雙氯芬酸預防經內鏡逆行胰膽管造影術后胰腺炎療效與安全性的系統評價_《中國循證醫學雜志》

作者：

賴薇 ¹ , 王烜 ² ,  鄧明明 ² , 康德英 ³ , 賈紅 ⁴

1. 瀘州醫學院（瀘州 646000）；2. 瀘州醫學院附屬醫院消化內科（瀘州 646000）；3. 四川大學華西臨床醫學院循證醫學與臨床流行病學教研室（成都 610041）；4. 瀘州醫學院公共衛生學院（瀘州 646000）;

關鍵詞：

經內鏡逆行胰膽管造影術后胰腺炎胰膽管造影術雙氯芬酸 Meta 分析系統評價

DOI：

10.7507/1672-2531.20120073

視頻：

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目的　系統評價常規非甾體類抗炎藥雙氯芬酸預防經內鏡逆行胰膽管造影術后胰腺炎（PEP）的有效性及安全性。
方法　計算機檢索Cochrane圖書館、PubMed、EMbase、OVID、CBM、 CNKI、VIP、WanFang Data，并輔以手工檢索2011年6月以前出版的《胃腸病學雜志》等12種中文專業期刊及相關學術會議紀要，追溯所獲文獻的參考文獻，全面收集雙氯芬酸預防PEP的隨機對照試驗（RCT），并按Cochrane協作網推薦的方法進行系統評價。
結果　共納入5個RCT，共計675例PEP患者。Meta分析結果顯示：應用雙氯芬酸可降低PEP發病率［OR=0.41，95%CI（0.18，0.95），P=0.04］，但敏感性分析提示結果穩定性較差；雙氯芬酸不能顯著降低重度PEP發病率［OR=0.40，95%CI（0.08，2.06），P=0.27］。5個納入研究均未報告藥物相關不良反應。
結論　雙氯芬酸預防PEP相對安全，有可能會降低PEP的發病率，但對于重度PEP，雙氯芬酸預防效果不明顯。鑒于本系統評價納入研究的方法學局限性，且例數有限，上述結論尚待開展更多大樣本、高質量的RCT加以驗證。

引用本文： 賴薇,王烜,鄧明明,康德英,賈紅. 雙氯芬酸預防經內鏡逆行胰膽管造影術后胰腺炎療效與安全性的系統評價. 中國循證醫學雜志, 2012, 12(4): 470-476. doi: 10.7507/1672-2531.20120073 復制

1.	Gross V, Leser HG, Heinisch A, et al. Infammatory mediators and cytokines-new aspects of the pathophysiology and assessment of severity of acute pancreatitis? Hepatogastroenterology, 1993, 40(6): 522-530.
2.	Makela A, Kuusi T, Schrdder T. Inhibition of serum phospholipase-A2 in acute pancreatitis by pharmacological agents in vitro. Scand J Clin Lab Invest, 1997, 57(5): 401-407.
3.	Senol A, Saritas U, Demirkan H. Ef?cacy of intramuscular diclofenac and ?uid replacement in prevention of post-ERCP pancreatitis. World J Gastroenterol, 2009, 15(32): 3999-4004.
4.	Cotton PB, Lehm an G, Vennes JA, et al. Endoscopic sphincterotomy complications and their management:an at tempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
5.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochranehandbook.org.
6.	Murry B, Cater R, Imrie C, et al. Diclofenac Reduces the Incidence of Acute Pancreatitis After Endoscopic Ret rograde Cholangiopancreatography. Astroenterology, 2003, 124(7): 1786-1791.
7.	Cheon YK, Cho KB, Watkins JL, et al. Efficacy of diclofenac in the prevention of post-ERCP pancreatitis in predominantly high-risk patients:a randomized double-blind prospective trial. Gastrointest Endosc, 2007, 66(6): 112 6-1132.
8.	Khoshbaten M, Khorram H, Madad M, et al. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol, 2008, 23(7): e11-e16.
9.	黃唯, 龔飛躍, 段小芳. 雙氯芬酸鈉預防ERCP后急性胰腺炎的臨床對比研究. 中華腹部疾病雜志, 2004, 4(4): 237-238.
10.	劉華, 毛建生, 何雪云等. 雙氯芬酸鈉預防ERCP術后胰腺炎的臨床研究. 現代醫藥衛生, 2011, 27(2): 173-174.
11.	靳紅旗, 劉東鳴, 趙軍. 大劑量維生素C治療重癥急性胰腺炎的實驗研究. 陜西醫學雜志, 2007, 36(6): 652-653.
12.	Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac:Therapeutic insights and pitfalls. Clin Pharmacokinet, 1997, 33(3): 184-213.
13.	Elmunzer BJ, Waljee AK, Elta GH, et al. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut, 2008, 57(9): 1262-1267.
14.	Zheng MH, Xia HH, Chen YP. Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut, 2008, 57(11): 1632-1633.
15.	Dai HF, Wang XW, Zhao K. Role of nonsteroidal anti-infammatory drugs in the prevention of post-ERCP pancr eatitis:a meta-analysis. Hepatobiliary Pancreat Dis Int, 2009, 8(1): 11-16.
16.	Zheng MH, Meng MB, Gu DN, et al. Effectiveness and Tolerability of NSAIDs in the Prophylaxis of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis. Current Therapeutic Research, 2009, 70(4): 323-334.
17.	Schulz KF, Moher D, Altman DG. CONSORT 2010 comments. Lancet, 2010, 376(9748): 1222-1223.

