乌司他丁预防经内镜逆行胰胆管造影术后胰腺炎的Meta分析

李路; 韦宏成; 冯淑芬

doi:10.3969/j.issn.1001-5256.2017.01.024

乌司他丁预防经内镜逆行胰胆管造影术后胰腺炎的Meta分析

DOI: 10.3969/j.issn.1001-5256.2017.01.024

暨南大学附属第一医院消化科

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- 出版日期: 2017-01-20

Clinical effect of ulinastatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a Meta-analysis

Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China

摘要

摘要:
目的评价乌司他丁预防经内镜逆行胰胆管造影(ERCP)术后胰腺炎的有效性。方法检索Cochrane图书馆、Pub Med、EMBASE、CNKI、维普、万方数据库,收集乌司他丁预防ERCP术后胰腺炎的随机对照试验,检索时限为1970年至2016年6月。由2名研究者独立选择试验、提取资料和评估方法学质量,采用Rev M5.3软件进行Meta分析,各纳入研究间的异质性分析采用χ2检验,采用漏斗图评估发表偏倚情况。结果纳入6篇随机对照试验,共923例患者。乌司他丁预防ERCP术后胰腺炎[优势比(OR)=0.26,95%可信区间(95%CI):0.13~0.53]、高淀粉酶血症(OR=0.47,95%CI:0.33~0.67)、腹痛(OR=0.56,95%CI:0.34~0.91)的效果均优于安慰剂,差异均有统计学意义(P值分别为0.000 2、<0.001、0.020);乌司他丁预防ERCP术后胰腺炎、高淀粉酶血症、腹痛的效果与加贝酯相比,差异均无统计学意义(P值分别为0.52、0.13、0.79);小剂量乌司他丁预防ERCP术后胰腺炎、高淀粉酶血症的效果与加贝酯相比,差异亦无统计学意义...
- 胰腺炎 /
- 胰胆管造影术,内窥镜逆行 /
- 手术后并发症 /
- 乌司他丁 /
- Meta分析
Abstract:
Objective To investigate the clinical effect of ulinastatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography( ERCP). Methods The Cochrane Library,Pub Med,EMBASE,CNKI,VIP,and Wanfang Data were searched for randomized controlled trials( RCTs) on ulinastatin for the prevention of post- ERCP pancreatitis published from 1970 to June 2016. Two researchers selected RCTs,extracted data,and evaluated methodological quality independently,and Rev Man 5. 3 software was used for the meta- analysis. The chi- square test was used for the heterogeneity analysis of RCTs included,and the funnel plots were used to evaluate publication bias. Results A total of six RCTs with 923 patients were included in this analysis. Compared with the placebo,ulinastatin had significantly better effects in preventing post- ERCP pancreatitis( OR = 0. 26,95% CI: 0. 13- 0. 53,P = 0. 000 2),hyperamylasemia( OR = 0. 47,95% CI: 0. 33- 0. 67,P < 0. 001),and abdominal pain( OR = 0. 56,95% CI: 0. 34- 0. 91,P = 0. 020). Compared with gabexate,ulinastatin had similar effects in preventing post- ERCP pancreatitis,hyperamylasemia,and abdominal pain( P = 0. 52,0. 13,and 0. 79);low- dose ulinastatin also had similar effects as gabexate in preventing post- ERCP pancreatitis and hyperamylasemia( P = 0. 49 and0. 25). The funnel plots based on the effect of ulinastatin in preventing post- ERCP pancreatitis were slightly asymmetric,which suggested the presence of publication bias. Conclusion Ulinastatin( ≥15 × 104U) can effectively prevent post- ERCP pancreatitis,hyperlipidemia,and abdominal pain in the general population and it is recommended to start using this drug before surgery.
- pancreatitis /
- cholangiopancreatography /
- endoscopic retrograde /
- postoperative complications /
- ulinastatin

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参考文献(23)

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