奥曲肽预防胰腺移植术后并发症有效性和安全性的Meta分析_《中国循证医学杂志》

作者：

李璐璐 ¹ , 李永胜 ¹ , 庞丽丽 ¹ , 赵娜 ¹ , 冯莉 ¹ , 李胜富 ¹ , 龙丹 ¹ ,  李幼平 ¹²

1.四川大学华西医院卫生部移植免疫实验室（成都 610041）2.四川大学华西医院中国循证医学中心;

关键词：

胰腺移植并发症预防奥曲肽系统评价

DOI：

10.7507/1672-2531.20080057

视频：

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目的　系统评价奥曲肽预防胰腺移植术后并发症的有效性和安全性。
方法　计算机检索EMbase（1974～2008.1）、PubMed（1970～2008.1）、Cochrane图书馆（2008年第1期），中国生物医学文献数据库（1978～2008.1）查找有关奥曲肽预防胰腺移植术后并发症的临床试验研究。由两名评价者独立选择试验、提取资料和评估方法学质量，而后采用Cochrane协作网RevMan4.2.8软件进行统计分析。
结果　最终纳入3个RCT共82例胰腺移植受者。在移植术后第5天，奥曲肽组与空白对照组相比可降低尿淀粉酶，其差异有统计学意义［SMD=–784.86，95%CI（–1464.24，–105.49），P=0.02］，但两组血淀粉酶的差异无统计学意义［SMD=–12.26，95%CI（–56.53，32.06），P=0.59］。奥曲肽组与空白对照组相比，术后各种并发症发生率的差异无统计学意义。奥曲肽组在胰腺移植90天存活和受者6个月生存率与空白对照组比较，其差异亦均无统计学意义［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，未报道奥曲肽对CsA和FK506吸收的影响，也无其他不良反应的报道。
结论　现有研究结果显示，与空白对照相比，奥曲肽不能明显降低胰腺移植术后胰腺炎、胰瘘及急性排斥反应的发生，对移植物和受者近期存活率也无明显影响。本系统评价纳入的RCT质量虽较高，但例数不多，上述结论尚需大样本、长期随访的高质量随机对照研究证实。

引用本文： 李璐璐,李永胜,庞丽丽,赵娜,冯莉,李胜富,龙丹,李幼平. 奥曲肽预防胰腺移植术后并发症有效性和安全性的Meta分析. 中国循证医学杂志, 2008, 08(4): 267-272. doi: 10.7507/1672-2531.20080057 复制

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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.
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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.	张娟, 丁惠国, 尤红, 等. 生长抑素受体亚型在人肝星状细胞的表达及其临床意义. 首都医科大学学报, 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. 张娟, 丁惠国, 尤红, 等. 生长抑素受体亚型在人肝星状细胞的表达及其临床意义. 首都医科大学学报, 2006, 27(4): 441-444.

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奥曲肽预防胰腺移植术后并发症有效性和安全性的Meta分析

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《中国循证医学杂志》

奥曲肽预防胰腺移植术后并发症有效性和安全性的Meta分析

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