血红蛋白靶目标值对慢性肾脏病患者生存影响的荟萃分析

A meta-analysis of hemoglobin target for anemia of patients with chronic kidney disease

目的探讨血红蛋白（Hb）水平对慢性肾脏病（CKD）患者生存时间的影响，为明确CKD患者最佳Hb靶目标值提供参考依据。方法采用荟萃分析的方法，利用Medline、Embase和Cochrane数据库检索国内外公开发表的有关Hb水平对CKD患者生存影响的临床试验，通过Cochrane协作网提供的Revman软件对检索结果进行荟萃分析。结果纳入本次荟萃分析的文献共23篇，随访样本总量10204例。综合分析后发现，与低Hb（Hb〈100g／L）水平组患者相比，维持高Hb（Hb〉127g／L）水平可增加患者死亡及发生高血压、中风及住院治疗的风险，相对危险度（RR）值分别为1．10、1．40、1．73和1．07，两组比较差异均有统计学意义（P〈0．05）。但两组非致命性心肌梗死（RR：1．13，95％C10．79～1．62）及肾脏替代治疗（RR=1．00，95％C10．85-1．18）的发生率差异均无统计学意义。结论在纠正CKD患者贫血过程中，维持低Hb水平可以降低患者发生高血压、中风、入院治疗和死亡的风险，但不能改善心肌梗死发生及肾脏替代治疗的风险。

Objective To explore the role of hemoglobin （Hb） level in mortality and morbidity of chronic kidney disease （CKD） patients, aiming to give some evidence f6r therapy of anemia. Methods Randomized, clinical trials （RCTs） were identified by searching Medline, Embase and the Cochrane library. All the analyses were performed using the Revman software available free from the Cochrane collaboration. Results Twenty-three trials involving 10 204 patients were identified. Overall, the high Hb target was associated with increased risk of all-cause mortality （RR=1.10, 95% CI 1.00 to 1.21）, hypertension （RR=1.40, 95% CI 1.12 to 1.75）, stroke and hospitalization （RR=1.07, 95% CI 1.00 to 1.14） compared with low Hb target （P〈 0.05）. No significant difference was found in the risks of non-fatal mycardial infarction （RR=1.13, 95% CI 0.79 to 1.62） and renal replacement therapy （RR =1.00, 95% CI 0.85 to 1.18）. Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension, hospitalization, stroke and all-cause mortality. However, no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.