国际移植与血液净化杂志
國際移植與血液淨化雜誌
국제이식여혈액정화잡지
INTERNATIONAL JOURNAL OF TRANSPLANTATION AND HEMOPURIFICATION
2014年
2期
23-30
,共8页
杨雪芬%陈星华%石明%丁国华
楊雪芬%陳星華%石明%丁國華
양설분%진성화%석명%정국화
高通量血液透析%低流量血液透析%血液透析滤过
高通量血液透析%低流量血液透析%血液透析濾過
고통량혈액투석%저류량혈액투석%혈액투석려과
High flux hemodialysis%Low-flux hemodialysis%Hemodiafiltration
目的 系统评价不同血液净化方式对维持性血液透析患者毒素清除、营养、钙磷代谢的影响.方法 计算机检索Medline、Embase和Cochrane数据库中有关不同血液净化方式治疗维持性血液透析患者的临床研究,对纳入文献的参考文献进行筛检.检索时间为建立数据库至2013年12月.对所选文献的质量进行严格评价和资料提取,对最终确定符合标准的文献采用RevMan 5.1和GRADEprofiler 3.6软件进行荟萃分析.结果 共纳入12项临床研究,其中2项为自身对照研究,10项为随机对照试验,共纳入患者2 583例.分析结果显示,血液透析滤过与血液透析两种血液净化方式对维持性血液透析患者Kt/V值、血尿素、血肌酐、β2微球蛋白、白蛋白、C反应蛋白、血钙、血磷、甲状旁腺素、血红蛋白、红细胞比容的影响差异无统计学意义;血液透析滤过与高通量血液透析相比,血清尿素变化差异有统计学意义,加权均数差[95％可信区间(CI)]为1.58(0.57,2.59),即血液透析滤过较高通量血液透析清除尿素效果差,两种治疗方式对患者Kt/V值、血肌酐、β2微球蛋白、白蛋白、C反应蛋白、血钙、血磷的影响差异无统计学意义;与低流量血液透析相比,血液透析滤过对白蛋白的清除减少,加权均数差(95％ CI)为0.91(0.60,1.23),在血肌酐、β2微球蛋白方面两种治疗方式差异无统计学意义.结论 维持性血液透析患者采用血液透析滤过较血液透析对各物质的清除差异无统计学意义.将血液透析分为高通量血液透析和低流量血液透析两个亚组分别与血液透析滤过进行评价,在尿素、白蛋白方面存在一定差异.
目的 繫統評價不同血液淨化方式對維持性血液透析患者毒素清除、營養、鈣燐代謝的影響.方法 計算機檢索Medline、Embase和Cochrane數據庫中有關不同血液淨化方式治療維持性血液透析患者的臨床研究,對納入文獻的參攷文獻進行篩檢.檢索時間為建立數據庫至2013年12月.對所選文獻的質量進行嚴格評價和資料提取,對最終確定符閤標準的文獻採用RevMan 5.1和GRADEprofiler 3.6軟件進行薈萃分析.結果 共納入12項臨床研究,其中2項為自身對照研究,10項為隨機對照試驗,共納入患者2 583例.分析結果顯示,血液透析濾過與血液透析兩種血液淨化方式對維持性血液透析患者Kt/V值、血尿素、血肌酐、β2微毬蛋白、白蛋白、C反應蛋白、血鈣、血燐、甲狀徬腺素、血紅蛋白、紅細胞比容的影響差異無統計學意義;血液透析濾過與高通量血液透析相比,血清尿素變化差異有統計學意義,加權均數差[95％可信區間(CI)]為1.58(0.57,2.59),即血液透析濾過較高通量血液透析清除尿素效果差,兩種治療方式對患者Kt/V值、血肌酐、β2微毬蛋白、白蛋白、C反應蛋白、血鈣、血燐的影響差異無統計學意義;與低流量血液透析相比,血液透析濾過對白蛋白的清除減少,加權均數差(95％ CI)為0.91(0.60,1.23),在血肌酐、β2微毬蛋白方麵兩種治療方式差異無統計學意義.結論 維持性血液透析患者採用血液透析濾過較血液透析對各物質的清除差異無統計學意義.將血液透析分為高通量血液透析和低流量血液透析兩箇亞組分彆與血液透析濾過進行評價,在尿素、白蛋白方麵存在一定差異.
