吲哚美辛直肠给药减少经内镜下逆行性胰胆管造影术后胰腺炎发生的荟萃分析

Indomethacin reduces the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography: a meta-analysis

目的荟萃分析评估吲哚美辛对于预防经内镜下逆行性胰胆管造影(ERCP)术后胰腺炎(PEP)安全性与有效性。方法通过检索PubMed/Medicine,EMBASE和the Cochrane Central Register等数据库,以及对文献二次检索,截止到2016年4月已经发表关于吲哚美辛与安慰剂预防ERCP术后胰腺炎复发作用的临床随机对照研究。进行数据提取、质量评价以及运用Stata12.0软件对于搜集整理数据进行分析,并且运用随机效应模型或固定效应模型对数据进行统计分析,相对危险度RR及可信区间进行组间比较。结果纳入此次荟萃分析文献数7篇,总样本量为3 082例,术后胰腺炎发生率相对危险度RR为0.58(CI 0.40～0.83),I2=49.8%,P=0.063。亚组分别是ERCP术前给药和ERCP术后给药,并分别进行数据统计分析显示,ERCP术前给予吲哚美辛栓剂能显著减少术后胰腺炎发生率,相对危险度为RR=0.56(CI 0.39～0.79),I2=2.7%,P=0.379;而在ERCP术后给予吲哚美辛栓剂对术后胰腺炎的发生率则无明显作用,其相对危险度为RR=0.61(CI 0.26～1.44),I2=77%,P=0.013。结论 ERCP术前应用吲哚美辛能显著减少术后胰腺炎的发生率。

Objective To evaluate the efficacy and safety of rectal Indomethacin for preventing the incidence of post-ERCP pancreatitis(PEP).Method PubMed/Medicine,Chinese biomedical literature service system,of Controlled Trials databases were used to search for relevant randomized double-blind placebo controlled trials published before April 2016.STATA software was used to investigateheterogeneity between studies,and analysis was performed using a randomized-effects model to calculate andmerge data.Results Seven studies,with 3082 subjects,were included.The incidence of post-ERCP in all studies was 0.58(CI 0.40-0.83)I2=49.8%P=0.063,and when we divided these studies into two subgroups as Preoperative ERCP and after ERCP,the RR respectively were RR=0.56(CI 0.39-0.79)I2=2.7%P=0.379,RR=0.61(CI 0.26-1.44)I2=77%P=0.013.Conclusion This meta-analysis indicated that application of indomethacin before ERCP can significantly reduce the incidence of PEP.