1. Gross V, Leser HG, Heinisch A, et al. Infammatory mediators and cytokines-new aspects of the pathophysiology and assessment of severity of acute pancreatitis? Hepatogastroenterology, 1993, 40(6): 522-530.
2. Makela A, Kuusi T, Schrdder T. Inhibition of serum phospholipase-A2 in acute pancreatitis by pharmacological agents in vitro. Scand J Clin Lab Invest, 1997, 57(5): 401-407.
3. Senol A, Saritas U, Demirkan H. Ef?cacy of intramuscular diclofenac and ?uid replacement in prevention of post-ERCP pancreatitis. World J Gastroenterol, 2009, 15(32): 3999-4004.
4. Cotton PB, Lehm an G, Vennes JA, et al. Endoscopic sphincterotomy complications and their management:an at tempt at consensus. Gastrointest Endosc, 1991, 37(3): 383-393.
5. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochranehandbook.org.
6. Murry B, Cater R, Imrie C, et al. Diclofenac Reduces the Incidence of Acute Pancreatitis After Endoscopic Ret rograde Cholangiopancreatography. Astroenterology, 2003, 124(7): 1786-1791.
7. Cheon YK, Cho KB, Watkins JL, et al. Efficacy of diclofenac in the prevention of post-ERCP pancreatitis in predominantly high-risk patients:a randomized double-blind prospective trial. Gastrointest Endosc, 2007, 66(6): 112 6-1132.
8. Khoshbaten M, Khorram H, Madad M, et al. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol, 2008, 23(7): e11-e16.
9. 黃唯, 龔飛躍, 段小芳. 雙氯芬酸鈉預防ERCP后急性胰腺炎的臨床對比研究. 中華腹部疾病雜志, 2004, 4(4): 237-238.
10. 劉華, 毛建生, 何雪云等. 雙氯芬酸鈉預防ERCP術后胰腺炎的臨床研究. 現代醫藥衛生, 2011, 27(2): 173-174.
11. 靳紅旗, 劉東鳴, 趙軍. 大劑量維生素C治療重癥急性胰腺炎的實驗研究. 陜西醫學雜志, 2007, 36(6): 652-653.
12. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac:Therapeutic insights and pitfalls. Clin Pharmacokinet, 1997, 33(3): 184-213.
13. Elmunzer BJ, Waljee AK, Elta GH, et al. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut, 2008, 57(9): 1262-1267.
14. Zheng MH, Xia HH, Chen YP. Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut, 2008, 57(11): 1632-1633.
15. Dai HF, Wang XW, Zhao K. Role of nonsteroidal anti-infammatory drugs in the prevention of post-ERCP pancr eatitis:a meta-analysis. Hepatobiliary Pancreat Dis Int, 2009, 8(1): 11-16.
16. Zheng MH, Meng MB, Gu DN, et al. Effectiveness and Tolerability of NSAIDs in the Prophylaxis of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis. Current Therapeutic Research, 2009, 70(4): 323-334.
17. Schulz KF, Moher D, Altman DG. CONSORT 2010 comments. Lancet, 2010, 376(9748): 1222-1223.

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《中國循證醫學雜志》

雙氯芬酸預防經內鏡逆行胰膽管造影術后胰腺炎療效與安全性的系統評價

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《中國循證醫學雜志》

雙氯芬酸預防經內鏡逆行胰膽管造影術后胰腺炎療效與安全性的系統評價

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