生长抑素预防ERCP术后胰腺炎及高淀粉酶血症有效性的Meta分析

林秋满　邱萍　徐林芳　龚敏　 文萍　 文剑波 李兴 王桂良

[摘要] 目的 對应用生长抑素预防内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）和ERCP术后高淀粉酶血症（PEHA）的研究进行Meta分析。 方法 搜索电子数据库，包括PubMed、EMBASE、Cochrane图书馆和科学引文索引以检索相关试验。纳入比较生长抑素和空白对照预防PEP的对照试验。使用随机效应模型和固定效应模型进行Meta分析以评估PEP、PEHA和ERCP术后腹痛的比率。 结果 生长抑素组PEP和PEHA比率均明显低于空白对照组（RR=0.45，95%CI：0.33～0.61，P<0.00001;RR=0.51，95%CI：0.39～0.67，P<0.00001）。对于短时间注射亚组，生长抑素组与空白对照组之间的PEP和PEHA比率比较，差异无统计学意义（RR=0.49，95%CI：0.22～1.11，P=0.09;RR=0.88，95%CI：0.450～0.172，P=0.71）。对于长时间注射亚组，生长抑素组的PEP和PEHA比率明显低于空白对照组（RR=0.43，95%CI：0.31～0.59，P<0.00001;RR=0.51，95%CI：0.30～0.69，P<0.00001）。对低危PEP亚组，生长抑素组与空白对照组PEP比率比较，差异无统计学意义（RR=0.60，95%CI：0.37～0.97，P=0.96）;对于高危PEP亚组，生长抑素组PEP比率显著低于空白对照组（RR=0.62，95%CI：0.41～0.93）。对于长时间注射高风险PEP亚组，生长抑素组的PEP比率明显低于空白对照组（RR=0.54，95%CI：0.34～0.86，P=0.01）。生长抑素组的ERCP术后腹痛总发生率明显低于空白对照组（RR=0.60，95%CI：0.33～1.10，P=0.01）。PEP发病率的漏斗图显示没有不对称性和负斜率。结论 长时间注射生长抑素可以显著降低高风险患者PEP、PEHA和ERCP后腹痛的发生率，而对于低风险患者则无需使用。

[关键词] 内镜逆行胰胆管造影;生长抑素;胰腺炎;高淀粉酶血症

[中图分类号] R657.3          [文献标识码] A          [文章编号] 1673-9701（2021）06-0001-09

Meta analysis of the effectiveness of somatostatin in preventing pancreatitis and hyperamylasemia after ERCP

LIN Qiuman QIU Ping XU Linfang GONG Min WEN Ping WEN Jianbo LI Xing WANG Guiliang

Department of Gastroenterology， Pingxiang Hospital Affiliated to Southern Medical University， Pingxiang   337000， China

[Abstract] Objective To conduct a meta-analysis of somatostatin in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis（PEP） and post-endoscopic retrograde cholangiopancreatography hyperamylasemia （PEHA）. Methods The electronic databases， including PubMed， EMBASE， Cochrane Library， and Science Citation Index， were searched to retrieve relevant experiments. A controlled trial comparing somatostatin and blank control to prevent PEP was included. Random effects model and fixed effects model were used for meta-analysis to evaluate the rate of abdominal pain after PEP， PEHA， and ERCP. Results The ratios of PEP and PEHA in the somatostatin group were significantly lower than those in the blank control group（RR=0.45， 95%CI： 0.33-0.61， P<0.00001; RR=0.51， 95%CI： 0.39-0.67， P<0.00001）. For the short-term injection subgroup，there was no statistical difference between the ratios of PEP and PEHA between the somatostatin group and the blank control group（RR=0.49， 95%CI： 0.22-1.11， P=0.090; RR=0.88， 95%CI： 0.450-0.172， P=0.71）. For the long-term injection subgroup， the ratio of PEP and PEHA in the somatostatin group was significantly lower than that of the blank control group（RR=0.43， 95%CI： 0.31-0.59， P<0.00001; RR=0.51， 95%CI： 0.30-0.69， P<0.00001）. For the low-risk PEP subgroup， there was no significant difference in the PEP ratio between the somatostatin group and the blank control group （RR=0.60， 95%CI： 0.37-0.97， P=0.96）. For the high-risk PEP subgroup，the PEP ratio of the somatostatin group was significantly lower than that of the blank control group（RR=0.62， 95%CI： 0.41-0.93）. For the long-term injection of the high-risk PEP subgroup， the PEP ratio of the somatostatin group was significantly lower than that of the blank control group（RR=0.54， 95%CI： 0.34-0.86， P=0.01）. The total rate of abdominal pain after ERCP in the somatostatin group was significantly lower than that of the blank control group（RR=0.60， 95%CI： 0.33-1.10， P=0.01）. The funnel chart of the incidence of PEP showed no asymmetry or negative slope. Conclusion Long-term injection of somatostatin can significantly reduce the incidence of abdominal pain after PEP， PEHA and ERCP in high-risk patients， but it is not necessary for low-risk patients.

[Key words] Endoscopic retrograde cholangiopancreatography; Somatostatin; Pancreatitis; Hyperamylasemia

内镜逆行胰胆管造影（Endoscopic retrograde cholangiopancreatography，ERCP）是一项发展很快的重要的诊断与治疗技术，可用于胆总管结石、胆道肿瘤、胆管狭窄、胰腺癌等疾病的诊断和治疗，具有创伤小、术后恢复快、疗效可靠等优点，其主要并发症是腹痛、腹胀、术后胰腺炎（Post-ERCP pancreatitis，PEP）、高淀粉酶血症、胆管炎、脓毒血症、消化道出血和十二指肠穿孔等，其中PEP是最为常见的并发症，如何预防PEP是临床工作者的一项重要研究课题[1]。预防PEP的主要药物有非甾体类抗炎药物（吲哚美辛、双氯芬酸和布洛芬等）和蛋白酶抑制剂（生长抑素、乌司他丁、奥曲肽、加贝酯和奈莫司他等），生长抑素是这类药物中最为广泛应用，能抑制胰腺外分泌功能，减少胃泌素及缩胆囊素分泌[2]。但在国内外应用生长抑素抑制PEP的临床研究中，得出的结论不一致。本研究运用循证医学方法，对已报道的国内外应用生长抑素抑制PEP的文献进行Meta分析，为预防ERCP术后并发症提供理论证据，现报道如下。……