吲哚美辛栓纳肛分别联合奥曲肽、生长抑素预防ERCP术后胰腺炎及高淀粉酶血症的效果比较

Effects of indomethacin suppository combined with octreotide and somatostatin respectively on preventing hyperamylasemia and pancreatitis after ERCP

目的比较吲哚美辛栓纳肛分别联合奥曲肽、生长抑素预防内镜下逆行胰胆管造影术(ERCP)后胰腺炎及高淀粉酶血症的效果。方法抽取2016年9月至2021年9月于山西省汾阳医院接受ERCP治疗的100例患者,回顾性分析其相关资料。根据治疗方法分为对照组(33例,术前吲哚美辛栓纳肛)、奥曲肽组(35例,术前吲哚美辛栓纳肛联合静脉泵注奥曲肽)与生长抑素组(32例,术前吲哚美辛栓纳肛联合生长抑素)。比较三组术后高淀粉酶血症、胰腺炎及不良反应发生率。比较三组手术前后血清淀粉酶水平、调节性T细胞(regulatory T cell,Treg)/辅助性T细胞(T-helper cell,Th17)及相关细胞因子水平。结果生长抑素组(3.03%,1/32;0.00%,0/32)与奥曲肽组(22.86%,8/32;17.14%,6/32)术后高淀粉酶血症与胰腺炎发生率低于对照组(48.48%,1/32;42.42%,14/32),P<0.05;生长抑素组术后高淀粉酶血症与胰腺炎发生率低于奥曲肽组(P<0.05)。三组术后血清淀粉酶、Treg/Th17及相关细胞因子水平优于术前(P<0.05);生长抑素组与奥曲肽组患者术后Treg、转化生长因子β(TGF-β)水平高于对照组,血清淀粉酶、Th17、白细胞介素-23(IL-23)水平、白细胞介素-17(IL-17)水平低于对照组(P<0.05);生长抑素组术后Treg、TGF-β水平高于奥曲肽组,血清淀粉酶、Th17、IL-23水平、IL-17水平低于奥曲肽组(P<0.05)。对照组、奥曲肽组与生长抑素组不良反应发生率比较差异未见统计学意义(χ^(2)=0.67,P=0.714)。结论相对于联合奥曲肽,行ERCP患者术前应用吲哚美辛栓纳肛联合术后生长抑素对于减少患者术后高淀粉酶血症与胰腺炎效果更显著。

Objective To compare the effects of indomethacin suppository respectively combined with octreotide and somatostatin on preventing hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 100 patients who underwent ERCP in Shanxi Fenyang Hospital from September 2016 to September 2021 were selected,and their related data were retrospectively analyzed.According to treatment method,the selected patients were divided into control group(33 cases,receiving intrarectal application of indomethacin suppository before operation),octreotide group(35 cases,receiving intrarectal application of indomethacin suppository combined with intravenous infusion of octreotide)and somatostatin group(32 cases,receiving intrarectal application of indomethacin suppository combined with somatostatin).The incidence of postoperative hyperamylasemia,pancreatitis,and adverse reactions were compared among the 3 groups.Levels of serum amylase,regulatory T cell(Treg)/T-helper 17 cell(Th17)and related cytokines were compared among the 3 groups.Results The incidence of postoperative hyperamylasemia and pancreatitis in somatostatin group(3.03%,1/32;0.00%,0/32)and octreotide group(22.86%,8/32;17.14%,6/32)were lower than those in control group(48.48%,1/32;42.42%,14/32),P<0.05;and incidence of postoperative hyperamylasemia and pancreatitis in somatostatin group were lower than those in octreotide group(P<0.05).After operation,levels of serum amylase,Treg/Th17 and related cytokines in the three groups were superior to those before operation(P<0.05);and the levels of Treg,transforming growth factorβ(TGF-β),serum amylase,Th17,interleukin-23(IL-23)and interleukin-17(IL-17)in somatostatin group and octreotide group were lower than those in control group after operation(P<0.05);while the levels of Treg and TGF-β in somatostatin group were higher than those in octreotide group(P<0.05),and the levels of serum amylase,Th17,IL-23 and IL-17 were lower than those in octreotide group after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions among control group,octreotide group and somatostatin group(χ^(2)=0.67,P=0.714).Conclusions Compared with combined therapy with octreotide,intrarectal application of indomethacin suppository before ERCP combined with somatostatin is more effective in reducing the incidence of postoperative hyperamylasemia and pancreatitis.