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目的:总结中性p H、低葡萄糖降解产物(GDP)腹膜透析液(Np HLGDPPDF)在腹膜透析(PD)中的随机对照研究(RCT),采用Meta分析评价Np HLGDPPDF对PD患者临床预后的影响。方法:在Medline、EMBASE及Cochrane图书馆内进行相关的检索。按照纳入/排除标准对纳入研究进行资料提取、方法学质量评价后,采用Rev Man 5.2和Stata12.0软件进行Meta分析。结果:16项研究共计1 546例患者入选Meta分析,结果显示,与传统PDF相比,Np HLGDPPDF维持高水平的尿量(WMD 131 ml,95%CI 64~197);随访时间延长,有延缓肾小球滤过率(GFR)下降的趋势(12月、18月及>24月的SMD分别为-0.01 ml/min、0.12 ml/min、0.21 ml/min);未能降低PD患者全因死亡率、技术失败率;有降低腹膜炎发生的趋势(RR 0.84,95%CI 0.67~1.05)。Meta回归分析显示,随着样本数的增大,Np HLGDPPDF组的腹膜炎发生率下降(β=-0.006,P=0.01);亚组分析显示,亚裔患者(RR0.67,95%CI 0.50~0.90)及联合使用血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(RR 0.57,95%CI 0.33~0.99)可降低腹膜炎发生率。结论:Np HLGDPPDF能维持高水平尿量,但未能延缓GFR下降和改善临床预后。
OBJECTIVE: To summarize the randomized control study (RCT) of neutral p H and GDP peritoneal dialysis fluid (PDG) in peritoneal dialysis (PD) and evaluate the effect of Np HLGDPPDF on the clinical prognosis of PD patients by Meta-analysis . Methods: The related searches were performed in Medline, EMBASE and the Cochrane Library. Meta-analysis was performed using Rev Man 5.2 and Stata12.0 software after data extraction and methodological quality evaluation were included in the inclusion / exclusion criteria. RESULTS: A total of 1646 studies were enrolled in the meta-analysis of 1 546 patients. Np HLGDPPDF maintained high levels of urine output (WMD 131 ml, 95% CI 64-197) compared to conventional PDF; delayed follow-up Glomerular filtration rate (GFR) decreased (-0.01 ml / min, 0.12 ml / min, 0.21 ml / min on December, 18 and 24 months respectively) Mortality, technical failure rate; there is a trend to reduce peritonitis (RR 0.84, 95% CI 0.67 ~ 1.05). Meta-regression analysis showed that as the number of samples increased, the incidence of peritonitis in the Np HLGDPPDF group decreased (β = -0.006, P = 0.01). In the subgroup analysis, Asian patients (RR 0.67, 95% CI 0.50 ~ 0.90) and the combination of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RR 0.57, 95% CI 0.33 to 0.99) reduced the incidence of peritonitis. Conclusion: Np HLGDPPDF can maintain a high level of urine output, but failed to delay the decline of GFR and improve clinical prognosis.