非甾体抗炎药联合用药预防经内镜逆行胰胆管造影术后胰腺炎的有效性分析——一项贝叶斯网状Meta分析

Efficacy of Combination of Nonsteroidal Anti-Inflammatory Drugs for Prevention of Pancreatitis after Endoscopic Retrograde Cholangiography—A Bayesian Network Meta-Analysis

目的:综合评价直肠100 mg非甾体类抗炎药(NSAIDs)及其组合用药预防经内镜逆行胰胆管造影术后胰腺炎的临床疗效。方法:检索PubMed、Cochrane Library、Embase数据库从建库至2021年7月7日所有关于胰腺炎、经内镜逆行胰胆管造影术(ERCP)、吲哚美辛、双氯芬酸的随机对照试验(RCTs),根据纳入排除标准筛选文献并提取数据,采用Stata14MP、ADDIS进行数据分析。结果:纳入27项RCTs,术后胰腺炎患者13,496例,8种干预措施。网状Meta分析结果显示单用NSAIDs、高剂量NSAIDs、及NSAIDs组合用药与安慰剂相比在预防经内镜逆行胰腺胆管造影术后胰腺炎均具有显著差异,NSAIDs + 硝酸甘油是预防PEP最好的药物组合(OR = 0.20, 95% CI: 0.09, 0.41),与单用NSAIDs比较,NSAIDs + 硝酸甘油也有明显预防效果(OR = 0.44, 95% CI: 0.21, 0.92)。概率排序结果显示NSAIDs + 硝酸甘油效果最优,高剂量NSAIDs疗效最弱。与安慰剂比较,单用NSAIDs (OR = 0.37, 95% CI: 0.14, 0.83)在中高风险人群中在预防PEP有效率方面差异有统计学意义。概率排序结果显示NSAIDs + 硝酸甘油在预防PEP有效率上成为最好干预措施的可能性最大(OR = 0.22, 95% CI: 0.03, 1.57),其次为NSAIDs + 水合作用。结论:8项干预措施中,NSAIDs + 舌下硝酸甘油在总体以及高危人群中消除PEP的疗效明显优于其余药物;NSAIDs + 硝酸甘油、NSAIDs + 水合作用则可能是高危人群的最佳选择。

Aim: To evaluate the clinical efficacy of 100 mg non-steroidal anti-inflammatory drugs (NSAIDs) and their combination in preventing pancreatitis after endoscopic retrograde cholangiopancreatography. Methods: All RCTs on pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP), indomethacin and diclofenac from the establishment of PubMed, Cochrane Library and Embase databases to July 7, 2021 were searched. Literatures were screened and data were extracted according to inclusion and exclusion criteria. Stata14MP and ADDIS were used for data analysis. Result: A total of 27 Randomized controlled trial (RCTs) met inclusion criteria in the study, including eight interventions in 13,496 patients with post-ERCP pancreatitis (PEP). Results of a network meta-analysis showed significant differences in prevention of PEP between NSAIDs alone, high-dose NSAIDs, NSAIDs combination and placebo. NSAIDs + sublingual nitroglycerin was the best drug combination for PEP prevention (OR = 0.20, 95% CI: 0.09, 0.41), and there was also a statistically significant difference between NSAIDs + nitroglycerin and NSAIDS alone (OR = 0.44, 95% CI: 0.21, 0.92). Probability ranks showed that NSAIDs + sublingual nitroglycerin was the best, while high dose NSAID was the weakest. Compared with placebo, NSAIDs alone (OR = 0.43, 95% CI: 0.21, 0.81) and NSAIDs + hydration (OR = 0.31, 95% CI: 0.07, 0.95) had statistically significant differences in PEP prevention in middle and high-risk groups. Probability ranks showed that NSAIDs + sublingual nitroglycerin was the most likely intervention to prevent PEP effectiveness (OR = 0.22, 95% CI: 0.04, 1.12), followed by NSAIDs + hydration. Conclusion: Among the eight interventions, NSAIDs + nitroglycerin had a better efficacy in eliminating PEP than the other drugs in the general population;NSAIDs + hydration may be the best choice for high-risk groups, as may NSAIDs + nitroglycerin.