临床肾替代治疗安全性和有效性的系统评价

目的：评价肾替代治疗的安全性和有效性。设计：Cochrane系统评价。研究的检索：检索Medline（1983—2003／1）、Embase药理学分册1984—2003／1、CBMA1983—2002、Cochrane数据库2002／4，通过机检和手检获取相关文献。纳入标准：比较肾移植与血液透析，肾移植与腹膜透析研究，包括随机对照试验（RCF）、半随机对照试验、临床对照试验（CCT）、前瞻性队列研究。资料提取和统计方法：两名评价人员独立提取资料。文献质量评价原则参照Cochrane非随机对照研究方法学小组http//www.cochrane.dk/nrsmg/,应用设计好的表格进行数据提取，数据运用ReMan4．11软件进行统计分析。结果：12篇文献符合纳入标准。1篇前瞻性研究，其余为回顾性纵向研究，失安全数计算表明，无明显发表偏倚。与透析治疗比较，肾移植远期死亡风险较小，RR合并=0．38（95％可信区间0．33—0．447。在糖尿病和老年人中肾移植也有优势。结论：目前资料显示肾移植是安全性更好的肾脏替代治疗选择，由于研究设计的质量还不太高，要评价ESRD患者从肾移植中的确切获益尚需设计严格的前瞻性研究进一步明确。

A Systematic Evaluation of the Clinical Safty and Effectiveness of Renal Replacement Therapy J

Objective:To evaluate the effectiveness and safety of renal replacement therapy by meta analysis.Method:Searching data base which included Medline,Embase,Cochrane library and CBMA,identifing data of safety and effectiveness on comparison of kidney transplantation with dialysis.Assess the quality of the collected data according to Cochrane methodology group of nonrandomized studies,entering the data into Review Manager 4.11.Results:There were 12 studies about safety and effectiveness of renal replacement therapy which met the inclusion criteria.Meta analysis showed that the combined RR and 95% CI of the relative mortality risk of renal transplantation versus dialysis were 0.38 and 0.33-0.44.Conclusion:Kidney transplantation is the best alternative modality in the treatments of ESRD.However,the evidence was too weak to evaluate the accurate benefits of kidney transplantation and rigorously designed,prospective trials were needed.