不同剂量奥曲肽治疗重症急性胰腺炎的有效性和安全性的系统评价

目的 系统评价不同剂量奥曲肽治疗重症急性胰腺炎（SAP）的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、Science Direct、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普生物医学数据库（VIP）和万方数据库，收集奥曲肽高剂量（1.2 mg/d）对比低剂量（0.6 mg/d）治疗SAP的病例对照研究，采用RevMan 5.3软件进行Meta分析。结果 共纳入12篇文献，901例SAP患者，其中低剂量组450例、高剂量组451例。Meta分析结果显示：相较于低剂量组，高剂量组显著提高总有效率（RR=1.17，95% CI=1.10～1.24，P<0.01）、减少并发症发生率（RR=0.36，95% CI=0.22～0.58，P<0.01）、缩短血淀粉酶恢复正常时间（MD=-1.72，95% CI=-1.98～-1.45，P<0.01）和腹痛消失时间（MD=-1.90，95% CI=-2.04～-1.76，P<0.01）；高剂量组和低剂量组病死率分别为3.74%和8.56%，中转手术率分别为13.24%和19.87%，不良反应发生率分别为11.16%和9.87%，差异均无统计学意义。结论 高剂量（1.2 mg/d）奥曲肽治疗SAP的临床有效率、减少并发症、缩短血淀粉酶恢复时间和腹痛消失时间明显优于低剂量（0.6 mg/d），但降低死亡率和中转手术率未见明显优势。

System assessment of clinical effect and safety of different does octreotide on severe acute pancreatitis

Objective To systematically evaluate the efficacy and safety of different does octreotide on severe acute pancreatitis (SAP). Methods Databases including PubMed, Embase, the Cochrane Library, Science Direct, CNKI, CBM, VIP and Wanfang Data were searched to collect the controlled trials of octreotide with high-does (1.2 mg/d) versus low-does (0.6 mg/d) on the SAP. The RevMan 5.3 software was used to carry out the Meta-analysis. Results A total of 12 literatures and 901 patients were included in this study, including 451 patients in high-does group and 450 patients in low-does group. Meta-analysis results showed that, compared with the low-dose group, the high-dose group was significantly increased in the clinical effective rate (RR=1.17,95%CI=1.10-1.24,P<0.01), significantly reduced the complication rate (RR=0.36, 95%CI=0.22-0.58, P<0.01); significantly reduced the time of blood amylase return to normal (MD=-1.72, 95%CI=-1.98--1.45, P<0.01) and abdominal pain disappear (MD=-1.90, 95%CI=-2.04--1.76, P<0.01). The fatality rates of the high-dose group and low-dose group respectively were 3.74% and 8.56%, the transfer rate respectively were 13.24% and 19.87%, the ADR rate respectively were 11.16% and 9.87%, and the difference was not statistically significant. Conclusion The high dose octreotide in the treatment of SAP is significantly better than the low dose in the clinical effectiveness, reduction of complications, reduction of blood amylase recovery time and disappearance of abdominal pain, but there is no significant advantage in the reduction of mortality and conversion rate to surgery.