• 四川大學(xué)華西醫(yī)院消化內(nèi)科,成都,610041;

目的 　評價生長抑素及其類似物能否降低內(nèi)鏡逆行胰膽管造影術(shù)(ERCP)后胰腺炎(PEP)的發(fā)生率及嚴重程度,以及臨床應(yīng)用的安全性.
方法 　計算機檢索、Cochrane臨床對照試驗試驗資料庫(2004年第1期)、MEDLINE(1966～2004.4)、EMBASE(1985～2004.4)、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(1970～2004.4)和中國循證醫(yī)學(xué)中心隨機對照試驗資料庫,并輔以手工檢索,全面收集全世界關(guān)于生長抑素及其類似物預(yù)防PEP的RCT,按Cochrane協(xié)作網(wǎng)推薦的方法進行系統(tǒng)評價.
結(jié)果 　共31篇RCT包括4 728例患者被納入評價.Meta分析結(jié)果顯示,生長抑素可降低PEP的發(fā)生率[OR 0.33,95%CI (0.20,0.54);P=0.000 01;NNT＝13];與安慰劑或空白對照試驗相比,生長抑素類似物奧曲肽可降低ERCP術(shù)后高淀粉酶血癥的發(fā)生率[OR=0.54,95%CI (0.38,0.77);P=0.000 7],但對PEP、重度PEP和ERCP術(shù)后腹痛的發(fā)生率無影響.
結(jié)論 　生長抑素可降低PEP的發(fā)生率,可能是預(yù)防PEP的有效方法.由于納入的研究數(shù)量較多,有4篇為高質(zhì)量的研究,且敏感性分析的結(jié)果與Meta分析的結(jié)果一致,上述結(jié)論具有一定的可信度.但目前的證據(jù)不支持奧曲肽降低PEP的發(fā)生率,故不推薦臨床用于PEP的預(yù)防.鑒于敏感性分析的結(jié)果提示奧曲肽甚至有增高PEP發(fā)生率的趨勢,是否有必要進行進一步的臨床試驗需審慎看待.

引用本文： 潘 濤,王一平,楊錦林,吳宗英,曾 超. 生長抑素及其類似物奧曲肽預(yù)防內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2005, 05(10): 767-777. doi: 復(fù)制

1. Cotton PB,Lehman G,Vennes JA,Geenen JE,Russell RCG,Meyers WC,Liguory C,Nickl N.Endoscopic sphincterotomy complications and their management:an attempt at consensus[J].Gastrointest Endosc,1991;37(3):383-393.
2. Freeman ML,Disario JA,Nelson DB,Fennerty MB,Lee JG,Bjorkman DJ,Overby CS,Aas J,Ryan ME,Bochna GS,Shaw MJ,Snady HW,Erickson RV,Moore JP,Roel JP.Risk factors for post-ERCP pancreatitis:a prospective,multicenter study[J].Gastrointest Endosc,2001;54(4):425-434.
3. Masci E,Toti G,Mariani A,Curioni S,Lomazzi A,Dinelli M,Minoli G,Crosta C,Comin U,Fertitta A,Prada A,Passoni GR,Testoni PA.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study[J].Am J Gastroenterol,2001;96(2):417-423.
4. Loperfido S,Angelini G,Benedetti G,Chilovi F,Costan F,De Berardinis F,De Bernardin M,Ederle A,Fina P,Fratton A.Major early complications from diagnostic and therapeutic ERCP:a prospective multicenter study[J].Gastrointest Endosc,1998;48(1):1-10.
5. Glasbrenner B,Adler G.Pathophysiology of acute pancreatitis[J].Hepatogastroenterology,1993;40(4):517-521.
6. Tulassay Z.Somatostatin and the gastrointestinal tract[J].Scand J Gastroenterol,1998;228(Suppl):115-121.
7. Harris AG.Octreotide in the treatment of disorders of the gastrointestinal tract[J].Drug Invest,1992;4(Suppl 3):1-54.
8. Binmoeller KF,Harris AG,Dumas R,Grimaldi C,Delmont PJ.Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis[J]? Gut,1992;33(8):1129-1133.
