高通量血液透析对维持性血透患者预后的meta分析

目的 采用meta分析评价高通量血液透析（HFHD）对维持性血透（MHD）患者临床预后的影响。方法 检索国内外发表的关于HFHD对比低通量血液透析（LFHD）随机对照试验（RCT）和临床对照试验（CCT）研究，并经过严格的方法学质量评价，meta综合后，系统评价HFHD对MHD患者的生存率、心脑血管死因病死率等指标对预后的影响。结果 共纳入8篇相关研究，其中3篇为高质量RCT，5篇为CCT。经meta综合，共计5 015例患者入选。结果显示：HFHD组相对于LFHD组病死率差异无统计学意义（RR=0.85, 95%CI：0.71~1.01，P=0.06）。3项RCT经meta分析后显示HFHD可以降低心血管疾病病死率（RR=0.83, 95%CI：0.71~0.98，P=0.03）。2项RCT使用相同单位描述β2微球蛋白（β2-MG）清除情况，经meta分析后显示HDHF具有更好的β2-MG清除率（MD=-10.89, 95%CI：-14.89~6.97，P〈0.000 1）。结论 HFHD虽然能提高β2-MG的清除率及降低心血管死亡率，但是并不能降低MHD患者的病死率。HFHD对血清白蛋白较低的患者以及糖尿病肾病患者可能有较好的远期效果。

Meta-analysis of high flux hemodialysis for prognosis of maintenance hemodialysis patients

Objective To assess the effect of high flux hemodialysis （HFHD） on the clinical prognosis of maintenance hemodialysis （MHD） patients by the meta analysis. Methods Published studies on the comparisons of HFHD and low-flux hemodialysis （LFHD） of randomized controlled trials （RCTs） and clinical controlled trials （CCTs） were retrieved, strictly evaluated by the methodological quality, and analyzed by the mata-synthesis. The effects of HFHD on the survival rate, cardiovascular mortality, and causes of mortality of MHD patients were systematically evaluated. Results A total of 8 studies （3 RCTs and 5 CCTs） were included and 5 015 patients were selected after being analyzed by the mata-synthesis. Results of meta-analysis showed that the difference of mortality of the HFHD group and LFHD group was not statistically significant （RR=0.85, 95%CI：0.71-1.01, P=0.06）. Three RCTs showed that HFHD significantly reduced the cardiovascular mortality （RR=0.83, 95%CI：0.71-0.98, P=0.03）. Two RCTs that used the same unit for describing the clearance of β2-microglobulin （β2-MG） indicated that HFHD had a better clearance rate of β2-MG （MD=-10.89, 95%CI： -14.89-6.97, P〈0.000 1）. Conclusion HFHD can improve the clearance rate of β2-MG and reduce the cardiovascular mortality but can not reduce the mortality of MHD patients. HFHD may have good long-term effect for MHD patients with low serum albumin or diabetic nephropathy.