목적 계통평개불동혈액정화방식대유지성혈액투석환자독소청제、영양、개린대사적영향.방법 계산궤검색Medline、Embase화Cochrane수거고중유관불동혈액정화방식치료유지성혈액투석환자적림상연구,대납입문헌적삼고문헌진행사검.검색시간위건립수거고지2013년12월.대소선문헌적질량진행엄격평개화자료제취,대최종학정부합표준적문헌채용RevMan 5.1화GRADEprofiler 3.6연건진행회췌분석.결과 공납입12항림상연구,기중2항위자신대조연구,10항위수궤대조시험,공납입환자2 583례.분석결과현시,혈액투석려과여혈액투석량충혈액정화방식대유지성혈액투석환자Kt/V치、혈뇨소、혈기항、β2미구단백、백단백、C반응단백、혈개、혈린、갑상방선소、혈홍단백、홍세포비용적영향차이무통계학의의;혈액투석려과여고통량혈액투석상비,혈청뇨소변화차이유통계학의의,가권균수차[95％가신구간(CI)]위1.58(0.57,2.59),즉혈액투석려과교고통량혈액투석청제뇨소효과차,량충치료방식대환자Kt/V치、혈기항、β2미구단백、백단백、C반응단백、혈개、혈린적영향차이무통계학의의;여저류량혈액투석상비,혈액투석려과대백단백적청제감소,가권균수차(95％ CI)위0.91(0.60,1.23),재혈기항、β2미구단백방면량충치료방식차이무통계학의의.결론 유지성혈액투석환자채용혈액투석려과교혈액투석대각물질적청제차이무통계학의의.장혈액투석분위고통량혈액투석화저류량혈액투석량개아조분별여혈액투석려과진행평개,재뇨소、백단백방면존재일정차이.
Objective To investigate the impact of different blood purification methods on clinical outcomes in patients with end-stage renal disease.Methods We searched Medline,Embase and the Cochrane library from the establishment of the databases to December 2013 to identify clinical trials on the impact of different blood purification methods on residual renal function,beta-2 microglobulin,albumin,and other indicators among maintenance hemodialysis patients.The bibliographies of included studies were searched.The quality of the selected trials was critically appraised and the data were extracted.Metaanalyses were conducted for the eligible trials.RevMan 5.1 and GRADEprofiler 3.6 software were used for statistical analysis.Results We identified 12 unique studies,including 2 583 patients.The meta-analysis found that:(1) there were no significant difference in Kt/V,urea,creatinine,β2-microglobulin,albumin,C-reactive protein (CRP),calcium,phosphate,parathyroid hormone (PTH),hemoglobin (Hb) and hematocrit (Hot) between hemodiafiltration (HDF) and hemodialysis (HD) groups; (2) compared with HDF,high-flux hemodialysis (HFHD) were associated with higher urea,and weighted mean difference (WMD,95％ confidence interval (CI) was 1.58 (0.57,2.59),but the Kt/V,creatinine,β2-microglobulin,albumin,CRP,calcium and phosphate levels did not significantly differ between the two treatment modalities; (3) similarly,no difference between HDF and low-flux hemodialysis (LFHD) was observed for creatinine and β2-microglobulin,but there was a significant increase in the plasma level of Alb,WMD (95％ CI) was 0.91 (0.60,1.23).Conclusions Maintained hemodialysis patients with HDF compared to HD for removal of the material had no significant difference.We also divided HD into HFHD and LFHD groups and compared with HDF,the results showed that there were differences in urea and albumin.