9. Sternlieb JM,Aronchick CA,Retig JN,Dabezies M,Saunders F,Goosenberg E,Infantolino A,Ionna S,Maislin G,Wright SH,Lipshutz WH.A multicenter randomized controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis[J].Am J Gastroenterol,1992;87(11):1561-1566.
10. Arcidiacono R,Gambitta P,Rossi A,Grosso C,Bini M,Zanasi G.The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy[J].Endoscopy,1994;26(9):715-718.
11. Tulassay Z,Papp J.The effect of long-acting somatostatin analogue on enzyme change after endoscopic pancreatography[J].Gastrointest Endosc,1991;37(1):48-50.
12. Testoni PA,Bagnolo F,Andriulli A,Bernasconi G,Crotta S,Lella F,Lomazzi A,Minoli G,Natale C,Prada A,Toti GL,Zambelli A.Octreotide 24 h prophylaxis in patients at high risk for post-ERCP pancreatitis:results of a multicenter,randomized,controlled trial[J].Aliment Pharmacol Ther,2001;15(7):965-972.
13. Manolakopoulos S,Avgerinos A,Vlachogiannakos J,Armonis A,Viazis N,Papadiumitriou N,Mathou N,Stefanidis G,Rekoumis G,Vienna E,Tzourmakliotis D,Raptis SA.Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis:a multicenter randomized controlled trial[J].Gastrointestinal Endoscopy,2002;55(4):470-475.
14. Tulassay Z,Dobronte Z,Pronal L,Zagoni T,Juhasz L.Octreotide in the prevention of pancreatic injury associated with endoscopic cholangiopancreatography[J].Aliment Pharmacol Ther,1998;12(11):1109-1112.
15. Badra G,Galad AS,Rowaish I,Moustafa M,Waked I,Saled SM.Allopurinol vs octreotide in the prevention of post-ERCP pancreatitis in patient with billiary obstruction.A randomized controlled trial[J].Hepatology,2000;32(4):163A.
16. Duvnjak M,Supanc V,Simicevic VN,Hrabar D,Troskot B,Smircic-Duvnjak L,Bekavac-Beslin M.Use of octreotide-acetate in preventing pancreatitis-like changes following therapeutic endoscopic retrograde cholangiopancreatography[J].Acta Med Croatica,1999;53(3):115-118.
17. Arvanitidis D,Hatzipanayiotis J,Koutsounopoulos G,Frangou E.The effect of octreotide on the prevention of acute pancreatitis and hyperamylasemia after diagnostic and therapeutic ERCP[J].Hepatogastroenterology,1998;45(19):248-252.
18. Testoni PA,Lella F,Bagndo F,Buizza M,Colombo E.Controlled trial of different dosages of octreotide in the prevention of hyperamylasemia induced by endoscopic papillosphincterotomy[J].Ita J Gastroenterol,1994;26(9):431-436.
19. Testoni PA,Lella F,Bagndo F,Caporuscio S,Cattani L,Colombo E,Buizza M.Long-term prophylactic administration of octreotide reduces the rise in serm amylase after endoscopic procedures on Vaters papilla[J].Pancreas,1996;13(1):61-65.
20. Baldazzi G,Conti C,Spotti EG,Arisi GP,Scevola M,Gobetti F,Agliardi CM,Galasso P,Bonomi E,Bianchi F.Prevention of post-ERCP acute pancreatitis with octreotide[J].G Chir,1994;15(8):359-362.
21. Armonis A,Manolakopoulos S,Papadimitrious N,Gouma P,Avgerinos A.The effect of long acting somatostatin analogue in the prevention of post-ERCP pancreatitis[J].Gut,1994;35(suppl 4):A85.
