奥曲肽联合前列地尔治疗急性胰腺炎的Meta分析

Meta-analysis of effectiveness and safety of octreotide combined with alprostadil for acute pancreatitis

目的:系统评价奥曲肽联合前列地尔治疗急性胰腺炎的安全性及有效性.方法:计算机检索Pub Med、中国生物医学文献数据库、维普、中国知网)、万方数据库,查找有关应用奥曲肽联合前列地尔治疗急性胰腺炎的随机对照试验(randomized controlled trials,RCT),并追索纳入文献的参考文献,检索时限:建库至2015-10.由2名评价者独立选择试验、提取资料和评估方法学质量后,采用Rev Man5.2软件进行Meta分析.结果:最终纳入18个研究,共1277例受试者.Meta分析结果显示:奥曲肽与前列地尔联用在以下方面均优于常规治疗+奥曲肽治疗,且差异有统计学意义:总有效率(RR=1.20,95%CI:1.15-1.26),腹部症状缓解时间[SMD=-2.68,95%CI:-3.11-(-2.25)],腹部体征缓解时间[SMD=-2.54,95%CI:-2.79-(-2.30)],血淀粉酶恢复正常时间[SMD=-1.95,95%CI:-2.15-(-1.76)],并发症发生率(R R=0.30,95%C I:0.13-0.69),平均住院时间[S M D=-8.95,95%CI:-13.61-(-4.29)].结论:本Meta分析结果提示,奥曲肽与前列地尔联用优于单用奥曲肽治疗,为急性胰腺炎的治疗提供了一个新的选择.但本研究纳入研究的样本量小、质量偏低,上述结论尚需要更多高质量的研究验证.

AIM： To systematically evaluate the effectivenessand safety of octreotide combined with alprostadil in the treatment of acute pancreatitis（AP）.METHODS： Relevant randomized controlled trials（RCTs） were searched via databases including Pub Med,CBM,VIP,CNKI and Wan Fang Data from their inception to October 2015,and the references of the included studies were also screened.Two reviewers screened the literature,assessed the quality of studies and extracted the data.Rev Man 5.2 software was used to complete the meta-analysis.RESULTS： Eighteen trials involving 1277 participants were included.The results of the systematic review showed that compared with the control group,the experimental group was superior with regard to clinical effective rate（RR = 1.20,95%CI： 1.15-1.26）,time to relief of bellyache [SMD =-2.68,95%CI：-3.11-（-2.25）],time to relief of signs of abdominal tenderness [SMD =-2.54,95%CI：-2.79-（-2.30）],time to recovery of blood amylase [SMD =-1.95,95%CI：-2.15-（-1.76）],incidence of AP complications（RR = 0.30,95%CI： 0.13-0.69）,and average length of hospital stay [SMD =-8.95,95%CI：-13.61-（-4.29）].CONCLUSION： Octreotide combined with alprostadil for treating AP is superior to octreotide alone.Due to the limited quality of the included studies,our conclusion needs to be verified by more high quality studies.