摘要
目的比较高通量血液透析(HFHD)和低通量血液透析(LFHD)对维持性血液透析(MHD)患者肾性贫血的疗效和安全性。方法 计算机检索Cochrane图书馆、PubMed、EMBASE、CNKI、万方数据库、CBM数据库中比较HFHD和LFHD对MHD患者肾性贫血疗效的随机对照试验(RCT)。根据纳入和排除标准,系统评估员独立进行数据提取和质量评价,并使用Revman5.0软件进行荟萃分析。结果 共纳入10项研究,731例患者。Meta分析显示,对于肾性贫血的MHD患者,与LFHD相比,HFHD可升高血红蛋白(Hb)及红细胞比容(Hct)水平(MD=9.55,95%CI4.56~14.53,P=0.000;MD=-22.55,95%CI-33.49^-11.61,P<0.01),降低C反应蛋白(CRP)水平(MD=-1.36,95%CI-1.81^-0.91,P<0.001)。在不良反应方面,HFHD组肌肉酸痛发生率更低(RR=0.15,95%CI0.05~0.41,P=0.000);而其他不良反应发生率2组无明显差异(P>0.05)。2种透析方式对尿素氮(BUN)及血清白蛋白(Alb)等指标改善的效果比较差异无统计学意义(MD=-0.72,95%CI-1.68~0.23,P=0.14;MD=1.33,95%CI-1.89~4.56,P=0.42)。结论 对MHD肾性贫血患者,HFHD比LFHD可有效改善Hb、Hct水平,缓解CRP的升高,降低肌肉酸痛的发生率,但不能减少恶心、胸痛和燥热等不良反应的发生,且对BUN、Alb等指标的改善无明显效果。
Objective To compare the efficacy and safety of high flux hemodialysis (HFHD) and low flux hemodialysis (LFHD) in the treatment of renal anemia in maintenance hemodialysis (MHD) patients. Methods A randomized controlled trial (RCT) comparing the efficacy of HFHD and LFHD in renal anemia in patients with MHD was performed in a computer search of the Cochrane Library, PubMed, EMBASE, CNKI, Wanfang Database, and CBM database. Based on inclusion and exclusion criteria, the system evaluator independently performed data extraction and quality assessment and meta-analysis using Revman 5.0 software. Results A total of 10 studies were included in 731 patients. Meta-analysis showed that HFHD increased hemoglobin (Hb) and hematocrit (Hct) levels compared with LFHD in patients with renal anemia (MD=9.55, 95% CI 4.56~14.53, P =0.000;MD =-22.55, 95% CI -33.49^-11.61, P <0.01), decreased C-reactive protein (CRP) levels (MD=-1.36, 95% CI -1.81^-0.91, P <0.001). In terms of adverse reactions, the incidence of muscle soreness was lower in the HFHD group ( RR =0.15, 95% CI 0.05~0.41, P =0.000);the incidence of other adverse reactions was not significantly different between the two groups ( P >0.05). There was no significant difference between the two dialysis methods in improving the effects of urea nitrogen (BUN) and serum albumin (Alb)(MD=-0.72, 95% CI -1.68~0.23, P =0.14;MD=1.33, 95% CI -1.89~4.56, P =0.42). Conclusion Compared with LFHD, HFHD can effectively improve the level of Hb and Hct, alleviate the increase of CRP and reduce the incidence of muscle ache in patients with MHD renal anemia, but it cannot reduce the incidence of nausea, chest pain and dry heat, and has no significant effect on the improvement of BUN, Alb and other indicators.
作者
刘鑫阔
刘洋
文南萍
张喜梅
杨波
LIU Xinkuo;LIU Yang;WEN Nanping;ZHANG Ximei;YANG Bo(Department of Nephrology, the First Affiliated Hospital of University of South China,Hengyang 421000,China)
出处
《疑难病杂志》
CAS
2019年第8期841-846,共6页
Chinese Journal of Difficult and Complicated Cases
