生长抑素及其类似物联合质子泵抑制剂预防经内镜逆行胰胆管造影术后胰腺炎的Meta分析

Somatostatin and its analogues combined with proton pump inhibitor in prevention of post-ERCP pancreatitis: a meta-analysis

目的采用循证医学的方法,系统评价生长抑素及其类似物联合质子泵抑制剂预防经内镜逆行胰胆管造影(ERCP)术后胰腺炎的疗效。方法采用计算机和手工检索的方法查阅文献,使用Cochrane系统评价员手册推荐的方法纳入文献,应用Rev Man5.2软件进行Meta分析。结果最终纳入5个随机对照研究,总计1092例患者,其中试验组554例,对照组538例。Meta分析结果显示,生长抑素及类似物联合质子泵抑制剂预防组术后短期血淀粉酶水平(MD=-198.44,95%CI:-305.83^-91.05)及长期血淀粉酶水平(MD=-103.48,95%CI:-157.53^-49.42)均较对照组降低;生长抑素及类似物联合质子泵抑制剂预防组ERCP术后高淀粉酶血症发生率(OR=0.29,95%CI:0.17~0.51)及术后胰腺炎发生率(OR=0.24,95%CI:0.13~0.46)均较对照组低。结论生长抑素及其类似物联合质子泵抑制剂可有效降低ERCP术后血淀粉酶水平,在预防ERCP术后胰腺炎发生中有明显的效果。

Objective To systematically evaluate the clinical efficacy of somatostatin and its analogues combined with proton pump inhibitor in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography （ERCP） by an evidence -based medicine approach. Methods Articles were searched manually or by computer, and were enrolled using methods recommended by the Cochrane Reviewer＇s Handbook. The meta - analysis was performed using RevMan 5.2 software. Results Five randomized controlled trials were finally enrolled, which involved 1092 patients, including 538 patients in the control group and 554 patients in the experimental group. According to the results of the meta - analysis, patients who received somatostatin and its analogues combined with proton pump inhibitor had lower short - term and long - term serum amylase levels after surgery than patients in the control group （ MD = - 198.44, 95% CI： - 305. 83 - - 91.05 ; MD = - 103.48, 95% CI： - 157.53 - -49. 42）. Patients who received somatostatin and its analogues combined with proton pump inhibitor also had lower incidence rates of hyperamylasemia and pancreatitis after ERCP than patients in the control group （OR = 0. 29, 95% CI：0. 17 0. 51 ; OR = O. 24, 95 % CI：0. 13 -0. 46）. Conclusion Somatostatiu and its analogues combined with proton pump inhibitor are effective in reduction of the serum amylase level and prevention of the incidence of pancreatitis after ERCP.