22. Ng KW,Jiang CF,Liang CT,Wu CS,Chen HC,Yang CL,Tan SW,Yeh CH.A prospective,randomized,controlled trial to evaluate the effect of prophylactic sandostatin on ERCP-induced hyperamylasemia and pancreatitis.Gastroenterological[J].Journal of TaiWan,1997;14(2):192-197.
23. Russo A,Virgilio C,Aprile G.Influenza delloctreotide sulla reazione pancreatica indotta de colangiopancreatografia retrograda.Giorn[J].Ital End Dig,1992;15(2):139-145.
24. Lin Q,Wang KD,Tang GY,Li HL.Preventive effect of octreotide on pancreatitis after ERCP[J].Journal of modern practical medicine,2001;13(1):21-22.
25. Sun FQ,Zou DW,Li ZS,Xu GM,Sun ZX.Pevention of ERCP from pancreatitis[J].Chin J Dig Endosc,2000;17(2):81-83.
26. Li ZS,Qian XD,Xu GM,Sun ZX,Zou XP,Xie SQ.Prophylaxis of hyperamylasemia and post-ERCP pancreatitis by octreotide[J].Chin J Hepatobiliary Surg,2000;6(1):67-68.
27. Poon RT,Yeung C,Lo CM,Yuen WK,Liu CL,Fan ST.Prophylactic effect of somatostatin on post-ERCP pancreatitis:a randomized controlled trial[J].Gastrointest Endosc,1999;49(5):593-598.
28. Bordas JM,Toledo-Pimentel V,Llach J,Elena M,Mondelo F,Gines A,Teres J.Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography:results of a randomized study[J].Gastrointest Endosc,1998;47(3):230-234.
29. Persson B,Slezak P,Efendic S,Haggmark A.Can somatostatin prevent injection pancreatitis after ERCP[J]? Hepatogastroenterology,1992;39(3):259-261.
30. Guelrud M,Mendoza S,Viera L,Gelrud D.Somatostatin prevents acute pancreatitis after pancreatic duct sphincter hydrostatic balloon dilation in patients with idiopathic recurrent pancreatitis[J].Gastrointest Endosc,1991;37(1):44-47.
31. Bordas JM,Toledo V,Mondelo F,Rodes J.Prevention of pancreatic reactions by bolus somatostatin administration in patients undergoing endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy[J].Hormone Res,1988;29(2):106-108.
32. Saari A,Kivilaakso E,Schroder R.The influence of somatostatin on pancreatic irritation after pancreatography.An experimental and clinical study[J].Surg Res Comm,1988;2(3):271-278.
33. Testoni PA,Masci E,Bagnolo F,Tittobello A.Endoscopic papillo-sphincterotomy:prevention of pancreatic reaction by somatostatin[J].Ital J Gastroenterol,1988;20(2):70-73.
34. Deschner K,Kalloo A,Collen M,Cattau EL,Maher KA,Fleischer DE,Berrjamin SB.Somatostatin:an evaluation of its utility as adjunctive medication for ERCP[J].Gastrointest Endosc,1989;35(2):149-150.
35. Circero GF,lauger R,Sahel J.Effect of somatostatin on clinical,biochemical and morphological changes following ERCP[J].Ital J Gastroenterol,1985;17(3):256-258.
36. Poon RT,Yeung C,Liu CL,Lam CM,Yuen WK,Lo CM,Tang A,Fan ST.Intravenous bolus somatostatin after diagnostic cholangiopancreatography reduces the incidence of pancreatitis associated with therapeutic endoscopic retrograde cholangiopancreatography procedures:a randomized controlled trial[J].Gut,2003;52(12):1768-1773.
37. Li ZS,Xu GM,Sun ZX,Zou XP,Jin ZD,Xie SQ.Clinical study on somatostatin in prevention of hyperamylasemia and pancreatitis after ERCP[J].Acad J Sec Mil Med Univ,1997;18(5):426-427.
