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 [中文引用][英文引用]

 [摘要]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15min给予100mg双氯芬酸钠栓纳肛）、对照组（46例，术前15min给予100mg甘油灌肠剂纳肛）。观察两组患者术前、术后3h、术后24h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3h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24h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。

 [Abstract]  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.