Nafamostat Mesilate for Prevention of Post-ERCP Pancreatitis A Meta-analysis of Prospective, Randomized, Controlled Trials
Nafamostat Mesilate for Prevention of Post-ERCP Pancreatitis A Meta-analysis of Prospective, Randomized, Controlled Trials
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甲磺酸萘莫司他预防 ERCP 后胰腺炎：前瞻性、随机、对照试验的荟萃分析。
DOI：
10.1097/mpa.0000000000000310
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发表时间：
2015-05-01
期刊：
影响因子：
2.9
通讯作者：
Hu, Guoyong
中科院分区：
文献类型：
--
作者：
Yu, Ge;Li, Shuang;Hu, Guoyong
目的：方法：计算机检索Medline、Embase、科克伦中心对照试验注册中心和Web of Science，检索截止日期为2014年4月18日。与nonnafamostat相比，接受nafamostat的患者PEP的发生率降低至53%（风险比[RR]，0.47; 95%置信区间[CI]，0.34-0.63）。根据不同的风险分类进行了进一步分析（高风险患者n = 641：RR，0.54; 95% CI，0.30-0.96;低风险患者n = 944：RR，0.31; 95% CI，0.17-0.56），PEP严重程度（n = 1654：轻度RR，0.38; 95% CI，0.25-0.59;中度RR，0.37; 95% CI，0.15-0.96;重度RR，0.92; 95% CI，0.13-6.38），以及萘莫司他剂量（20 mg组n = 1902：RR，0.42; 95% CI，0.28-0.63; 50 mg组n = 1150：RR，0.40; 95% CI，0.25-0.63）。然而，ERCP术后高淀粉酶血症（n = 1585; 95%CI，0.68-1.45）或插管困难（n = 1585; 95%CI，0.91-1.23）的发生率没有降低。结论：目前随机对照试验的汇总分析支持萘莫司他预防PEP的有效性。
Objectives: We aimed to evaluate the efficacy of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched until April 18, 2014.Results: Seven randomized controlled trials and 2956 patients met the search criteria. When compared with nonnafamostat, the incidence of PEP was reduced to 53% in the patients who received nafamostat (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.34-0.63). Further analyses were conducted based on the different risk classifications (n = 641 in patients with high risks: RR, 0.54; 95% CI, 0.30-0.96 and n = 944 with low risks: RR, 0.31; 95% CI, 0.17-0.56), PEP severities (n = 1654: RR, 0.38; 95% CI, 0.25-0.59 for mild; RR, 0.37; 95% CI, 0.15-0.96 for moderate; RR, 0.92; 95% CI, 0.13-6.38 for severe), and nafamostat doses (n = 1902: RR, 0.42; 95% CI, 0.28-0.63 for 20 mg; n = 1150: RR, 0.40; 95% CI, 0.25-0.63 for 50 mg). However, there was no reduction of the incidence of post-ERCP hyperamylasemia (n = 1585; 95% CI, 0.68-1.45) or cannulation difficulty (n = 1585; 95% CI, 0.91-1.23).Conclusions: Pooled analyses from current randomized controlled trials support the effectiveness of nafamostat for prophylaxis of PEP.