38. Gong L,Tang XJ,Xi M.Prophylaxis of hyperamylasemia and pancreatitis post-ERCP treated by little dosage somatostatin[J].Acad J Qiqihaer Med Col,2002;23(8):855-856.
39. Saluja AK,Steer ML.Pathophysiology of acute pancreatitis:role of cytokines and other mediators of inflammation[J].Digestion,1999;60(1):27-33.
40. Yuan Y,Gong Z,Lou K.Effects and mechanisms of somatostatin analogs on apoptosis of pancreatic acinar cells in acute pancreatitis in mice[J].J Gastroenterol Hepatol,2001;16(5):683-688.
41. Binmoeller KF,Dumas R,Harris AG,Delmont JP.Effect of somatostatin analog octreotide on human sphincter of Oddi[J].Dig Dis Sci,1992;37(5):773-777.
  1. 1. Cotton PB,Lehman G,Vennes JA,Geenen JE,Russell RCG,Meyers WC,Liguory C,Nickl N.Endoscopic sphincterotomy complications and their management:an attempt at consensus[J].Gastrointest Endosc,1991;37(3):383-393.
  2. 2. Freeman ML,Disario JA,Nelson DB,Fennerty MB,Lee JG,Bjorkman DJ,Overby CS,Aas J,Ryan ME,Bochna GS,Shaw MJ,Snady HW,Erickson RV,Moore JP,Roel JP.Risk factors for post-ERCP pancreatitis:a prospective,multicenter study[J].Gastrointest Endosc,2001;54(4):425-434.
  3. 3. Masci E,Toti G,Mariani A,Curioni S,Lomazzi A,Dinelli M,Minoli G,Crosta C,Comin U,Fertitta A,Prada A,Passoni GR,Testoni PA.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study[J].Am J Gastroenterol,2001;96(2):417-423.
  4. 4. Loperfido S,Angelini G,Benedetti G,Chilovi F,Costan F,De Berardinis F,De Bernardin M,Ederle A,Fina P,Fratton A.Major early complications from diagnostic and therapeutic ERCP:a prospective multicenter study[J].Gastrointest Endosc,1998;48(1):1-10.
  5. 5. Glasbrenner B,Adler G.Pathophysiology of acute pancreatitis[J].Hepatogastroenterology,1993;40(4):517-521.
  6. 6. Tulassay Z.Somatostatin and the gastrointestinal tract[J].Scand J Gastroenterol,1998;228(Suppl):115-121.
  7. 7. Harris AG.Octreotide in the treatment of disorders of the gastrointestinal tract[J].Drug Invest,1992;4(Suppl 3):1-54.
  8. 8. Binmoeller KF,Harris AG,Dumas R,Grimaldi C,Delmont PJ.Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis[J]? Gut,1992;33(8):1129-1133.
  9. 9. Sternlieb JM,Aronchick CA,Retig JN,Dabezies M,Saunders F,Goosenberg E,Infantolino A,Ionna S,Maislin G,Wright SH,Lipshutz WH.A multicenter randomized controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis[J].Am J Gastroenterol,1992;87(11):1561-1566.
  10. 10. Arcidiacono R,Gambitta P,Rossi A,Grosso C,Bini M,Zanasi G.The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy[J].Endoscopy,1994;26(9):715-718.
  11. 11. Tulassay Z,Papp J.The effect of long-acting somatostatin analogue on enzyme change after endoscopic pancreatography[J].Gastrointest Endosc,1991;37(1):48-50.
  12. 12. Testoni PA,Bagnolo F,Andriulli A,Bernasconi G,Crotta S,Lella F,Lomazzi A,Minoli G,Natale C,Prada A,Toti GL,Zambelli A.Octreotide 24 h prophylaxis in patients at high risk for post-ERCP pancreatitis:results of a multicenter,randomized,controlled trial[J].Aliment Pharmacol Ther,2001;15(7):965-972.
