在线血液透析滤过对维持性血液透析患者生存率影响的Meta分析  

The meta analysis of influence of online hemodiafiltration on survival rate of maintenance hemodialysis patients

作　　者：侯国存[1] 李静[1] 甘华[2] 孙秀丽[1] 

机构地区：[1]包头市中心医院,重庆404100 [2]重庆医科大学第一附属医院肾内科,包头014040

出　　处：《中国血液净化》2014年第5期372-376,共5页Chinese Journal of Blood Purification

摘　　要：目的分析在线血液透析滤过(online hemodiafiltration,OL-HDF)能否改善维持性血液透析(maintenance hemodialysis,MHD)患者生存率。方法检索了Pubmed/MEDLINE、EMBASE和Cochrane Library电子数据库的OL-HDF对MHD患者生存率影响的随机对照试验(randomized controlled trials,RCT),前瞻性对照研究(prospective controlled trials,PCT)和前瞻性队列研究(prospective cohort study),使用优势比进行计算。结果 3个RCT,1个PCT和1个前瞻性队列研究共5009名患者纳入本次研究,5个研究均比较了在线血液透析滤过与血液透析(高通量透析,HFHD或低通量透析,LFHD)对患者生存率的影响。与透析组比较,OL-HDF组患者生存率没有得到改善,进一步以OL-HDF过程中置换液量进一步分组分析,高效率OL-HDF(high volume OL-HDF)组患者较HD组患者生存率明显得到改善(OR=0.53,Z=5.51,P<0.00001,I2=38%);低效OL-HDF在降低死亡率方面与HD组患者比较无明显差异(OR=1.0,Z=0.01,P=0.99,I2=0%)。结论高效率OL-HDF可降低MHD患者死亡率,并与OL-HDF置换液剂量相关。Objective To evaluate the effect of online hemodiafiltration（OL-HDF）in the survival rate of maintenance hemodilysis （MHD） patients.Methods Randomized controlled trials（RCT）,prospective controlled trials （PCT） and prospective cohort trials studying the effect of OL-HDF on survival rate of MHD patients were searched in the Pubmed/Medline,EMBASE、and Cochrane Library electronic databases,then the odds ratio was calculated.Results 5009 patients were included in this study：the effect of survival rate was compared in the OL-HDF and HD group.Compared with the HD group,the survival rate of OL-HDF group wasn not improved （Fixed effect model,OR =0.53,Z =5.51,P＜0.00001,I2 =38％）.The subgroup of OLHDF patients treated with a high substitution volume per session had better overall mortality compared with the HD group.There were no significant difference of overall mortality rate between low volume OL-HDF group and HD group （OR=l.0,Z=0.01,P=0.99,I2=0％）.Conclusions High volume OL-HDF may not improve the survival rate of MHD patients,associated with OL-HDF substitution volume.

关 键 词：在线血液滤过 生存率 META分析 

分 类 号：R318.16[医药卫生—生物医学工程]