生长抑素预防内镜逆行胰胆管造影术后胰腺炎效果的Meta分析

Meta-analysis： somatostatin for prophylaxis against post endoscopic retrograde cholangiopancreatography pancreatitis

目的 系统评价生长抑素预防内镜逆行胰胆管造影（ERCP）术后胰腺炎的效果.方法 以内镜下逆行胰胆管造影术或ERCP、生长抑素、胰腺炎为关键词检索Cochrane library、PubMed、OVID、Springer Linker、Science Direct、EBSCO数据库,并手工检索相关的参考文献,纳入2015年10月之前有关生长抑素预防ERCP术后胰腺炎效果的前瞻性随机对照试验的英文文献进行分析.按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用Review Manager 5.3软件进行Meta分析.结果 共纳人12篇随机对照研究文献（3 268例患者）,其中生长抑素组1674例,安慰剂组1594例.Meta分析结果显示,与对照组相比,大剂量静脉滴注（＞3 mg/12 h）组患者ERCP术后胰腺炎发生率显著降低,差异有统计学意义（11.3％比4.9％,OR=0.34,95％ CI：0.20 ～0.58,P=0.000）;小剂量静脉滴注组和一次性静脉团注组患者ERCP术后胰腺炎发生率与对照组相比,差异无统计学意义（8.5％比6.4％,OR=1.37,95％ CI：0.89 ～2.12,P=0.150;4.9％比9.3％,OR=0.39,95％ CI：0.14～ 1.04,P=0.060）;意向性分析结果显示,大剂量静脉滴注与静脉团注生长抑素可降低ERCP术后胰腺炎的发生率（OR=0.45、0.49,95％ CI：0.25～0.81、0.27 ～0.91,P=0.008、0.020）.结论 大剂量静脉滴注生长抑素可有效降低ERCP术后胰腺炎发生率,而小剂量静脉滴注与静脉团注生长抑素无预防ERCP术后胰腺炎的作用.

Objective To evaluate the efficacy of somatostatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography （ERCP）.Methods A standardized comprehensive literature search was performed by Cochrane library,PubMed,OVID,Springer Linker,Science Direct,EBSCO.Randomized controlled studies on the prevention of pancreatitis after ERCP before Octorber 2015were enrolled in the study and were analyzed by 2 independent reviewers.Random-effects model （REM） or fixed-effects model （FEM） was applied to calculate pooled estimates of drug efficacy depending on the outcomes.The bias risk of the included studies was evaluated by Cochrane Handbook 5.1.All data were analyzed by the RevMan 5.3 software.Results Twelve studies,including 3 268 participants,met the inclusion criteria.The results of subgroup analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP（11.3% vs.4.9%,OR =0.34,95%CI：0.20-0.58,P =0.000）,however,low-dose or bolus injection proved ineffective in reducing rate of pancreatitis after ERCP （8.5% vs.6.4%,OR =1.37,95% CI：0.89-2.12,P =0.150;4.9% vs.9.3%,OR =0.39,95% CI：0.14-1.04,P =0.060）.Results of intention-to-treat analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP （OR =0.45,0.49;95% CI：0.25-0.81,0.27-0.91;P =0.008,0.020）.Conclusions High-dose somatostatin could prevent post-ERCP pancreatitis.Low-dose nor bolus injection somatostatin produced no significant effect in reducing pancreatic injury.