Messori A, Rampazzo R, Scroccaro G, Olivato R, Bassi C, Falconi M, Pederzoli P, Martini N
Drug Information Center, Policlinico Careggi Hospital, Florence, Italy.
Dig Dis Sci. 1995 Apr;40(4):734-8. doi: 10.1007/BF02064970.
Since the effectiveness of gabexate mesilate in patients with acute pancreatitis is controversial, a metaanalysis of the published literature was conducted to address this problem. Five randomized trials were identified by our literature search. Three end points (mortality, complications, and complications requiring surgery) were evaluated. The results of our metaanalysis indicate that the treatment with gabexate mesilate does not affect mortality at 90 days (P = 0.27), but significantly reduces the incidence of complications requiring surgery (odds ratio = 0.61, 95% CI: 0.41-0.89; P < 0.05) and of complications in general (odds ratio = 0.69, 95% CI: 0.54-0.89; P < 0.05). Because the drug proves to be beneficial only to a low proportion of the treated patients, its clinical impact seems to be small. A pharmacoeconomic evaluation shows that its use in all patients with acute pancreatitis would imply a very high cost for preventing each complication. The administration of the drug to select patients who are at higher risk of complications could have a better cost-effectiveness ratio. However, specific studies on this point are still lacking.
由于甲磺酸加贝酯对急性胰腺炎患者的疗效存在争议，因此对已发表的文献进行了荟萃分析以解决这一问题。通过文献检索确定了五项随机试验。评估了三个终点（死亡率、并发症以及需要手术的并发症）。我们的荟萃分析结果表明，甲磺酸加贝酯治疗在90天时不影响死亡率（P = 0.27），但显著降低了需要手术的并发症的发生率（优势比= 0.61，95%置信区间：0.41 - 0.89；P < 0.05）以及总体并发症的发生率（优势比= 0.69，95%置信区间：0.54 - 0.89；P < 0.05）。由于该药物仅对一小部分接受治疗的患者有益，其临床影响似乎较小。药物经济学评估表明，在所有急性胰腺炎患者中使用该药物预防每种并发症的成本将非常高。对并发症风险较高的特定患者使用该药物可能具有更好的成本效益比。然而，关于这一点仍缺乏具体研究。
