| Background Endoscopic retrograde cholangiopancreatography(ERCP)is an endoscopic procedure used to treat biliary and pancreatic diseases.Compared with other endoscopic operations,ERCP is complicated to operate,requires high skill requirements for the doctors,and has a high risk of postoperative complications.These factors limit the wide application of ERCP to a certain extent.Complications of ERCP mainly include post-ERCP pancreatitis(PEP),post-ERCP cholangitis and postoperative bleeding.Among them,PEP is one of the most common complications after ERCP,which can endanger the life of patients in severe cases.Existing studies have proved that risk manipulation factors and immune function are involved in the pathogenesis of PEP.Under the effects of mechanical stimulation of ERCP and the immune function,pancreatic inflammation is aggravated and a large number of platelet particles(PMPs)released by platelet activation.Studies have shown that indomethacin,a kind of NSAIDs,can be effectively used in the clinical prevention and treatment of PEP and significantly reduce the occurrence of PEP.The main mechanism of non-steroidal anti-inflammatory drugs to prevent and treat PEP is to affect the arachidonic acid metabolic pathway,including inhibition of platelet aggregation and activation.However,it is not clear whether non-steroidal anti-inflammatory drugs affect platelet activation in the process of PEP.The study is to detect the clinical correlation between indomethacin on the preoperative and postoperative PMPs levels and the occurrence of PEP in patients with ERCP,and to explore whether indomethacin affects the platelet activation function in the process of PEP.Objective To investigate the efficacy and mechanism of 100 mg indometacin in the prevention of post-ERCP pancreatitis.Methods Data of a total of 191 patients with ERCP were collected from June 2019 to October 2020 and were randomly divided into indometacin group(n=96)and control group(n=95).The indometacin group patients received a 100 mg indometacin suppositorie before ERCP.Platelet-poor plasma(PPP)was separated by differential centrifugation and flow cytometry was used to measure the level of PMPs,the levels of IL-1,IL-6,TNF-αand CRP in the plasma of ERCP patients were also detected.Collect the two groups of patients in gender,age,smoking,drinking,WBC,PLT,TBIL,ALP,ALT,Hb,PDW and MPV before surgery to calculate the APACHE II score and Ranson score.Results 1.There was no significant difference between the indomethacin group and the control group in terms of gender,age,smoking history,drinking history,hypertension,and diabetes;the preoperative WBC,TBIL,ALP,ALT and Hb of the two groups were not statistically different difference.2.The incidence of PEP in the indomethacin group was 5.2%,the incidence of PEP in the control group was 13.68%,and the incidence of PEP in the control group was significantly higher than that in the indomethacin group(p=0.004)3.Indomethacin There was no significant difference between the preoperative and postoperative PLT levels between the control group and the control group(p>0.05).The preoperative PDW and MPV [13.68±2.88 f L,11.35±1.35 f L] of the indomethacin group were not significantly different from the control group [12.54±2.21 f L,10.92±1.17 f L](p>0.05).PDW and MPV [12.17±2.30 f L,10.94±1.14 f L] in the indomethacin group were significantly lower than those in the control group[14.54±2.56 f L,12.51±1.25 f L](p<0.05)at 3h postoperatively;indole at 24 h postoperatively PDW and MPV [11.91±0.51,10.55±0.98] in the mexin group are still lower than those in the control group [14.15±2.97,12.23±1.90](p<0.05)3.The preoperative PMPs level in the indomethacin group [1910.01(887.94)] Slightly lower than the control group [2351.87(5127.86)](p>0.05);the PMPs levels of the indomethacin group 3h and 24 h after the operation [1671.47(1592.39),862.74(1334.15)] were significantly lower than the control group [2443.75(8829.34),2536.76(5903.81)](p<0.05).4.The preoperative IL-1,IL-6,CRP and TNF-α in the indomethacin group were [76.65±18.19(pg/ml),73.85±28.06(pg/ml),23.68±18.37(mg/L),36.57±18.96(pg/ml)] and the control group [85.55±27.37(pg/ml),97.33±18.94(pg/ml),34.41±47.16(mg/L),51.71±10.11(pg/ml)] The difference is not significant(p>0.05).3h in the indomethacin group at 3h and 24 h after operation [72.81±14.92(pg/ml),80.22±32.88(pg/ml),28.13±29.01(mg/L),42.38±18.11(pg/ml)],24h[77.17±22.81(pg/ml),69.92±21.59(pg/ml),16.85±25.29(mg/L),38.53±14.25(pg/ml)];control group3h[150.21±69.97(pg/ml)),141.12±27.04(pg/ml),64.28±61.65(mg/L),122.06±23.53(pg/ml)];24h[147.51±71.44(pg/ml),136.67±16.62(pg/ml),63.21±60.67(mg/L),86.02±26.38(pg/ml)].The postoperative levels of IL-1,IL-6,CRP and TNF-α in the indomethacin group were significantly lower than those in the control group(p<0.05).Conclusion Indometacin can reduce the incidence of PEP.The mechanism may be the decreasing of the levels of PMPs made by indometacin. |
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