双氯芬酸预防经内镜逆行胰胆管造影术后胰腺炎疗效与安全性的系统评价_《中国循证医学杂志》

作者：

赖薇 ¹ , 王烜 ² ,  邓明明 ² , 康德英 ³ , 贾红 ⁴

1. 泸州医学院（泸州 646000）；2. 泸州医学院附属医院消化内科（泸州 646000）；3. 四川大学华西临床医学院循证医学与临床流行病学教研室（成都 610041）；4. 泸州医学院公共卫生学院（泸州 646000）;

关键词：

经内镜逆行胰胆管造影术后胰腺炎胰胆管造影术双氯芬酸 Meta 分析系统评价

DOI：

10.7507/1672-2531.20120073

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价常规非甾体类抗炎药双氯芬酸预防经内镜逆行胰胆管造影术后胰腺炎（PEP）的有效性及安全性。
方法　计算机检索Cochrane图书馆、PubMed、EMbase、OVID、CBM、 CNKI、VIP、WanFang Data，并辅以手工检索2011年6月以前出版的《胃肠病学杂志》等12种中文专业期刊及相关学术会议纪要，追溯所获文献的参考文献，全面收集双氯芬酸预防PEP的随机对照试验（RCT），并按Cochrane协作网推荐的方法进行系统评价。
结果　共纳入5个RCT，共计675例PEP患者。Meta分析结果显示：应用双氯芬酸可降低PEP发病率［OR=0.41，95%CI（0.18，0.95），P=0.04］，但敏感性分析提示结果稳定性较差；双氯芬酸不能显著降低重度PEP发病率［OR=0.40，95%CI（0.08，2.06），P=0.27］。5个纳入研究均未报告药物相关不良反应。
结论　双氯芬酸预防PEP相对安全，有可能会降低PEP的发病率，但对于重度PEP，双氯芬酸预防效果不明显。鉴于本系统评价纳入研究的方法学局限性，且例数有限，上述结论尚待开展更多大样本、高质量的RCT加以验证。

引用本文： 赖薇,王烜,邓明明,康德英,贾红. 双氯芬酸预防经内镜逆行胰胆管造影术后胰腺炎疗效与安全性的系统评价. 中国循证医学杂志, 2012, 12(4): 470-476. doi: 10.7507/1672-2531.20120073 复制

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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.	黄唯, 龚飞跃, 段小芳. 双氯芬酸钠预防ERCP后急性胰腺炎的临床对比研究. 中华腹部疾病杂志, 2004, 4(4): 237-238.
10.	刘华, 毛建生, 何雪云等. 双氯芬酸钠预防ERCP术后胰腺炎的临床研究. 现代医药卫生, 2011, 27(2): 173-174.
11.	靳红旗, 刘东鸣, 赵军. 大剂量维生素C治疗重症急性胰腺炎的实验研究. 陕西医学杂志, 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. 黄唯, 龚飞跃, 段小芳. 双氯芬酸钠预防ERCP后急性胰腺炎的临床对比研究. 中华腹部疾病杂志, 2004, 4(4): 237-238.
10. 刘华, 毛建生, 何雪云等. 双氯芬酸钠预防ERCP术后胰腺炎的临床研究. 现代医药卫生, 2011, 27(2): 173-174.
11. 靳红旗, 刘东鸣, 赵军. 大剂量维生素C治疗重症急性胰腺炎的实验研究. 陕西医学杂志, 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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《中国循证医学杂志》

双氯芬酸预防经内镜逆行胰胆管造影术后胰腺炎疗效与安全性的系统评价

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《中国循证医学杂志》

双氯芬酸预防经内镜逆行胰胆管造影术后胰腺炎疗效与安全性的系统评价

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