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生长抑素及蛋白酶抑制剂用于预防ERCP术后胰腺炎及高淀粉酶血症的贝叶斯网状Meta分析
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| 篇名： | 生长抑素及蛋白酶抑制剂用于预防ERCP术后胰腺炎及高淀粉酶血症的贝叶斯网状Meta分析 |
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| 摘要： | 目的：系统评价生长抑素及蛋白酶抑制剂预防内镜下逆行胰胆管造影术（ERCP）术后胰腺炎及高淀粉酶血症的临床效果。方法：计算机检索Cochrane library、PubMed、Embase等数据库，纳入生长抑素、蛋白酶抑制剂等预防ERCP术后胰腺炎效果的随机临床对照试验（RCT），采用EndNote X8软件剔除重复文献，按照Cochrane系统评价员手册5.3.3版评价文献质量，采用R 3.4.3软件Gemtc 0.8程序包通过马尔科夫链-蒙特卡洛（MCMC）方法进行贝叶斯网状Meta分析，采用Rev Man 5.3软件评估偏倚风险、Stata 14.0软件绘制漏斗图以评估发表偏倚。结果：共纳入33篇RCTs，共10 576例患者，涉及生长抑素、加贝酯、乌司他丁、萘莫司他4种药物。Meta分析结果显示，在预防ERCP术后胰腺炎方面，疗效概率从大到小排序为生长抑素（静脉团注）＞萘莫司他＞乌司他丁＞生长抑素（大剂量静脉滴注）＞加贝酯，生长抑素（小剂量静脉滴注）无效。在预防ERCP术后高淀粉酶血症方面，疗效概率从大到小排序为生长抑素（大剂量静脉滴注）＞生长抑素（静脉团注）＞乌司他丁。在预防高风险患者ERCP术后胰腺炎方面，仅萘莫司他有效。结论：与生长抑素（小剂量静脉滴注）、加贝酯相比，生长抑素术前静脉团注或大剂量静脉滴注、乌司他丁、萘莫司他等干预措施能较好地预防ERCP术后胰腺炎；虽然萘莫司他不能预防ERCP术后高淀粉酶血症，但可以预防高风险患者ERCP术后胰腺炎。 |
| ABSTRACT： | OBJECTIVE： To evaluate the clinical efficacy of somatostatin and protease inhibitors in the prevention of post-ERCP pancreatitis （PEP） and hyperamylasemia （PEHA）. METHODS： Retrieved from databases as Cochrane Library， PubMed， Embase， RCTs about therapeutic efficacy of somatostatin and protease inhibitors in the prevention of PEP were included. EndNote X8 software was used to eliminate duplicate documents， and the quality of included studies was evaluated according to Cochrane System Evaluator Manual version 5.3.3. Bayesian network Meta-analysis was conducted by MCMC method with R 3.4.3 software Gemtc 0.8 program package. Risk of bias was evaluated by using Rev Man 5.3 software， and risk of publication was evaluated by using Stata 14.0 software draws funnel map. RESULTS： A total of 33 RCTs were included， involving 10 576 patients， somatostatin， gabexate， ulinastatin， nafamostat. Network Meta-analysis showed that in the prevention of PEP， the order of curative effect was as follows： somatostatin （intravenous bolus）＞nafamostat＞ulinastatin＞somatostatin （high-dose intravenous drip）＞gabexate， somatostatin （low-dose intravenous drip） was ineffective. In the prevention of PEHA， the order of probability being somatostatin （high-dose intravenous drip）＞somatostatin （intravenous bolus）＞ulinastatin. Only nafamostat was effective in preventing PEP in high-risk patients. CONCLUSIONS： Compared with somatostatin （low-dose intravenous drip） and gabexate， somatostatin （intravenous bolus） and somatostatin （high-dose intravenous drip）， ulinastatin， nafamostat can more effectively prevent PEP. Nafamostat cannot prevent PEHA， but can prevent PEP in high risk patients. |
| 期刊： | 2018年第29卷第8期 |
| 作者： | 陈健刚，张丹丹，吕旭峰，杨悦 |
| AUTHORS： | CHEN Jiangang，ZHANG Dandan，LYU Xufeng，YANG Yue |
| 关键字： | 贝叶斯网状Meta分析；生长抑素；蛋白酶抑制剂；ERCP术后胰腺炎；ERCP术后高淀粉酶血症 |
| KEYWORDS： | Bayesian network Meta-analysis； Somatostatin； Protease inhibitors； Post-ERCP pancreatitis； Post-ERCP hyperamylasemia |
| 阅读数： | 585 次 |
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