切换至 "中华医学电子期刊资源库"

中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (03) : 146 -149. doi: 10.3877/cma.j.issn.2095-2015.2022.03.005

论著

双氯芬酸钠预防经十二指肠镜逆行胰胆管造影取石术后胰腺炎和高淀粉酶血症的疗效
刘苗苗1, 夏阳2,()   
  1. 1. 236800 安徽省,亳州市人民医院消化内科
    2. 241001 安徽芜湖,皖南医学院第一附属医院消化内科
  • 收稿日期:2021-12-02 出版日期:2022-06-01
  • 通信作者: 夏阳
  • 基金资助:
    2021亳州市重点研发计划项目(bzzc2021023)

Efficacy of diclofenac sodium in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography stone extraction

Miaomiao Liu1, Yang Xia2,()   

  1. 1. Department of Gastroenterology, Bozhou People′s Hospital, Bozhou 236800, China
    2. Department of Gastroenterology, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
  • Received:2021-12-02 Published:2022-06-01
  • Corresponding author: Yang Xia
引用本文:

刘苗苗, 夏阳. 双氯芬酸钠预防经十二指肠镜逆行胰胆管造影取石术后胰腺炎和高淀粉酶血症的疗效[J/OL]. 中华消化病与影像杂志(电子版), 2022, 12(03): 146-149.

Miaomiao Liu, Yang Xia. Efficacy of diclofenac sodium in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography stone extraction[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(03): 146-149.

目的

探究双氯芬酸钠预防经十二指肠镜逆行胰胆管造影(ERCP)取石术后胰腺炎和高淀粉酶血症的疗效,以及是否可通过影响前列腺素E2(PEG2)的表达来降低ERCP术后胰腺炎的发生率。

方法

按完全随机法将2019年6月至2019年12月皖南医学院第一附属医院拟行ERCP取石术的94例患者分为双氯芬酸钠组(48例,术前15 min给予100 mg双氯芬酸钠栓纳肛)、对照组(46例,术前15 min给予100 mg甘油灌肠剂纳肛)。观察两组患者术前、术后3 h、术后24 h血清淀粉酶、脂肪酶水平,采用ELISA法检测两组患者血清PEG2表达水平,比较两组患者胰腺炎、高淀粉酶血症的发生率以及血清PEG2表达水平差异。

结果

双氯芬酸钠组术后胰腺炎发生率明显降低,较对照组差异有统计学意义(P<0.05),但术后两组患者间高淀粉酶血症发生率差异无统计学意义(P>0.05)。术前两组患者间PEG2滴度差异无统计学意义(P>0.05)。术后3 h双氯芬酸组血清PEG2滴度低于对照组,差异有统计学意义(P<0.05)。术后24 h两组患者血清PEG2滴度差异无统计学意义,且恢复到术前水平(P>0.05)。

结论

双氯芬酸钠可预防ERCP取石术后胰腺炎的发生,可能与其降低血清PEG2的表达水平有关。

Objective

To investigate the efficacy of diclofenac sodium in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography(ERCP)stone extraction, and whether it can reduce the incidence of post-ERCP pancreatitis by affecting the expression of serum prostaglandin E2(PEG2).

Methods

According to random method, 94 patients who underwent ERCP stone extraction were divided into diclofenac sodium group(48 patients were given 100 mg diclofenac sodium for anal insertion 15 minutes before operation)and control group(46 patients were given 100 mg glycerol enema for anal insertion 15 minutes before operation). Serum amylase and lipase levels of the two groups were observed before and 3 hours and 24 hours after ERCP.ELISA was used to detected the levels of serum PEG2 in the two groups.The incidences of pancreatitis and hyperamylasemia and the expression levels of serum PEG2 were compared between the two groups.

Results

The incidence of post-ERCP pancreatitis in the diclofenac sodium group was significantly lower than that in the control group, with a statistically significant difference(P<0.05), but there was no statistically significant difference in the incidence of post-ERCP hyperamylasemia between the two groups(P>0.05). There was no statistically significant difference in PEG2 titer between the two groups before ERCP(P>0.05). The serum PEG2 titer in the diclofenac sodium group was lower than that in the control group 3 hours after ERCP, with a statistically significant difference(P<0.05). There was no statistically significant difference in serum PEG2 titer between the two groups 24 hours after ERCP, and returned to the preoperative level(P>0.05).

Conclusion

Diclofenac sodium can effectively prevent pancreatitis after ERCP stone extraction, which may be related to the decrease of serum PGE2 expression level.

