中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (12): 818-823.doi: 10.3969/j.issn.1671-4091.2018.12.007

• 临床研究 • 上一篇    下一篇

含糖透析液对糖尿病肾病患者血液透析期间血糖影响的Meta 分析

丁雪梅1,周光霞2,辛霞3   

  1. 1. 西安交通大学医学部护理系
    2. 延安大学医学院护理系
    3. 西安交通大学第一附属医院护理部
  • 收稿日期:2018-07-27 修回日期:2018-09-19 出版日期:2018-12-12 发布日期:2018-12-19
  • 通讯作者: 辛霞 1074116614@qq.com E-mail:1074116614@qq.com

Influence of glucose-added dialysate on blood glucose level in diabetic nephropathy patients during hemodialysis: a meta-analysis

  • Received:2018-07-27 Revised:2018-09-19 Online:2018-12-12 Published:2018-12-19

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摘要： 【摘要】目的 系统评价含糖透析液对糖尿病肾病(diabetic nephropathy, DN) 患者血液透析(hemodialysis, HD)期间血糖的影响。方法 计算机检索PubMed、Cochrane Library、EMbase、CNKI、VIP 和WanFang Data，搜集不同浓度的含糖透析液对DN 患者HD 期间血糖影响的随机对照试验(randomized controlled trial,RCT)，应用RevMan 5.3 软件根据透析液浓度分组进行Meta 分析。结果共纳入10个RCT，其中3 个自身对照研究，包括51 例患者，其余7 个RCT，共281 例患者。Meta 分析结果显示:①透析液葡萄糖浓度为0～3mmol/L 组，纳入1 个3mmol/L 的研究，2 组透析期间的血糖及低血糖发生率无统计学差异；②透析液浓度为3～6mmol/L 组，共纳入5 个5.5mmol/L 和2 个5mmol/L 的研究，透析期间含糖组的低血糖发生率低于无糖组[MD=0.16，95% CI:0.06～0.48，P＜0.001]，血糖高于无糖组，透析开始1h血糖(MD=3.04，95% CI:2.42～3.67，P＜0.001)、2h 血糖(MD=3.50，95% CI:3.08～3.91，P＜0.001)、3h血糖(MD=5.59，95% CI:5.07～6.11，P＜0.001)和4h 血糖(MD=3.94，95% CI:3.31～4.56，P＜0.001)；③透析液浓度为9～12mmol/L 组，包括2 个11.1mmol/L 的研究，透析期间含糖组的血糖明显高于无糖组，引起明显的高血糖和副交感神经活动增加。结论5mmol/L 或5.5mmol/L 的含糖透析液既增加了透析期间DN 患者的血糖，预防透析低血糖的发生，还避免了血糖过高和其引起的副交感神经的活动，建议条件允许的医疗单位使用与生理浓度相接近的5mmol/L 或5.5mmol/L 的葡萄糖透析液。受纳入文献数量和质量的限制，上述结论尚需开展更多高质量的RCT予以验证。

关键词: 透析液, 糖尿病肾病, 血液透析, 低血糖, Meta分析, 系统评价

Abstract: 【Abstract】Objective To systematically evaluate the effect of glucose-added dialysate on blood glucose level in diabetic nephropathy (DN) patients during hemodialysis (HD). Methods We searched PubMed, Cochrane Library, EMbase, CNKI, VIP and WanFang databases to collect randomized controlled trials (RCTs) that studied the effects of dialysate with different glucose concentrations on blood glucose level in DN patients during hemodialysis. Meta-analysis was performed by RevMan5.3 software. Results Ten trials involving 51 patients in 3 self-control trials and 281 patients in 7 RCTs were included and assessed. Meta-analysis suggested three groups of information. (a) The group of 0-3 mmol/L glucose included a study containing 3mmol/L glucose; there were no statistical differences in blood glucose and incidence of hypoglycemia during hemodialysis between the two groups. (b) The group of 3-6 mmol/L glucose included 5 studies containing 5.5mmol/L glucose and 2 studies containing 5 mmol/L glucose; compared with the group using glucose-free dialysate, the group using glucose-added dialysate had lower incidence of hypoglycemia (MD=0.16, 95% CI 0.06-0.48, P<0.001) and higher blood glucose level, including blood glucose after beginning of dialysis for one hour (MD=3.04, 95% CI 2.42-3.67, P<0.001), 2 hours (MD=3.50, 95% CI 3.08-3.91, P<0.001), 3 hours (MD=5. 59, 95% CI 5.07-6.11, P<0.001) and 4 hours (MD=3.94, 95% CI 3.31-4.56, P<0.001). (c) The group of 9-12 mmol/L glucose included 2 studies containing 11.1 mmol/L glucose; this group used glucose-added dialysate and blood glucose was significantly higher than that of the group using glucose-free dialysate, resulting in significant hyperglycemia and parasympathetic hyperactivity. Conclusion The dialysate containing 5 mmol/L or 5.5 mmol/L glucose not only increases blood glucose and prevents the occurrence of hypoglycemia but also avoids excessive high blood glucose and parasympathetic hyperactivity. If the conditions of the medical units permit, we recommend using dialysate containing 5 mmol/L or 5.5 mmol/L glucose, which are similar to the physiological concentration. Due to limitation of quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.

Key words: Dialysate, Diabetic nephropathy, Hemodialysis, Hypoglycemia, Meta-analysis, Systematic review