中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (05): 402-406,419.doi: 10.3969/j.issn.1671-4091.2026.05.008

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长效与短效红细胞生成刺激剂治疗维持性血液透析患者肾性贫血的Meta分析

张 园    张东雪    靳晶晶    程美娟    刘 兰    张胜雷   

  1. 050011 石家庄，1河北医科大学第四医院肾内科
  • 收稿日期:2025-09-11 修回日期:2026-01-12 出版日期:2026-05-12 发布日期:2026-05-12
  • 通讯作者: 张胜雷 E-mail:lei06352511@163.com
  • 基金资助:

Meta-analysis of long-acting and short-acting erythropoiesis-stimulating agents for the treatment of renal anemia in maintenance hemodialysis patients

ZHANG Yuan, ZHANG Dong-xue, JIN Jing-jing, CHENG Mei-juan, LIU Lan, ZHANG Sheng-lei   

  1. Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
  • Received:2025-09-11 Revised:2026-01-12 Online:2026-05-12 Published:2026-05-12
  • Contact: 050011 石家庄，1河北医科大学第四医院肾内科 E-mail:lei06352511@163.com

摘要： 目的 系统评价长效红细胞生成刺激剂(erythropoiesis-stimulating agents，ESAs)与短效ESAs治疗维持性血液透析(maintenance hemodialysis，MHD)患者肾性贫血的有效性及安全性。 方法 检索Cochrane Library、Web of science、Embase、PubMed、中国期刊全文数据库、万方数据知识服务平台、维普资讯中文期刊服务平台数据库，筛选关于红细胞生成刺激剂的文献，检索时间截至2025年6月30日。筛选RCT研究，使用RevMan 5.4软件分析。 结果 本研究共纳入16篇文献，3961例患者。Meta分析结果显示：长效ESAs在提高MHD患者的血红蛋白增长幅度(MD=-0.05，95%CI：-0.19～-0.09，P=0.480)、血红蛋白达标率(RR=0.97，95%CI：0.92～1.02，P=0.280)、铁蛋白(MD=7.90，95%CI：-14.81～30.61，P=0.500)、转铁蛋白饱和度(MD=0.16，95%CI：-1.08～1.40，P=0.800)水平方面与短效ESAs无统计学差异；按照长效ESAs给药周期进行亚组分析，结果显示1～2周使用1次达依波汀a的患者血红蛋白增长幅度优于短效ESAs(MD=0.13，95%CI：0.11～0.15，P＜0.001)，1月使用1次甲氧基聚乙二醇红细胞生成素β的患者血红蛋白增长幅度劣于短效ESAs(MD=-0.29，95%CI：-0.42～-0.16，P＜0.001)。长效ESAs发生心脑血管血栓栓塞的风险低于短效ESAs(RR=0.85，95%CI：0.75～0.97，P=0.020)，2组间呼吸道感染(RR=1.13，95%CI：0.89～1.43，P=0.330)、胃肠道疾病(RR=0.98，95%CI：0.89～1.07，P=0.600)、高血压(RR=1.06，95%CI：0.91～1.23，P=0.470)、死亡(RR=0.98，95%CI：0.78～1.24，P=0.880)、总不良事件发生率(RR=0.96，95%CI：0.91～1.02，P=0.220)均无统计学差异。 结论 长效与短效ESAs提升血液透析患者血红蛋白等指标总体无明显差异，但长效ESAs在血红蛋白增长幅度方面表现更佳，且长效ESAs相关的心脑血管血栓栓塞风险更低。

关键词: 血液透析, 长效红细胞生成刺激剂, 短效红细胞生成刺激剂, 有效性, 安全性

Abstract: Objective  To systematically evaluate the efficacy and safety of long-acting and short-acting erythropoiesis-stimulating agents (ESAs) for the treatment of renal anemia in patients with maintenance hemodialysis (MHD).  Methods  We searched the Cochrane Library, Web of Science, Embase, PubMed, China Journal Full-Text Database, VIP Information Chinese Journal Service Platform, and WanFang Data Knowledge Service Platform to obtain literature on ESAs. The search period was up to June 30, 2025. RevMan 5.4 software was used to screen and analyze the randomized controlled trials.  Results  A total of 16 studies involving 3,961 patients were included in the meta-analysis. Meta-analysis showed that no significant differences were found between long-acting and short-acting ESAs in terms of hemoglobin increase range [MD=-0.05, 95% CI：(-0.19, -0.09), P=0.480], hemoglobin response rate [RR=0.97, 95% CI：(0.92, 1.02), P=0.280], ferritin level [MD=7.90, 95% CI：(-14.81, 30.61), P=0.500], and transferrin saturation level [MD=0.16, 95% CI：  (-1.08, 1.40), P=0.800] in MHD patients. Subgroup analysis based on treatment interval of long-acting ESAs indicated that patients receiving Darbepoetin alfa once every 1～2 weeks had a greater increase in hemoglobin level than those receiving short-acting ESAs [MD=0.13, 95% CI：(0.11, 0.15), P＜0.001]. In contrast, patients receiving Methoxy Polyethylene Glycol-Epoetin beta once a month had a lower increase in hemoglobin level than those receiving short-acting ESAs [MD=- 0.29, 95% CI：(-0.42, -0.16), P＜0.001]. The risk of cardiovascular and cerebrovascular thromboembolism was lower in patients receiving long-acting ESAs than those receiving short-acting ESAs [RR=0.85, 95% CI：(0.75,0.97), P=0.020]. There were no statistically significant differences between the two groups in terms of respiratory tract infection [RR=1.13, 95% CI：(0.89,1.43),P=0.330], gastrointestinal diseases [RR=0.98, 95% CI：(0.89,1.07), P=0.600], hypertension [RR=1.06, 95% CI：(0.91, 1.23),P=0.470], mortality [RR=0.98, 95% CI：(0.78,1.24), P=0.880], and the incidence of total adverse events [RR=0.96, 95% CI：(0.91,1.02), P=0.220].  Conclusion  There are no significant differences in improving hemoglobin indicators between long-acting and short-acting ESAs for MHD patients. However, long-acting ESAs are better in increase of hemoglobin level with a lower risk of cardiovascular and cerebrovascular thromboembolism.

Key words: Hemodialysis, Long-acting ESA, Short-acting ESA, Efficacy, Safety

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