双氯芬酸钠预防经内镜逆行胰胆管造影术后胰腺炎机制的临床研究

Preventive effect of diclofenac for post-ERCP pancreatitis and its mechanism

目的探讨双氯芬酸钠预防经内镜逆行胰胆管造影术（ERCP）术后胰腺炎的疗效及相关机制。方法2012年9月至2013年10月进行ERCP治疗的120例胆总管结石患者，随机分为双氯芬酸钠组和对照组各60例，双氯芬酸钠组患者ERCP术后立即肌注双氯芬酸钠75mg，观测两组患者术后3h、24h淀粉酶水平和胰腺炎发生率。各组测定30例患者术前及术后3h、24h血清中脂氧素A4、消退素E1和D1的水平。结果双氯芬酸钠组ERCP术后胰腺炎发生率（6．7％）低于对照组（20．0％），差异有统计学意义（P=0．032）。双氯芬酸钠组术后3h、24h淀粉酶水平分别低于对照组，但差异无统计学意义（P均〉0．05）。双氯芬酸钠组术后脂氧素A4、消退素E1和消退素D1水平均较术前明显升高（P均〈0．05），且与对照组术后同时段比较，脂氧素A4、消退素E1和D1水平显著增加（P均〈0．05）。结论双氯芬酸钠可预防ERCP术后胰腺炎的发生，其机制可能与增加脂氧素A4及消退素E1和D1水平有关。

Objective To investigate the efficacy and mechanism of diclofenac in the prevention of post-ERCP pancreatitis. Methods Data of a total of 120 patients with choledocholithiasis were collected from September 2012 to October 2013 and were randomly divided into diclofenac group （n = 60） and control group（ n = 60）. The diclofenac group patients received a single dose of intramuscular diclofenac immediately after ERCP. Serum amylase level was measured before and 3 h and 24 h after ERCP, and the rate of acute pancreatitis after ERCP were assessed in both groups. The Lipoxin Ag, Resolvin DI and Resolvin E1 levels of two groups were measured before and 3 h and 24 h after ERCP. Results The incidence of PEP in diclofenac group was 6. 7%, and was significantly lower compared with the control group （20. 0% ,P 〈0. 05）. Serum amylase levels at 3 h and 24 h after ERCP in diclofenac and control groups were （214. 93 ± 309. 28）U/L and （192. 50 ± 282. 37）U/L, respectively, which were lower than those in the control group [ （328. 70±369. 55） U/L at 3 h and （251.17 ± 175.18） U/L at 24 h after ERCP]. There were no significant differences between them（P 〉0. 05）. The Lipoxin A4, Resolvin D1 and Resolvin E1 levels in diclofenac group at 3 h and 24 h after ERCP were higher than those before ERCP（P 〈0. 05）. Compared with the control group, the Lipoxin A4, Resolvin D1 and Resolvin E1 levels in dielofenac group at 3 h and 24 h after ERCP were significantly higher（ P 〈 0. 05）. Conclusion Diclofenac can reduce the incidence of PEP after ERCP. The mechanism may be that diclofenac could increase the levels of Lipoxin A4, Resolvin D1 and Resolvin El.