCP 后给予甲磺酸萘莫司他。因此，我们研究了 ERCP 后给予甲磺酸萘莫司他是否会影响高危患者的 ERCP 后胰腺炎（PEP）。
方法
在一家三级医院，回顾性分析了 350 例 PEP 高危患者。其中，201 例患者在 ERCP 后接受了甲磺酸萘莫司他。收集了与患者相关和与操作相关的 PEP 危险因素。我们进行了倾向评分匹配，以调整显著不同的基线特征。根据是否输注甲磺酸萘莫司他评估 PEP 的发生率和严重程度。还通过多变量逻辑回归分析了 PEP 的危险因素。
结果
匹配后基线特征无差异。PEP 发生率（17.4%比 10.3%，P=0.141）无统计学意义。在 PEP 患者中，甲磺酸萘莫司他组轻度 PEP 明显更高（85.7%比 45.5%，P=0.021）。甲磺酸萘莫司他组仅 1 例发生重度 PEP。尽管年轻（比值比 [OR] 3.60，95%置信区间 [CI] 1.09-11.85，P=0.035）是危险因素，但甲磺酸萘莫司他（OR 0.30，95%CI 0.09-0.98，P=0.047）是中重度 PEP 的保护因素。
结论
在高危患者中 ERCP 后给予甲磺酸萘莫司他不能有效预防 PEP，但可能减轻 PEP 的严重程度。
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