吲哚美辛直肠给药预防ERCP术后胰腺炎随机对照试验的Meta分析

摘要

Objective To evaluate the efficacy and safety of prophylactic rectal indomethacin on PEP by Meta-analy-sis. Methods By searching Medline, Etnbase, CBM, four independent randomized controlled trials (RCTs) that implemented the inclusion criteria and a Meta-analysis of these clinical trials was performed. Results The trials without significant heterogeneity enrolled 1 422 cases. Meta-analysis of these studies demonstrated a pooled relative risk for PEP after prophylactic administration of indomethacin of 0.49 [95% CI (0.34, 0.71) , P= 0.0002] and the incidence of severe PEP [OR =0.41 , 95% CI (0.21 , 0.78) , P=0.007] had markedly difference. There were no adverse events in all clinical trials. Conclusion Rectal indomethacin can reduce the incidence of PEP, including mild and severe. In view of PEP clinical prophylaxis remains skeptical, a large, multicenter and long-term follow-up of high quality randomized controlled trials are conducted to confirm this tactics.%目的 评价吲哚美辛直肠给药预防经内镜逆行胰胆管造影术后胰腺炎(post-ERCP pancreatitis,PEP)的安全性和有效性.方法 计算机检索Medline、Embase、中国生物医学文献数据库(CBM),对于符合条件的文献,由2名研究者独立选择试验、提取资料和评估方法学质量并对这些临床试验完成Meta分析.结果 共有4篇文献1 422例患者纳入本研究,这些试验均存在统计同质性.吲哚美辛组与安慰剂比较:两组PEP发生率有统计学意义[OR =0.49,95％ CI(0.34,0.71),P=0.0002],两组重症PEP的发生率有统计学意义[OR =0.41,95％ CI(0.21,0.78),P=0.007].结论 吲哚美辛可以预防PEP,在ERCP中广泛预防性应用吲哚美辛能够明显减少PEP发生率,对ERCP术后重症胰腺炎预防也有一定的效果.但由于目前临床上对PEP预防性用药仍持怀疑态度,仍需多中心、大样本和长期随访的高质量随机对照研究证实.