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]. 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]. 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] 张秋彬, 张楠, 林清婷, 徐军, 朱华栋, 姜辉. 急性胰腺炎合并急性肾损伤患者的预后评估[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 382-389.
[2] 黄翠君, 张喜玲, 刘思嘉, 刘云建. 重症急性胰腺炎营养支持治疗研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(05): 385-390.
[3] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[4] 陈朔, 陈峰, 程飞, 项捷. 糖原累积病Ⅰ型并发胰腺炎肝移植术后胰腺梗死一例[J]. 中华移植杂志(电子版), 2023, 17(05): 300-302.
[5] 陈海艳, 周惠敏, 崔佳琪, 杨军. 经尿道膀胱镜钬激光碎石术后并发中度重症急性胰腺炎一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 461-463.
[6] 许磊, 孙杰, 陈先志, 张家泉, 李旺勇, 冯其柱, 王琦. 血液净化治疗在高血脂性重症胰腺炎中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 464-468.
[7] 黄岩, 刘晓巍, 杨春玲, 兰烨. 急性胰腺炎合并糖尿病患者的临床特征及血糖代谢与病情严重度的相关性[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 439-442.
[8] 吉茜茜, 田尧, 马林, 钱进. 红细胞分布宽度-白蛋白比值联合BISAP评分对急性胰腺炎严重程度及死亡率的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 433-438.
[9] 陆萍, 邹健. 凝血和纤维蛋白溶解标志物的动态变化对急性胰腺炎患者预后的评估价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 427-432.
[10] 王小红, 钱晶, 翁文俊, 周国雄, 朱顺星, 祁小鸣, 刘春, 王萍, 沈伟, 程睿智, 秦璟灏. 巯基丙酮酸硫基转移酶调控核因子κB信号介导自噬对重症急性胰腺炎大鼠的影响及机制[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 422-426.
[11] 孙旻. 血液淀粉酶、C反应蛋白、降钙素原及乳酸脱氢酶在急性胰腺炎患者病情评价及预后预测中的价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 331-336.
[12] 马强, 李军, 苟丽娟. 重症急性胰腺炎miR-21-3p、RUNX3表达水平及对病情发展程度的预测[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 337-341.
[13] 王庆, 夏婷婷. 未成熟粒细胞计数、C反应蛋白、中性粒细胞/淋巴细胞、降钙素原结合MCTSI评分在急性胆源性胰腺炎中的诊断价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 224-228.
[14] 姜巧, 张溱乐, 张艳玲, 余展鹏. 基于MIMIC-Ⅲ数据库的急性胰腺炎并发脓毒症风险预测模型构建与评价[J]. 中华临床实验室管理电子杂志, 2023, 11(03): 151-157.
[15] 韩优, 郝婧, 董红霞, 戴丽, 周保硕, 高慧贤. 经鼻空肠营养管在急性重症胰腺炎的早期应用及护理方法分析[J]. 中华胃肠内镜电子杂志, 2023, 10(04): 274-277.
阅读次数
全文


摘要