新型腹膜透析液影响患者临床预后的Meta分析  

Effect of neutral p H,low-GDP peritoneal dialysis solutions on clinical outcome in patients with peritoneal dialysis:A meta-analysis

作　　者：王奕[1] 江薇[1] 刘峰[1] 王俊[1] 张颖莹[1] 马姝琛[1] 严海东[1] 庄守纲[1] 齐华林[1] 

机构地区：[1]上海市东方医院肾内科,上海200120

出　　处：《肾脏病与透析肾移植杂志》2014年第6期533-538,547,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：上海市浦东新区科技发展基金创新资金(PKJ2011-Y04)

摘　　要：目的：总结中性pH、低葡萄糖降解产物（GDP）腹膜透析液（NpHLGDPPDF）在腹膜透析（PD）中的随机对照研究（RCT）,采用Meta分析评价NpHLGDPPDF对PD患者临床预后的影响. 方法：在Medline、EMBASE及Cochrane图书馆内进行相关的检索.按照纳入/排除标准对纳入研究进行资料提取、方法学质量评价后,采用RevMan 5.2和Stata12.0软件进行Meta分析. 结果：16项研究共计1 546例患者入选Meta分析,结果显示,与传统PDF相比,NpHLGDPPDF维持高水平的尿量（WMD 131 ml,95％CI 64～ 197）;随访时间延长,有延缓肾小球滤过率（GFR）下降的趋势（12月、18月及＞24月的SMD分别为-0.01 ml/min、0.12 ml/min、0.21 ml/min）;未能降低PD患者全因死亡率、技术失败率;有降低腹膜炎发生的趋势（RR 0.84,95％CI 0.67～1.05）.Meta回归分析显示,随着样本数的增大,NpHLGDPPDF组的腹膜炎发生率下降（β=-0.006,P=0.01）;亚组分析显示,亚裔患者（RR0.67,95％ CI 0.50～0.90）及联合使用血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂（RR 0.57,95％ CI0.33～0.99）可降低腹膜炎发生率. 结论：NpHLGDPPDF能维持高水平尿量,但未能延缓GFR下降和改善临床预后.Objective：To assess the effect of neutral pH, low-GDP peritoneal dialysis solutions （NpHLGDPPDF） on clinical outcome in peritoneal dialysis （PD） patients with meta-analysis of parallel randomized controlled trials （RCTs）. Methodology： Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database. All of the RCTs that compared the clinical outcome between NpHLGDP and conventional PDF were eligible. According to the inclusion and exclusion criteria, data of the included studies were extracted, and the methodological quality was evaluated. Then meta-analysis was performed using RevMan 5.2 and Stata 12.0 software. Results：A total of 16 RCTs involving 1 546 patients was included. The quality od studies was generally poor. The results of meta-analysis showed that compared to conventional PDF, use of NpHLGDP PDF resulted in more urine outputs （8 trials; 699 patients; WMD 131 ml, 95%CI 64- 197） ; a trend to reduce gradually the decline of GFR during the whole follow-up （SMD, -0.01,0. 12,0. 21 ml/min of 12,18 and 24 months or more than respectively）. However, it didn＇t improve the patient and technique survival. NpHLGDP PDF was associated non-significant 16% peritonitis risk reduction （9 trials; 727 patients; Risk Ratio, 0. 84, 95% 0. 67 - 1.05）. Meta-regression analysis showed that peritonitis risk was negatively associated with sample numbers （β = - 0. 006, P = 0. 01 ）. Subgroup analyses showed that the risk of peritonitis was significantly lower in several studies of which PD patient was oriental and used ACEI/ARB. Conclusion：The use of NpHLGDPPDF resulted in more urine outputs while failed to improve the clinical outcome in PD patients.

关 键 词：腹膜透析 生物相容性 随机对照研究 预后 残余肾功能 

分 类 号：R692.5[医药卫生—泌尿科学]