糖尿病肾病患者血液透析中发生低血糖危险因素的Meta分析  

Meta-analysis of Risk Factors for Hypoglycemia during Hemodialysis in Patients with Diabetic Nephropathy

作　　者：张敏娜[1] 周佩如 黄洁微 叶凯明 闫俊岚 ZHANG Minna;ZHOU Peiru;HUANG Jiewei;YE Kaiming;YAN Junlan(School of Nursing of Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学护理学院,广东广州510630 [2]暨南大学附属第一医院

出　　处：《中外医学研究》2021年第4期5-10,共6页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：广东省科技计划项目(2016B010108008)。

摘　　要：目的:通过Meta分析明确糖尿病肾病(diabetic nephropathy,DN)患者血液透析中发生低血糖的危险因素。方法:计算机检索PubMed、Web of Science、Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库和维普数据库,搜集建库至2020年5月关于DN患者血液透析中发生低血糖危险因素的文献。由两名研究者按照标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果:共纳入18篇文献,包括11项相关危险因素,危险因素为年龄≥60岁(OR=4.16,P<0.000 01)、DN病程>1年(OR=2.98,P<0.000 01)、空腹血糖<6.1 mmol/L(RR=4.14,P<0.000 01)、应用无糖透析液(RR=4.04,P=0.005)、使用胰岛素(RR=3.86,P<0.000 01)、使用口服降糖药(RR=2.12,P<0.000 01)。结论:年龄≥60岁、DN病程>1年、空腹血糖<6.1 mmol/L、应用无糖透析液、使用胰岛素是DN患者血液透析中低血糖的危险因素。使用口服降糖药的预测价值,研究证据尚不足,尚需进行更多高质量研究进行验证。Objective:To identify the risk factors of hypoglycemia during hemodialysis in patients with diabetic nephropathy using meta-analysis.Method:Databases were searched including PubMed,Web of Science,Cochrane Library,CNKI,CBM,Wanfang Data and VIP to collect studies about risk factors of hypoglycemia during hemodialysis in patients with diabetic nephropathy published from inception to May 2020.Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria by two researchers independently.Result:Eighteen studies were included,and eleven related risk factors were analyzed.The statistically significant risk factors were age ≥60 years (OR=4.16,P<0.000 01),course of diabetic nephropathy >1 year (OR=2.98,P<0.000 01),fasting glucose <6.1 mmol/L (RR=4.14,P<0.000 01),application of sugar-free dialysate (RR=4.04,P=0.005),use of insulin (RR=3.86,P<0.000 01),and use of oral hypoglycemic agents (RR=2.12,P<0.000 01).Conclusion:The risk factors of hypoglycemia during hemodialysis in patients with diabetic nephropathy include age ≥60 years,course of diabetic nephropathy >1 year,fasting glucose <6.1 mmol/L,application of sugar-free dialysate,use of insulin.The predictive value of the use of oral hypoglycemic agents is still inconclusive,and more high-quality studies are needed to supplement and improve for future research.

关 键 词：糖尿病肾病 血液透析 低血糖 危险因素 META分析 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]