OBJECTIVES: Severe acute pancreatitis (SAP) is still a big challenge. Accumulated data showed that overexpression of cyclooxygenase-2 (COX-2) in acute pancreatitis and experimental pancreatitis could be attenuated with COX-2 inhibitors. This study was aimed to evaluate whether the occurrence of SAP could be prevented by selective COX-2 inhibitors. METHODS: A total of 190 patients with predicted SAP were randomized into convention group or convention plus COX-2 inhibitors (C+COX-2-Is) group. Besides conventional treatment to all patients in 2 groups, parecoxib (40 mg/d intravenous injection for 3 days) and celecoxib (200 mg oral or tube feeding twice daily for 7 days) were sequentially administrated to the patients in the C+COX-2-Is group. The primary outcome was predefined as the occurrence of SAP. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) for all of the patients were measured. RESULTS: The occurrence of SAP in the C+COX-2-Is group was decreased 47.08% compared with the convention group, 21.05% (20/95) vs 39.78% (37/93), P = 0.005. A reduction of late local complications was also shown in the C+COX-2-Is group, 18.95% (18/93) vs 34.41% (32/95), P = 0.016. The serum levels of IL-6 and TNF-α were significantly lower in the C+COX-2-Is group than those in the convention group, P < 0.05. Parecoxib relieved abdominal pain more rapidly and decreased the consumption of meperidine. An incremental reduction of cost for 1% decrease of SAP occurrence was RMB475. DISCUSSION: Sequential administration of parecoxib and celecoxib in patients with predicted SAP obtained about half-reduction of SAP occurrence through decreasing serum levels of TNF-α and IL-6. This regimen presented good cost-effectiveness.

中文翻译：

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用 Cyclooxygenase-2 抑制剂预防严重急性胰腺炎

目标：严重急性胰腺炎（SAP）仍然是一个巨大的挑战。累积的数据表明，COX-2 抑制剂可以减轻急性胰腺炎和实验性胰腺炎中环氧合酶 2 (COX-2) 的过表达。本研究旨在评估选择性 COX-2 抑制剂是否可以预防 SAP 的发生。方法：将190例预测为SAP的患者随机分为常规组或常规加COX-2抑制剂（C+COX-2-Is）组。C+COX-2组患者除常规治疗外，依次给予帕瑞昔布（40 mg/d静脉注射3天）和塞来昔布（200 mg口服或管饲，每天2次，连续7天）。 -是组。主要结果预定义为 SAP 的发生。测量所有患者的血清白细胞介素6（IL-6）和肿瘤坏死因子-α（TNF-α）水平。结果：C+COX-2-Is组SAP发生率较常规组降低47.08%，分别为21.05%（20/95）和39.78%（37/93），P=0.005。C+COX-2-Is 组的晚期局部并发症也有所减少，分别为 18.95% (18/93) 和 34.41% (32/95)，P = 0.016。C+COX-2-Is组血清IL-6、TNF-α水平显着低于常规组，P < 0.05。帕瑞昔布更快地缓解腹痛并减少哌替啶的消耗。SAP 发生率每减少 1%，成本增量减少 475 元。讨论：通过降低 TNF-α 和 IL-6 的血清水平，在预测为 SAP 的患者中序贯给药帕瑞昔布和塞来昔布可使 SAP 发生率减少一半。该方案具有良好的成本效益。