CAJ | 학술논문

目的：评价血液灌流和血液透析滤过对维持性血液透析患者甲状旁腺素（PTH）的清除效果，指导临床选择最佳治疗方案。方法计算机检索MEDLINE（1966—2013.8）、Embase(1974—2013.8)、中文万方数据库（1996—2013.8）、CNKI（1979—2013.8）、Cochrane图书馆临床对照试验资料库。手工检索已发表或未发表的相关文献，包括会议摘要等。纳入血液灌流和血液透析滤过对维持性血液透析患者PTH清除作用的随机对照试验。由2名评价员独立对纳入的文献进行质量评价和数据提取，用RevMan 5.2软件进行Meta分析。结果共纳入12项随机对照试验，共计400例患者，Meta分析结果显示血液灌流（HP）与血液透析滤过（HDF）比较，在降低PTH疗效方面差异无统计学意义（WMD=-0.34，95%CI：-12.66～11.98，P=0.96），降低β2微球蛋白（β2-MG）的疗效方面差异无统计学意义（WMD=-2.92，95%CI：-16.64～10.8，P=0.68）。HP对患者皮肤瘙痒的缓解率高于HDF（RR=1.33，95%CI：1.08～1.62，P=0.006）。结论 HP和HDF均可降低终末期肾病维持性血液透析患者PTH的水平，两者疗效无明显差异。
목적：평개혈액관류화혈액투석려과대유지성혈액투석환자갑상방선소（PTH）적청제효과，지도림상선택최가치료방안。방법계산궤검색MEDLINE（1966—2013.8）、Embase(1974—2013.8)、중문만방수거고（1996—2013.8）、CNKI（1979—2013.8）、Cochrane도서관림상대조시험자료고。수공검색이발표혹미발표적상관문헌，포괄회의적요등。납입혈액관류화혈액투석려과대유지성혈액투석환자PTH청제작용적수궤대조시험。유2명평개원독립대납입적문헌진행질량평개화수거제취，용RevMan 5.2연건진행Meta분석。결과공납입12항수궤대조시험，공계400례환자，Meta분석결과현시혈액관류（HP）여혈액투석려과（HDF）비교，재강저PTH료효방면차이무통계학의의（WMD=-0.34，95%CI：-12.66～11.98，P=0.96），강저β2미구단백（β2-MG）적료효방면차이무통계학의의（WMD=-2.92，95%CI：-16.64～10.8，P=0.68）。HP대환자피부소양적완해솔고우HDF（RR=1.33，95%CI：1.08～1.62，P=0.006）。결론 HP화HDF균가강저종말기신병유지성혈액투석환자PTH적수평，량자료효무명현차이。
Objective To assess the effect of hemoperfusion (HP) and hemodiafiltration (HDF) on elimination of para?thyroid hormone (PTH) from plasma in long-term hemodialysis patients.Methods MEDLINE (1966—2013.8), Embase (1974—2013.8), Chinese Wanfang database (1996—2013.8),CNKI(1979—2013.8)and the clinical control test database of Cochrane Library were searched. Published reports, unpublished studies and abstract from conference were retrieved manu?ally, all of which include studies of effect of PTH elimination through hemoperfusion and hemodiafiltration. Quality assess?ment and data mining were conducted by two independent investigators who performed meta-analysis using RevMan 5.2. Re?sults A total of 12 reports (400 patients) met the inclusion criteria and were included in this study. The meta-analysis showed that the elimination rate of PTH in long term hemodialysis patients was similar between using hemoperfusion and us?ing hemodiafiltration(WMD=-0.34,95%CI:-12.66-11.98,P=0.96). What’s more the elimination rate ofβ2-MG were also similar(WMD=-2.92,95%CI:-16.64-10.8,P=0.68)between those two treatments. However,The remission rate of pruritus was higher in patients using HP group than in HDF group(RR=1.33,95%CI:1.08-1.62,P=0.006). Conclusion HP and HDF can effectively clear PTH in chronic hemodialysis patients, but there was no statistically different between the two treat?ment methods.