Glyceryl trinitrate for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a meta-analysis of randomized, double-blind, placebo-controlled trials
Glyceryl trinitrate for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a meta-analysis of randomized, double-blind, placebo-controlled trials
复制标题
三硝酸甘油预防内镜逆行胰胆管造影术后胰腺炎：随机、双盲、安慰剂对照试验的荟萃分析
DOI：
10.1055/s-0029-1214951
复制
发表时间：
2009-08-01
期刊：
影响因子：
9.3
通讯作者：
Li, Z. -S.
中科院分区：
文献类型：
--
作者：
Bai, Y.;Xu, C.;Li, Z. -S.
背景和研究结果：虽然有报道评估三硝酸甘油（GTN；硝酸甘油）对内镜逆行胰胆管造影（ERCP）后胰腺炎的预防作用，但对于预防性 GTN 治疗是否确实可以降低 ERCP 后胰腺炎的发生率尚未达成一致。我们进行了一项荟萃分析，以比较预防性 GTN 与安慰剂对 ERCP 后胰腺炎的影响。研究设计：检索包括 PubMed、EM-BASE、Cochrane 图书馆和科学引文索引在内的数据库以查找相关的随机对照试验 (RCT)。两位评审员独立鉴定了评估 GTN 对 ERCP 术后胰腺炎发生的预防作用的相关试验。结果测量是 ERCP 后胰腺炎的发生率。结果：对涉及 1920 名患者的 8 项试验进行了分析。 Meta分析显示，GTN治疗显着降低了ERCP术后胰腺炎的发生率（GTN组5.9%，安慰剂组9.8%，P=0.002），相对风险为0.61（95%置信区间0.44-0.84）。接受 GTN 治疗的患者患胰腺炎的可能性降低了 39%。亚组分析表明，舌下或经皮途径给药GTN可能有用。结论：预防性GTN对于预防ERCP术后胰腺炎是有用的，但最佳剂量、最佳给药途径和时机需要进一步明确，才能进入临床常规使用。
Background and study alms: Although trials evaluating the preventive effect of glyceryl trinitrate (GTN; nitroglycerin) on pancreatitis occurring after endoscopic retrograde cholangiopancreatography (ERCP) have been reported, there is no agreement as to whether prophylactic GTN treatment can in fact reduce the incidence of post-ERCP pancreatitis. We performed a meta-analysis to compare the effects of prophylactic GTN with placebo on post-ERCP pancreatitis.Study design: Databases including PubMed, EM-BASE, the Cochrane Library, and the Science Citation Index were searched to find relevant randomized controlled trials (RCTs). Two reviewers independently identified relevant trials evaluating the prophylactic effect of GTN on the occurrence of post-ERCP pancreatitis. The outcome measure was the incidence of post-ERCP pancreatitis.Results: Eight trials involving 1920 patients were analyzed. Meta-analysis showed that the incidence of post-ERCP pancreatitis was significantly reduced by GTN treatment (GTN group 5.9%, placebo group 9.8%, P = 0.002), with a relative risk of 0.61 (95% confidence interval 0.44-0.84). Patients who received GTN were 39% less likely to develop pancreatitis. Subgroup analyses suggested that GTN administered by the sublingual or transdermal route may be useful.Conclusions: Prophylactic GTN is useful for prevention of post-ERCP pancreatitis, but the optimal dosage and the optimal route and timing of administration need further clarification before this treatment can come into routine clinical use.