  13. 13. Manolakopoulos S,Avgerinos A,Vlachogiannakos J,Armonis A,Viazis N,Papadiumitriou N,Mathou N,Stefanidis G,Rekoumis G,Vienna E,Tzourmakliotis D,Raptis SA.Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis:a multicenter randomized controlled trial[J].Gastrointestinal Endoscopy,2002;55(4):470-475.
  14. 14. Tulassay Z,Dobronte Z,Pronal L,Zagoni T,Juhasz L.Octreotide in the prevention of pancreatic injury associated with endoscopic cholangiopancreatography[J].Aliment Pharmacol Ther,1998;12(11):1109-1112.
  15. 15. Badra G,Galad AS,Rowaish I,Moustafa M,Waked I,Saled SM.Allopurinol vs octreotide in the prevention of post-ERCP pancreatitis in patient with billiary obstruction.A randomized controlled trial[J].Hepatology,2000;32(4):163A.
  16. 16. Duvnjak M,Supanc V,Simicevic VN,Hrabar D,Troskot B,Smircic-Duvnjak L,Bekavac-Beslin M.Use of octreotide-acetate in preventing pancreatitis-like changes following therapeutic endoscopic retrograde cholangiopancreatography[J].Acta Med Croatica,1999;53(3):115-118.
  17. 17. Arvanitidis D,Hatzipanayiotis J,Koutsounopoulos G,Frangou E.The effect of octreotide on the prevention of acute pancreatitis and hyperamylasemia after diagnostic and therapeutic ERCP[J].Hepatogastroenterology,1998;45(19):248-252.
  18. 18. Testoni PA,Lella F,Bagndo F,Buizza M,Colombo E.Controlled trial of different dosages of octreotide in the prevention of hyperamylasemia induced by endoscopic papillosphincterotomy[J].Ita J Gastroenterol,1994;26(9):431-436.
  19. 19. Testoni PA,Lella F,Bagndo F,Caporuscio S,Cattani L,Colombo E,Buizza M.Long-term prophylactic administration of octreotide reduces the rise in serm amylase after endoscopic procedures on Vaters papilla[J].Pancreas,1996;13(1):61-65.
  20. 20. Baldazzi G,Conti C,Spotti EG,Arisi GP,Scevola M,Gobetti F,Agliardi CM,Galasso P,Bonomi E,Bianchi F.Prevention of post-ERCP acute pancreatitis with octreotide[J].G Chir,1994;15(8):359-362.
  21. 21. Armonis A,Manolakopoulos S,Papadimitrious N,Gouma P,Avgerinos A.The effect of long acting somatostatin analogue in the prevention of post-ERCP pancreatitis[J].Gut,1994;35(suppl 4):A85.
  22. 22. Ng KW,Jiang CF,Liang CT,Wu CS,Chen HC,Yang CL,Tan SW,Yeh CH.A prospective,randomized,controlled trial to evaluate the effect of prophylactic sandostatin on ERCP-induced hyperamylasemia and pancreatitis.Gastroenterological[J].Journal of TaiWan,1997;14(2):192-197.
  23. 23. Russo A,Virgilio C,Aprile G.Influenza delloctreotide sulla reazione pancreatica indotta de colangiopancreatografia retrograda.Giorn[J].Ital End Dig,1992;15(2):139-145.
  24. 24. Lin Q,Wang KD,Tang GY,Li HL.Preventive effect of octreotide on pancreatitis after ERCP[J].Journal of modern practical medicine,2001;13(1):21-22.
  25. 25. Sun FQ,Zou DW,Li ZS,Xu GM,Sun ZX.Pevention of ERCP from pancreatitis[J].Chin J Dig Endosc,2000;17(2):81-83.
