他汀类药物的长期应用及其对ERCP术后胰腺炎的预防作用(翻译）

他汀类药物的长期应用及其对ERCP术后胰腺炎的预防作用

背景和目的：ERCP术后胰腺炎（PEP）是ERCP主要并发症之一。因此，已经研究了几种无创甚至有创的策略作为具有各种功效的PEP的预防性治疗。
方法：我们招募了在耶路撒冷ShaareZedek医疗中心和EMMS拿撒勒医院接受ERCP治疗的所有患者。使用单变量检验评估他汀类药物和不同变量的使用之间的关联（分类变量的卡方检验）。使用条件对数回归计算PEP发病率和胰腺炎严重程度的预测因子，纠正潜在的混杂因素。
结果：分析了958名受试者。平均年龄62.04 ± 21.18岁（中位数68）。他们大多数为女性（n = 558, 58.2%），犹太人(n = 827, 86.3%)和住院病人(n= 631, 65.9%)。只有少数ERCP是进行了急诊（n = 40,4.2％）。 27名患者重复了ERCP检查。PEP/高淀粉酶血症的总体发生率是16.8% (n = 161)，高淀粉酶血症的发生率是5.6% (n = 54)，PEP的发生率是11.2% (n = 107)。总之，6名严重胰腺炎被证实。逻辑回归分析表明长期使用他汀类药物是预防PEP /高淀粉酶血症发展的保护因素[OR 0.436 [95%CI 0.303–0.627], p < 0.001]，尤其是，PEP OR为0.318 [95％CI 0.169-0.597]，p <0.001，高淀粉酶血症OR为0.565 [95％CI 0.372-0.859]，p = 0.008。没有发现严重PEP风险的重要预测因子。
结论：我们的数据支持利用他汀类药物作为PEP的预防剂的可行性。可是，为了复制我们的研究结果，需要进一步研究，主要是RCT研究。


Chronic Use of Statins and Their Effect on Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Mahmud Mahamid1,2†, Abdulla Watad3,4*†, Nicola L. Bragazzi5, Dov Wengrower1, Julie Wolff6, Dan Livovsky1, Howard Amital3,4, Mohammad Adawi7† and Eran Goldin1†
 
Background and Aims: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the major complications of ERCP. Thus, several non-invasive as well as invasive strategies have been investigated as preventative therapies for PEP with various efficacy.
Methods: We enrolled any patients who underwent ERCP both at the ShaareZedek Medical Center in Jerusalem and EMMS Nazareth hospital. Association between use of statins and different variables were assessed with univariate tests (chi-squared for categorical variables). Predictors of incidence of PEP and severity of pancreatitis were computed using conditional logistic regression, correcting for potential confounding factors.
Results: 958 subjects were analyzed. Average age was 62.04 ± 21.18 years (median 68 years). Most of the patients were female (n = 558, 58.2%), Jewish (n = 827, 86.3%), and inpatients (n= 631, 65.9%). Only few ERCPs were performed emergently (n = 40, 4.2%). Twenty-Seven patients repeated the exam. Overall incidence of PEP/hyperamylasemia was 16.8% (n = 161); with a 5.6% (n = 54) incidence of hyperamylasemia and a 11.2% (n = 107) incidence of pancreatitis. Overall, 6 cases of severe pancreatitis were identified. The logistic regression analysis demonstrated that chronic use of statins is a protective factor in preventing development of PEP/hyperamylasemia [OR 0.436 [95%CI 0.303–0.627], p < 0.001]; Particularly, the PEP OR was of 0.318 [95%CI 0.169–0.597], p <0.001 and the hyperamylasemia OR was of 0.565 [95%CI 0.372–0.859], p = 0.008. No significant predictor could be found for the risk of developing severe PEP.
Conclusions: Our data support the possibility of exploiting statins as preventive agents for PEP. However, further studies, mainly RCTs, are warranted in order to replicate our findings.

翻译：王浩   审校：张立超、侯森林