中国血液净化

›› 2006, Vol. 5 ›› Issue (1): 33-37.

• 论著 • 上一篇    下一篇

连续性血液净化对炎性介质清除作用的meta分析

宋玉果   

  1. 100020 北京，首都医科大学附属北京朝阳医院职业病与中毒医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-01-12 发布日期:2006-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-01-12 Published:2006-01-12

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摘要： 目的 探究连续性血液净化（CVVH）对炎性介质的清除作用,比较高容量血液滤过（HVHF）(＞2L/h)与CVVH(＝＜2L/h)对炎性介质清除的差异。 方法 从MEDLINE和中国生物医学文献数据库(CBM)等光盘检索，并对相关研究进行meta分析。 结果 共9项随机病例对照(RCT)研究，133例进行CVVH与非CVVH治疗的RCT研究，71例HVHF与CVVH治疗的RCT研究。CVVH在12h、24h、大于24h较非CVVH治疗对TNF-α、IL-6的清除效应的合并标准化均数差值（WMD）及其95%CI分别为：TNF-α：WMD 12h：-0.02（95%CI -0.07，0.03），P12h=0.46; WMD24h：-0.06(95%CI -0.31，0.19)，P24h=0.64;WMD＞24h ：-0.06（95%CI -0.14，0.01），P＞24h=0.09；IL-6：WMD 12h：3.01 (95％CI -10.57，16.59)，P12h= 0.66;WMD24h：-1.26(95% CI -28.30,30.83)，P24h,=,0.93; WMD＞24h：-24.26(95％ CI-51.87，3.34)，P＞24h =0.08；CVVH较非CVVH治疗血TNF-α、IL-6的浓度变化差异均无显著性。而HVHF较CVVH,在8h～24h对TNF-α及IL-6清除作用的WMD及其95%CI分别为：-163.05(95％CI -227.53，-48.56)，P=0.005；-256.14(95% CI -392.68，-119.59)，P=0.0002；HVHF较CVVH治疗对血TNF-α、IL-6的浓度影响差异均有极显著性。 结论 传统CVVH(=＜2L/h)对炎性介质无明显的清除作用，但HVHF( ＞2L/h）对炎性介质（TNF-α,IL-6）有较显著的清除作用。

关键词: 连续性血液净化, 高容量血液滤过, 炎性介质, meta分析

Abstract: Objective To pool the data of randomized controlled trials (RCT) that compared continuous blood purification (CVVH) with non-CVVH or high volume hemofiltration (HVHF),and evaluate the efficacy of inflammatory mediators removal. Methods After search of the RCTs that studied the efficacy of CVVH or HVHF from MEDLINE and CBM discs, meta analysis was employed to evaluate the results of the RCTs. Results Nine RCTs comprising 204 cases were included, no significances were found in 12h, 24h, above 24h between CVVH and non-CVVH about removal on inflammatory mediators (TNF-α, IL-6), the weighted mean difference (WMD) and 95% confidence interval ( CI) were as follows: TNF-α：WMD12h ：-0.02（95％CI -0.07，0.03），P12h=0.46; WMD24h：-0.06（95％CI -0.31，0.19），P24h=0.64; WMD＞24h：-0.06（95％CI -0.14，0.01），P＞24h = 0.09；IL-6：WMD12h：3.01(95％CI -10.57，16.59)，P12h = 0.66; WMD24h：-1.26(95％CI -28.30，30.83)，P24h = 0.93; WMD＞24h ：-24.26 (95％CI -51.87，3.34)，P＞24h = 0.08。But between HVHF and CVVH, significant differences were found, to TNF-αthe WMD and 95% CI was -163.05(95% CI -227.53，-48.56)，P=0.005, and to IL-6, the WMD was -256.14(95% CI -392.68, -119.59)，P=0.0002. Conclusion The study showed that standard CVVH(=＜2L/h) was not able to eliminate inflammatory mediators effectively, HVHF(＞2L/h) significantly decreased the concentration of inflammatory mediators（TNF-α, IL-6）in plasma than standard CVVH.

Key words: High volume hemofiltration, Inflammatory mediators, Meta analysis

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