表1 术前两组基本情况比较(±s)
表2 94例十二指肠逆行胆胰管造影术后并发症发生情况
表3 两组十二指肠逆行胆胰管造影术后胰腺炎、高淀粉酶血症发生情况[例(%)]
表4 两组十二指肠逆行胆胰管造影术前、术后淀粉酶水平比较(U/L,±s)
表5 两组十二指肠逆行胆胰管造影术前、术后脂肪酶水平比较(U/L,±s)
表6 两组患者十二指肠逆行胆胰管造影术前、术后血清前列腺素E2滴度比较(pg/ml,±s)
1
Cotton PB, Eisen GM, Aabakken L,et al.A lexicon for endoscopic adverse events:report of an ASGE workshop[J].Gastrointest Endosc201071:446-454.
2
Dumonceau JM, Kapral C, Aabakken L,et al.ERCP-related adverse events:European Society of Gastrointestinal Endoscopy(ESGE)Guideline[J].Endoscopy202052(2):127-149.
3
Shan-Shan, Liu, Xiao-Hua,et al.Risks of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis and Hyperamylasemia After Endoscopic Papillary Balloon Dilation:A Retrospective Analysis[J].Surg Laparosc Endosc Percutan Tech, 201929(4):280-284.
4
Kato K, Shiba M, Kakiya Y,et al.Celecoxib Oral Administration for Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis:A Randomized Prospective Trial[J].Pancreas201746(7):880.
5
Elmunzer BJ, Waljee AK, Elta GH,et al.A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis[J].Gut200857:1262-1267.
6
Pekgöz M.Post-endoscopic retrograde cholangiopancreatography pancreatitis:A systematic review for prevention and treatment[J].World J Gastroenterol201925(29):4019-4042.
7
Tryliskyy Y, Bryce GJ.Post-ERCP pancreatitis:Pathophysiology,early identification and risk stratification[J].Adv Clin Exp Med201827(1):149-154.
8
Engel C.European Society of Gastrointestinal Endoscopy(ESGE)Guideline:Prophylaxis of post-ERCP pancreatitis[J].Endoscopy201042(6):503-515.
9
中华医学会消化内镜学分会ERCP学组,中国医师协会消化医师分会胆胰学组,国家消化系统疾病临床医学研究中心.中国ERCP指南(2018版)[J].中华消化内镜杂志201835(11):777-813.
10
Eling TE, Baek SJ, Shim M,et al.NSAID activated gene(NAG-1),a modulator of tumorigenesis[J].J Biochem Mol Biol200639(6):649-655.
11
Wagh MS, Sherman S.Indomethacin for Post-ERCP Pancreatitis Prophylaxis:Another Attempt at the Holy Grail[J].Am J Gastroenterol2007102(5):984-986.
12
Chi-Huan, Wu NJ, Liu CN,et al.Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography[J].World J Gastroenterology202026(40):6241-6249.
13
Serrano J, Moura DD, Bernardo W,et al.Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis:a systematic review and meta-analysis[J].Endosc Int Open20197(4):E477-E486.
14
Yang J, Wang W, Liu C, et al.Rectal Nonsteroidal Anti-Inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention:A Network Meta-Analysis[J].J Clin Gastroenterol202054(4):305-313.
15
Kalantzis I, Poulou A, Papatheodorou A,et al.Rectal versus intramuscular diclofenac in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis:experience of a Greek tertiary referral center[J].Ann Gastroenterol202033(4):412-417.
16
赵孝文,鲍峻峻,胡翠,等.双氯芬酸钠预防经内镜逆行胰胆管造影术后胰腺炎机制的临床研究[J].中华消化内镜杂志201431(10):575-578.
17
Khoshbaten M, Khorram H, Madad L,et al.Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis[J].J GastroenterolHepatol201023(7 Pt 2):e11-e16.
18
Lee HJ, Cho CM, Heo J,et al.Impact of Hospital Volume and the Experience of the Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography:A Prospective Observational Study[J].GutLiver202014(2):257-264.
19
Stefanelli Paola, Teloni Raffaela, Carannante Anna, et al.Neisseria gonorrhoeae triggers the PGE2/IL-23 pathway and promotes IL-17 production by human memory T cells[J].Prostaglandins Other Lipid Mediat201299(1/2):24-29.
20
蓝升红,周丽萍,屠金夫,等.前列腺素E2对重症胰腺炎大鼠血清肿瘤坏死因子及白介素-6的调控作用[J].肝胆胰外科杂志200113(2):67-69.
[1] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[2] 李嘉兴, 孙乙文, 李文星. NLRP3炎性小体在急性胰腺炎中作用的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 300-304.
[3] 李国煜, 丛赟, 祖丽胡马尔·麦麦提艾力, 何铁英. 急性胰腺炎并发门静脉系统血栓形成的危险因素及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 266-270.
[4] 张洁, 罗小霞, 余鸿. 系统性免疫炎症指数对急性胰腺炎患者并发器官功能损伤的预测价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 68-71.
[5] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[6] 党军强, 杨雁灵, 汪庆强, 尚琳, 朱磊, 项红军. 主动经皮穿刺引流治疗重症急性胰腺炎并发急性坏死物积聚的疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 671-674.
[7] 方开萱, 翟亚奇, 张贯军, 陈升鑫, 陈德鑫, 刘文静, 梁雅文, 李明阳. 内镜逆行胰胆管造影术治疗胰腺分裂症的安全性与远期疗效[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 284-289.
[8] 赵月, 田坤, 张宗明, 郭震天, 刘立民, 张翀, 刘卓. 降钙素原对老年急性重度胆囊炎发生的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 801-806.
[9] 史清泉, 苗彬, 王烁, 陶琳, 沈晨. miR-181a-5p 靶向ATG5 抑制雨蛙素诱导的大鼠胰腺腺泡细胞AR42J自噬的机制研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 524-530.
[10] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[11] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[12] 杨爽, 余宏亮, 谢敏. CT 与超声检查对急性胰腺炎合并脂肪肝的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 541-544.
[13] 商倩, 罗静, 卓振山, 苗园园, 吴静, 廖振林. 通腑泻浊法联合生长抑素对内镜逆行胰胆管造影治疗的急性胆源性胰腺炎患者预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 437-441.
[14] 丛黎, 马林, 陈旭, 李文文, 张亮亮, 周华亭. 改良CT严重指数联合炎症指标在重症急性胰腺炎患者胰腺感染预测及预后评估中的研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 432-436.
[15] 宋燕秋, 戚桂艳, 杨双双, 周萍. 重症急性胰腺炎肠道菌群特征及早期肠内营养联合微生态制剂治疗的临床价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 442-447.
阅读次数
全文


摘要