摘要
目的 系统评价延展性血液透析(expanded hemodialysis,HDx)在血液透析(hemodialysis,HD)患者中的有效性和安全性。方法 检索从建库至2022年9月Pubmed、Embase、Cochrane Library、Web of science、CNKI、万方及维普数据库,搜集报道HDx在HD患者中进行前瞻性干预的临床研究。依据Cochrane协作网的风险偏倚评估对纳入文献进行质量评价,使用RevMan 5.3软件进行Meta分析。结果共纳入20篇文献,846例患者;按照HD模式,分为HDx组、HD组和血液透析滤过(hemodiafiltration,HDF)组。HDx组Kt/V值高于HD组(MD=0.052,95%CI:0.012~0.092,P=0.012),与HDF组比较无统计学差异(MD=-0.012,95%CI:-0.118~0.094,P=0.828);HDx组对β2微球蛋白(β2microglobulin,β2-MG)的清除高于HD组(MD=6.542,95%CI:3.411~9.672,P<0.001),低于HDF组(MD=-3.733,95%CI:-5.262~-2.203,P<0.001);HDx组对人免疫球蛋白κ自由轻链(human immunoglobulinκfree light chain,κFLC)及人免疫球蛋白λ自由轻链(human immunoglobulinλfree light chain,λFLC)的清除高于HD组(κFLC:MD=15.793,95%CI:9.912~21.674,P<0.001;λFLC:MD=22.412,95%CI:18.282~26.542,P<0.001),与HDF组相当(κFLC:MD=-2.224,95%CI:-5.408~0.961,P=0.171;λFLC:MD=0.417,95%CI:-7.945~8.779,P=0.922);HDx组血清白蛋白(albumin,ALB)丢失多于HD组,与HDF组比较无差异(HD:MD=2.010,95%CI:1.327~2.692,P <0.001;HDF:MD=0.050,95%CI:-1.626~1.726,P=0.953);HDx组不良事件的发生与HD及HDF组比较均无差异(HD:MD=0.624,95%CI:0.365~1.066,P=0.084;HDF:MD=0.860,95%CI:0.726~1.020,P=0.141)。结论 HDx可增加中、大分子尿毒症毒素的清除,对血管通路不理想者是优选。
Objective To systematically evaluate the efficacy and safety of expanded hemodialysis(HDx)in hemodialysis(HD)patients.Methods Pubmed,Embase,Cochrane Library,Web of science,CNKI,Wanfang and VIP databases were searched from the establishment of the database to September 2022 for clinical and prospective studies on HDx intervention in HD patients.The quality of the included literature was evaluated according to the risk bias assessment of the Cochrane Collaboration Network.Meta-analysis was performed using RevMan5.3 software.Results Twenty trials including 846 HD patients were enrolled for the analyses.They were divided into HDx group,HD group and hemodiafiltration(HDF)group.The Kt/V value in HDx group was significantly higher than that in HD group(MD=0.052,95%CI:0.012~0.092,P=0.012),but there was no significant difference between HDx group and HDF group(MD=-0.012,95%CI:-0.118~0.094,P=0.828).The clearance rate ofβ2 microglobulin(β2-MG)in HDx group was significantly higher than that in HD group(MD=6.542,95%CI:3.411~9.672,P<0.001),and was lower than that in HDF group(MD=-3.733,95%CI:-5.262~-2.203,P<0.001).The clearance of human immunoglobulinκfree light chain(κFLC)and human immunoglobulinλfree light chain(λFLC)in HDx group was significantly higher than that in HD group(κFLC:MD=15.793,95%CI:9.912~21.647,P<0.001;λFLC:MD=22.412,95%CI:18.282~26.542,P<0.001),but was similar to that in HDF group(κFLC:MD=-2.224,95%CI:-5.408~0.961,P=0.171;λFLC:MD=0.417,95%CI:-7.945~8.779,P=0.922).Serum albumin(ALB)loss in HDx group was higher than that in HD group,and there was no difference between HDX group and HDF group(HD:MD=2.010,95%CI:1.327~2.692,P<0.001;HDF:MD=0.050,95%CI:-1.626~1.726,P=0.953).The incidence of adverse events showed no significant difference between the HDx group and both the HD and HDF groups(HD:MD=0.624,95%CI:0.365~1.066,P=0.084;HDF:MD=0.860,95%CI:0.726~1.020,P=0.141).Conclusion HDx increased the clearance of medium and large molecular weight uremia toxins,and is preferable for patients with unsatisfactory vascular access.
作者
丁红赟
姜安雅
颜华仙
周祖莲
DING Hongyun;JIANG An-ya;YAN Hua-xian;ZHOU Zu-lian(Department of Nephrology,Qianjiang Central Hospital of Chongqing,Qianjiang 409000,China)
出处
《中国血液净化》
CSCD
2024年第3期170-176,共7页
Chinese Journal of Blood Purification
关键词
延展性血液透析
血液透析
血液透析滤过
终末期肾病
中截留膜
Expanded hemodialysis
Hemodialysis
Hemodialysis filtration
End-stage renal disease
Medium interception membrane