  26. 26. Li ZS,Qian XD,Xu GM,Sun ZX,Zou XP,Xie SQ.Prophylaxis of hyperamylasemia and post-ERCP pancreatitis by octreotide[J].Chin J Hepatobiliary Surg,2000;6(1):67-68.
  27. 27. Poon RT,Yeung C,Lo CM,Yuen WK,Liu CL,Fan ST.Prophylactic effect of somatostatin on post-ERCP pancreatitis:a randomized controlled trial[J].Gastrointest Endosc,1999;49(5):593-598.
  28. 28. Bordas JM,Toledo-Pimentel V,Llach J,Elena M,Mondelo F,Gines A,Teres J.Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography:results of a randomized study[J].Gastrointest Endosc,1998;47(3):230-234.
  29. 29. Persson B,Slezak P,Efendic S,Haggmark A.Can somatostatin prevent injection pancreatitis after ERCP[J]? Hepatogastroenterology,1992;39(3):259-261.
  30. 30. Guelrud M,Mendoza S,Viera L,Gelrud D.Somatostatin prevents acute pancreatitis after pancreatic duct sphincter hydrostatic balloon dilation in patients with idiopathic recurrent pancreatitis[J].Gastrointest Endosc,1991;37(1):44-47.
  31. 31. Bordas JM,Toledo V,Mondelo F,Rodes J.Prevention of pancreatic reactions by bolus somatostatin administration in patients undergoing endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy[J].Hormone Res,1988;29(2):106-108.
  32. 32. Saari A,Kivilaakso E,Schroder R.The influence of somatostatin on pancreatic irritation after pancreatography.An experimental and clinical study[J].Surg Res Comm,1988;2(3):271-278.
  33. 33. Testoni PA,Masci E,Bagnolo F,Tittobello A.Endoscopic papillo-sphincterotomy:prevention of pancreatic reaction by somatostatin[J].Ital J Gastroenterol,1988;20(2):70-73.
  34. 34. Deschner K,Kalloo A,Collen M,Cattau EL,Maher KA,Fleischer DE,Berrjamin SB.Somatostatin:an evaluation of its utility as adjunctive medication for ERCP[J].Gastrointest Endosc,1989;35(2):149-150.
  35. 35. Circero GF,lauger R,Sahel J.Effect of somatostatin on clinical,biochemical and morphological changes following ERCP[J].Ital J Gastroenterol,1985;17(3):256-258.
  36. 36. Poon RT,Yeung C,Liu CL,Lam CM,Yuen WK,Lo CM,Tang A,Fan ST.Intravenous bolus somatostatin after diagnostic cholangiopancreatography reduces the incidence of pancreatitis associated with therapeutic endoscopic retrograde cholangiopancreatography procedures:a randomized controlled trial[J].Gut,2003;52(12):1768-1773.
  37. 37. Li ZS,Xu GM,Sun ZX,Zou XP,Jin ZD,Xie SQ.Clinical study on somatostatin in prevention of hyperamylasemia and pancreatitis after ERCP[J].Acad J Sec Mil Med Univ,1997;18(5):426-427.
  38. 38. Gong L,Tang XJ,Xi M.Prophylaxis of hyperamylasemia and pancreatitis post-ERCP treated by little dosage somatostatin[J].Acad J Qiqihaer Med Col,2002;23(8):855-856.
  39. 39. Saluja AK,Steer ML.Pathophysiology of acute pancreatitis:role of cytokines and other mediators of inflammation[J].Digestion,1999;60(1):27-33.
  40. 40. Yuan Y,Gong Z,Lou K.Effects and mechanisms of somatostatin analogs on apoptosis of pancreatic acinar cells in acute pancreatitis in mice[J].J Gastroenterol Hepatol,2001;16(5):683-688.
  41. 41. Binmoeller KF,Dumas R,Harris AG,Delmont JP.Effect of somatostatin analog octreotide on human sphincter of Oddi[J].Dig Dis Sci,1992;37(5):773-777.