奧曲肽預防胰腺移植術后并發癥有效性和安全性的Meta分析_《中國循證醫學雜志》

作者：

李璐璐 ¹ , 李永勝 ¹ , 龐麗麗 ¹ , 趙娜 ¹ , 馮莉 ¹ , 李勝富 ¹ , 龍丹 ¹ ,  李幼平 ¹²

1.四川大學華西醫院衛生部移植免疫實驗室（成都 610041）2.四川大學華西醫院中國循證醫學中心;

關鍵詞：

胰腺移植并發癥預防奧曲肽系統評價

DOI：

10.7507/1672-2531.20080057

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目的　系統評價奧曲肽預防胰腺移植術后并發癥的有效性和安全性。
方法　計算機檢索EMbase（1974～2008.1）、PubMed（1970～2008.1）、Cochrane圖書館（2008年第1期），中國生物醫學文獻數據庫（1978～2008.1）查找有關奧曲肽預防胰腺移植術后并發癥的臨床試驗研究。由兩名評價者獨立選擇試驗、提取資料和評估方法學質量，而后采用Cochrane協作網RevMan4.2.8軟件進行統計分析。
結果　最終納入3個RCT共82例胰腺移植受者。在移植術后第5天，奧曲肽組與空白對照組相比可降低尿淀粉酶，其差異有統計學意義［SMD=–784.86，95%CI（–1464.24，–105.49），P=0.02］，但兩組血淀粉酶的差異無統計學意義［SMD=–12.26，95%CI（–56.53，32.06），P=0.59］。奧曲肽組與空白對照組相比，術后各種并發癥發生率的差異無統計學意義。奧曲肽組在胰腺移植90天存活和受者6個月生存率與空白對照組比較，其差異亦均無統計學意義［RR=0.96，95%CI（0.83，1.11 ），P=0.56；RR=1.17，95%CI（0.86，1.58），P= 0.3］。在安全性方面，未報道奧曲肽對CsA和FK506吸收的影響，也無其他不良反應的報道。
結論　現有研究結果顯示，與空白對照相比，奧曲肽不能明顯降低胰腺移植術后胰腺炎、胰瘺及急性排斥反應的發生，對移植物和受者近期存活率也無明顯影響。本系統評價納入的RCT質量雖較高，但例數不多，上述結論尚需大樣本、長期隨訪的高質量隨機對照研究證實。

引用本文： 李璐璐,李永勝,龐麗麗,趙娜,馮莉,李勝富,龍丹,李幼平. 奧曲肽預防胰腺移植術后并發癥有效性和安全性的Meta分析. 中國循證醫學雜志, 2008, 08(4): 267-272. doi: 10.7507/1672-2531.20080057 復制

1.	Gruessner AC, Sutherland DER. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant, 2005, 19: 433-455.
2.	Humar A, Ramcharan T, Kandaswamy R, et al. The impact of donor obesity on outcomes after cadaver pancreas transplants: Why grafts fail and the risk factors-A multivariate analysis. Transplantation, 2004, 78(8): 1188-1192.
3.	Cooper M, Wringht F, Smith J, et al. Successful treatment of a high-output fistula with a somatostatin analogue following pancreas transplantation. Transplantation Proceedings, 1989, 21(4): 3738-3741.
4.	Stratta R, Taylor R, Lowell J, et al. Selective use of sandostatin in vascularized pancreas transplantation. American Journal of Surgery, 1993, 166(6): 598-604.
5.	Hesse UJ, Meester D, Troisi R, et al. The use of low dose octreotide prophyaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial. Clin Transplant, 2005, 19(3): 299-303.
6.	Benedetti E, Coady NT, Asolati M, et al. A prospective randomized clinical trial of perioperative treatment with octreotide in pancreas transplantation. Am J Surg, 1998, 175(1): 14-17.
7.	Stratta RJ, Taylor RJ, Lowell JA, et al. Randomized trial of Sandostatin prophylaxis for preservation injury after pancreas transplantation. Transplant Proceedings, 1993, 25(6): 3190-3192.
8.	Bogetti D, Nazatrwski S, Zielinski A, et al. Perioperative treatment with octreotide minimizes technical complications after enteric conversion of bladder-drained pancreas trandplants. Clin Transplant, 2004, 18(2): 137-141.
9.	Zielinski A, Nazatrwski S, Bogetti D, et al. Simultaneous pancreas-kidney transplant from living related donor: A single-center experience. Transplantation, 2003, 76(3): 547-552.
10.	Wadstrom J, Gannedahl G, Wahlberg J, et al. Persistent pancreatic fistula after pancreas transplantation treated with fibrin glue and octreotide. Transplant Proceedings, 1995, 27(6): 3491-3492.
11.	張娟, 丁惠國, 尤紅, 等. 生長抑素受體亞型在人肝星狀細胞的表達及其臨床意義. 首都醫科大學學報, 2006, 27(4): 441-444.

1. Gruessner AC, Sutherland DER. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant, 2005, 19: 433-455.
2. Humar A, Ramcharan T, Kandaswamy R, et al. The impact of donor obesity on outcomes after cadaver pancreas transplants: Why grafts fail and the risk factors-A multivariate analysis. Transplantation, 2004, 78(8): 1188-1192.
3. Cooper M, Wringht F, Smith J, et al. Successful treatment of a high-output fistula with a somatostatin analogue following pancreas transplantation. Transplantation Proceedings, 1989, 21(4): 3738-3741.
4. Stratta R, Taylor R, Lowell J, et al. Selective use of sandostatin in vascularized pancreas transplantation. American Journal of Surgery, 1993, 166(6): 598-604.
5. Hesse UJ, Meester D, Troisi R, et al. The use of low dose octreotide prophyaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial. Clin Transplant, 2005, 19(3): 299-303.
6. Benedetti E, Coady NT, Asolati M, et al. A prospective randomized clinical trial of perioperative treatment with octreotide in pancreas transplantation. Am J Surg, 1998, 175(1): 14-17.
7. Stratta RJ, Taylor RJ, Lowell JA, et al. Randomized trial of Sandostatin prophylaxis for preservation injury after pancreas transplantation. Transplant Proceedings, 1993, 25(6): 3190-3192.
8. Bogetti D, Nazatrwski S, Zielinski A, et al. Perioperative treatment with octreotide minimizes technical complications after enteric conversion of bladder-drained pancreas trandplants. Clin Transplant, 2004, 18(2): 137-141.
9. Zielinski A, Nazatrwski S, Bogetti D, et al. Simultaneous pancreas-kidney transplant from living related donor: A single-center experience. Transplantation, 2003, 76(3): 547-552.
10. Wadstrom J, Gannedahl G, Wahlberg J, et al. Persistent pancreatic fistula after pancreas transplantation treated with fibrin glue and octreotide. Transplant Proceedings, 1995, 27(6): 3491-3492.
11. 張娟, 丁惠國, 尤紅, 等. 生長抑素受體亞型在人肝星狀細胞的表達及其臨床意義. 首都醫科大學學報, 2006, 27(4): 441-444.

《中國循證醫學雜志》

奧曲肽預防胰腺移植術后并發癥有效性和安全性的Meta分析

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《中國循證醫學雜志》

奧曲肽預防胰腺移植術后并發癥有效性和安全性的Meta分析

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