Jenkins S A, Berein A
Department of Surgery, Royal Liverpool University Hospital, Vienna, Austria.
Aliment Pharmacol Ther. 1995 Aug;9(4):349-61. doi: 10.1111/j.1365-2036.1995.tb00393.x.
Somatostatin and octreotide inhibit basal and stimulated pancreatic secretion, stimulate reticuloendothelial system activity, modulate the cytokine cascade and are cytoprotective with respect to the pancreas. These effects of somatostatin and octreotide suggest that both drugs may be useful either in the treatment of pancreatic disorders, or in preventing acute pancreatitis following procedures on the pancreas. In recent years it has become clear that somatostatin is a useful and effective therapy for severe acute pancreatitis and in preventing complications following endoscopic retrograde cholangiopancreatography (ERCP), whereas octreotide has no beneficial effect and may be deleterious in both these indications. The differences in the therapeutic efficacy of somatostatin and octreotide in acute pancreatitis and ERCP appears to be related to their differential effects on sphincter of Oddi motility--the native hormone relaxing, and the analogue increasing, its contractility. Consequently, any beneficial effects of octreotide in both acute pancreatitis and ERCP are offset by the increased contractility of the sphincter of Oddi, which results in retention of activated enzymes within the pancreas and further autodigestion of the gland. Somatostatin and octreotide are equally effective in promoting the closure of pancreatic fistulae. However, the time to closure after commencement of therapy is much more variable and longer in patients treated with subcutaneous octreotide than those receiving intravenous somatostatin, possibly as a result of fluctuations in pancreatic enzyme secretion between consecutive administrations of the hormone. Furthermore, the initial potent inhibitory effect of octreotide on pancreatic secretion is lost after 7 days of continuous subcutaneous administration. Therefore, in terms of cost-effectiveness, somatostatin would appear to be the treatment of choice for pancreatic fistulae. Octreotide markedly reduces the complication rates after elective pancreatic surgery. It remains to be established whether somatostatin is as effective as octreotide in this indication.
生长抑素和奥曲肽可抑制基础状态及受刺激后的胰腺分泌，刺激网状内皮系统活性，调节细胞因子级联反应，对胰腺具有细胞保护作用。生长抑素和奥曲肽的这些作用表明，这两种药物或许可用于治疗胰腺疾病，或预防胰腺手术后的急性胰腺炎。近年来已明确，生长抑素是治疗重症急性胰腺炎以及预防内镜逆行胰胆管造影术（ERCP）后并发症的一种有用且有效的疗法，而奥曲肽在这两种情况下均无有益作用，甚至可能有害。生长抑素和奥曲肽在急性胰腺炎和ERCP治疗效果上的差异，似乎与其对Oddi括约肌运动的不同作用有关——天然激素使其松弛，而类似物则增强其收缩性。因此，奥曲肽在急性胰腺炎和ERCP中的任何有益作用，都会被Oddi括约肌收缩性增强所抵消，这会导致活化酶在胰腺内潴留，进而导致胰腺进一步自我消化。生长抑素和奥曲肽在促进胰瘘闭合方面同样有效。然而，与接受静脉注射生长抑素的患者相比，皮下注射奥曲肽治疗的患者在开始治疗后瘘口闭合的时间变化更大且更长，这可能是由于在连续给药期间胰腺酶分泌波动所致。此外，连续皮下注射奥曲肽7天后，其对胰腺分泌的初始强效抑制作用会消失。因此，就成本效益而言，生长抑素似乎是胰瘘治疗的首选。奥曲肽可显著降低择期胰腺手术后的并发症发生率。在这一适应证中，生长抑素是否与奥曲肽同样有效仍有待确定。
