他克莫司预防经内镜逆行胰胆管造影术后胰腺炎的临床研究

Clinical Research on Tacrolimus for Preventing Post-endoscopic Retrograde Cholangiopancre-atography Pancreatitis

[目的]探讨预防性应用他克莫司（Tacrolimus ，TAC）对经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography ，ERCP）后胰腺炎（post-ERCP pancreatitis ，PEP）的影响。[方法]将本院符合纳入病例条件行ERCP检查的168例患者随机分为三组（每组56例）：A组为常规对照组，B组为奥曲肽组，C组为他克莫司组。A组不做任何特殊处理，B组术前30 min皮下注射奥曲肽0．1 mg ，C组术前2 h口服TAC 5 mg。观察三组患者术前、术后24 h血清淀粉酶水平，并评估比较ERCP术后胰腺炎和高淀粉酶血症发生率。[结果]三组患者ERCP术前血清淀粉酶均正常，ERCP术后24 h血清淀粉酶水平，C组低于A、B组，B组低于A组，且各组之间相比较差异均有显著性（ P＜0．01）。A组患者发生高淀粉酶血症比例为50％（28/56，其中17例患者发生PEP（17/56，30．1％），B组患者发生高淀粉酶血症比例为30．1％（17/56），其中8例患者发生PEP（8/56，14．2％），C组患者发生高淀粉酶血症比例为14．2％（8/56），其中2例患者发生PEP（2/56，3．5％），C组患者的胰腺炎及高淀粉酶血症发病率明显低于A、B组，B组患者的胰腺炎及高淀粉酶血症发病率明显低于A组，且各组之间相比较差异均有显著性（ P ＜0．05）。[结论]ERCP术前应用TAC和奥曲肽均可有效降低术后胰腺炎和高淀粉酶血症的发生率，但是T AC的效果更好，更具有临床应用价值。

[Objective] To explore the effect of the preventive use of tacrolimus （TAC） on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis（PEP） .[Methods] A total of 168 patients undergo-ing ERCP were randomly divided into group A （control group） ,group B（octreotide group） and group C（TAC group） with 56 patients in each group .Group A was not treated .Group B was given octreotide 0 .1mg by sub-cutaneous injection 30min before operation .Group C was given oral TAC 5mg at 2h before operation .Serum amylase level in 3 groups before and 24h after operation was observed .The incidence of PEP and hyperamy-lasemia was evaluated .[Results]Serum amylase level of 3 groups before ERCP was normal .Serum amylase level in group C at 2h after ERCP was lower than that in group A and group B ,and that in group B was lower than that in group A ,and there was significant difference among groups （ P 〈 0 .01） .The incidence of hy-peramylasemia in group A was 50% （28/56） in which 17 patients （30 .1% ,17/56） were PEP ,and that in group B was 30 .1% （17 /56） in which 8 patients（14 .2% ,8/56） were PEP ,and that in group C was 14 .2%（8/56） in which 2 patients（3 .5% ,2/56） were PEP .The incidence of pancreatitis and hyperamylasemia in group C was obviously lower than that in group A and group B（ P〈0 .05） ,and that in group B was obviously lower than that in group A ,and there was significant difference among groups（ P 〈0 .05） .[Conclusion] The application of TAC and octreotide can effectively reduce the incidence of postoperative pancreatitis and hy-peramylasemia .The efficacy of TAC is better ,and it has more clinical application value .