天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (6): 684-689.doi: 10.11958/j.issn.0253-9896.2015.06.029

• 循证医学 • 上一篇    下一篇

血液灌流和血液透析滤过对甲状旁腺素清除效果的 Meta 分析

王喆， 魏芳， 陈海燕， 姜埃利   

  1. 天津医科大学第二医院血液净化科

  • 收稿日期:2014-08-29 修回日期:2014-12-08 出版日期:2015-06-15 发布日期:2015-06-10
  • 通讯作者: 王喆 E-mail:cmu_wz@hotmail.com

Meta analysis on effect of parathyroid hormone elimination through hemoperfusion and#br# hemodiafiltration

WANG Zhe, WEI Fang, CHEN Haiyan, JIANG Aili   

  1. Department of Blood Purification,The Second Hospital of Tianjin Medical University

  • Received:2014-08-29 Revised:2014-12-08 Published:2015-06-15 Online:2015-06-10
  • Contact: zhe Wang E-mail:cmu_wz@hotmail.com

PDF (PC)

3849

摘要： 目的 评价血液灌流和血液透析滤过对维持性血液透析患者甲状旁腺素（PTH）的清除效果， 指导临床选择最佳治疗方案。方法 计算机检索 MEDLINE（1966—2013.8）、 Embase(1974—2013.8)、 中文万方数据库 （1996—2013.8）、 CNKI（1979—2013.8）、 Cochrane 图书馆临床对照试验资料库。手工检索已发表或未发表的相关文献， 包括会议摘要等。纳入血液灌流和血液透析滤过对维持性血液透析患者 PTH 清除作用的随机对照试验。由 2 名评价员独立对纳入的文献进行质量评价和数据提取， 用 RevMan 5.2 软件进行 Meta 分析。结果 共纳入 12 项随机对照试验， 共计 400 例患者， Meta 分析结果显示血液灌流 （HP） 与血液透析滤过 （HDF） 比较， 在降低 PTH 疗效方面差异无统计学意义（WMD=-0.34， 95%CI： -12.66～11.98， P=0.96）， 降低β2 微球蛋白（β2-MG）的疗效方面差异无统计学意义（WMD=-2.92， 95%CI： -16.64～10.8， P=0.68）。HP 对患者皮肤瘙痒的缓解率高于 HDF（RR=1.33， 95%CI： 1.08～1.62， P=0.006）。结论 HP 和 HDF 均可降低终末期肾病维持性血液透析患者 PTH 的水平， 两者疗效无明显差异。

关键词: 甲状旁腺素, 肾透析, 血液滤过, Meta 分析, 终末期肾病

Abstract: Objective To assess the effect of hemoperfusion (HP) and hemodiafiltration (HDF) on elimination of parathyroid hormone (PTH) from plasma in long- term hemodialysis patients.Methods MEDLINE (1966—2013.8), Embase(1974—2013.8), Chinese Wanfang database (1996—2013.8） ,CNKI（1979—2013.8） and the clinical control test database of Cochrane Library were searched． Published reports, unpublished studies and abstract from conference were retrieved manually, all of which include studies of effect of PTH elimination through hemoperfusion and hemodiafiltration. Quality assessment and data mining were conducted by two independent investigators who performed meta-analysis using RevMan 5.2. Results A total of 12 reports (400 patients) met the inclusion criteria and were included in this study. The meta-analysis showed that the elimination rate of PTH in long term hemodialysis patients was similar between using hemoperfusion and using hemodiafiltration（WMD=-0.34， 95%CI： -12.66-11.98， P=0.96） . What’ s more the elimination rate of β2-MG were also similar（WMD=-2.92， 95%CI： -16.64-10.8， P=0.68）between those two treatments. However， The remission rate of pruritus
was higher in patients using HP group than in HDF group(RR=1.33， 95%CI： 1.08-1.62， P=0.006). Conclusion HP and HDF can effectively clear PTH in chronic hemodialysis patients, but there was no statistically different between the two treatment methods.

Key words: parathyroid hormone, renal dialysis, hemofiltration, Meta-analysis, end-stage renal disease