中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (05): 372-376.

• 临床研究 • 上一篇    下一篇

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

侯国存1,李静1,甘华2,孙秀丽1   

  1. 1. 包头市中心医院
    2. 重庆医科大学附属第一医院肾内科
  • 收稿日期:2013-12-02 修回日期:2014-02-28 出版日期:2014-05-12 发布日期:2014-05-11
  • 通讯作者: 侯国存 houguocun2007@163.com E-mail:houguocun2007@163.com

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

  • Received:2013-12-02 Revised:2014-02-28 Online:2014-05-12 Published:2014-05-11

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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。

Abstract: 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 OL-HDF 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=1.0,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.