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    吲哚美辛栓术前纳肛对内镜下逆行胆胰管造影术后血PGE2、IL-17、TNF-α的影响及临床意义

    Effect of the preoperative indomethacin suppository intrarectal application on the serum levels of PGE2, IL-17 and TNF-α after ERCP, and its clinical significance

      摘要
    • 摘要:
      目的探讨吲哚美辛预防内镜下逆行胆胰管造影（ERCP）术后胰腺炎的分子学机制。
      方法对临床拟行ERCP术的70例病人，随机分为对照组和观察组，各35例，观察组病人术前予吲哚美辛栓100 mg纳肛，对照组病人予安慰剂栓纳肛，观察2组术后高淀粉酶血症及胰腺炎发生率，同时检测术前和术后3、24 h血前列腺素E2（PGE2）、白细胞介素-17（IL-17）、肿瘤坏死因子α（TNF-α）水平。
      结果观察组术后并发胰腺炎1例，低于对照组的8例（P < 0.05），2组总的并发症发生率差异无统计学意义（P>0.05）。术前2组PGE2、IL-17、TNF-α水平差异均无统计学意义（P>0.05）。术后3 h观察组PGE2、IL-17、TNF-α水平均低于对照组（P < 0.05）；术后24 h观察组IL-17、TNF-α水平均低于对照组（P < 0.05和P < 0.01），2组PGE2差异无统计学意义（P>0.05）。对照组术前和术后各时间点IL-17、TNF-α水平差异均有统计学意义（P < 0.01和P < 0.05），而观察组差异均无统计学意义（P>0.05）。
      结论吲哚美辛栓术前纳肛可以有效降低ERCP术后胰腺炎发生率，可能与其降低体内PGE2、IL-17、TNF-α水平有关。

       

      Abstract:
      ObjectiveTo investigate the molecular mechanism of indometacin preventing pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP).
      MethodsSeventy patients scheduled by ERCP were randomly divided into the control group and observation group(35 cases each group).The observation group and control group were treated with 100 mg of indomethacin suppository and placebo suppository intrarectal application before operation, respectively.The incidence rates of postoperative hyperamylasemia and pancreatitis in two groups were observed, and the serum levels of prostaglanding E2(PGE2), interleukin-17(IL-17) and tumor necrosis factor-α(TNF-α) in two groups were detected before operation and after 3 h and 24 h of operation.
      ResultsThe postoperative pancreatitis in observation group(1 case)was lower than that in control group(8 cases)(P < 0.05).There was not statistical significance in the incidence rate of the total complications between two groups(P>0.05).There was not statistical significance in the levels of PGE2, IL-17 and TNF-α between two groups before operation(P>0.05).The levels of PGE2, IL-17 and TNF-α in observation group after 3 h of operation were lower than those in control group(P < 0.05).After 24 h of operation, the levels of IL-17 and TNF-α in observation group were lower than those in control group(P < 0.05 and P < 0.01), and the difference of the level of PGE2 between two groups was not statistically significant(P>0.05).The differences of the levels of IL-17 and TNF-α in control group between before and after operation were statistically significant(P < 0.01 and P < 0.05), but which in observation group was not statistically significant(P>0.05).
      ConclusionsIndomethacin suppository preoperative intrarectal application can effectively reduce the incidence rate of pancreatitis after ERCP, which may be related to the decreasing levels of PGE2, IL-17 and TNF-α.

       

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