吲哚美辛对经内镜逆行胰胆管造影术后胰腺炎患者血小板微粒水平的影响

Influence of indometacin on the level of platelet microparticles in patients with post-endoscopic retrograde cholangiopancreatography pancreatitis

摘要:

观察经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)术前使用吲哚美辛栓剂100 mg对ERCP术后胰腺炎（post-ERCP pancreatitis，PEP）患者的血小板微粒（platelet microparticles，PMPs）水平的影响。采用随机数字表法，将2019年6月—2020年10月在安徽医科大学第一附属医院行ERCP的191例患者分为吲哚美辛组（n=96）与对照组（n=95），吲哚美辛组ERCP术前吲哚美辛栓剂100 mg纳肛，对照组采用等质量安慰剂纳肛。采用流式细胞仪检测术前、术后3 h与术后24 h的血液标本的PMPs水平，同时检测患者术前、术后3 h、术后24 h血液标本中白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。吲哚美辛组PEP发生率为5.21％（5/96），对照组PEP发生率为13.68％（13/95），差异有统计学意义（P=0.044）。吲哚美辛组术前PMPs水平（1 910.01个/μL)略低于对照组(2 351.87个/μL,P＞0.05）；吲哚美辛组术后3 h和24 h的PMPs水平(1 671.47个/μL，862.74个/μL）明显低于对照组同时间点PMPs水平(2 443.75个/μL,2 536.76个/μL,P均＜0.05）。患者血浆中IL-1、IL-6和TNF-α水平出现相同趋势的改变。吲哚美辛降低PEP的发生率，可能与减少PMPs形成有关。

Abstract:

To observe the effect of indomethacin suppository 100 mg before endoscopic retrograde cholangiopancreatography (ERCP) on the level of platelet microparticles (PMPs) in patients with post-ERCP pancreatitis （PEP）. A total of 191 patients receiving ERCP were collected from June 2019 to October 2020 in the First Affiliated Hospital of Anhui Medical University and were randomly divided into the indometacin group (n=96) and the control group (n=95) by random number table method． The indometacin group received 100 mg indometacin suppositories before ERCP and the control group received placebo of equal quality. Levels of PMPs before operation, 3 hours and 24 hours after operation were measured by flow cytometry. The levels of IL-1, IL-6 and TNF-α in the plasma before ERCP, 3 hours and 24 hours after ERCP were also detected. The incidence of PEP in the indometacin group was 5.21% （5/96）, which was significantly lower than that in the control group [13.68％ （13/95）, P=0.044]. The preoperative PMPs level in the indometacin group (1 910.01/μL) was slightly lower than that in the control group (2 351.87/μL) with no significant difference （P＞0.05）. The PMPs levels in the indometacin group 3 hours and 24 hours after ERCP (1 671.47 /μL, 862.74/μL) were significantly lower than those of the control group (2 443.75/μL, 2 536.76/μL, both P＜0.05）. Inflammatory cytokines including IL-1, IL-6 and TNF-α showed the same tendency. Indometacin can reduce the incidence of PEP, for the reason that indometacin may decrease the levels of PMPs.