低葡萄糖降解产物的双室双袋腹透液在维持性腹膜透析患者中应用效果的Meta分析

Meta-analysis of the efficacy of two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis patients

目的 系统评价低葡萄糖降解产物的双室双袋腹透液（PDF）在腹膜透析（PD）患者中的应用效果.方法 检索Pubmed、EBMASE、Cochrane Library、万方、维普、CNKI、CBM等数据库,并手工检索相关文献,检索年限从建库至2013年12月,检索关于低葡萄糖降解产物的双室双袋PDF与传统PDF的随机对照试验,使用RevMan 5.2对入选试验进行Meta分析.结果 共纳入12篇文献,11项研究,1 059例患者.Meta分析结果显示：（1）低葡萄糖降解产物PDF组患者透出液CA125水平、残余肾功能高于传统PDF组（WMD=19.61,95％CI 12.04～ 27.18,P＜ 0.01：WMD=0.78,95％CI 0.14 ～ 1.43,P=0.02）,差异均有统计学意义;（2）两组患者24 h超滤量、血浆HCO3-、腹膜炎发生率差异均无统计学意义（均P＞0.05）;（3）4项研究报道低葡萄糖降解产物PDF组与传统PDF组PD技术生存时间差异无统计学意义（P＞0.05）.结论 低葡萄糖降解产物的双室双袋PDF安全、有效,在改善患者腹膜超滤及酸中毒方面没有特殊优势,不能减少腹膜炎的发生,但这种PDF可以保护腹膜间皮细胞功能,改善PD患者残余肾功能,且不影响患者PD技术生存时间.

Objectives To study the efficacy of the two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis （PD） patients.Methods Pubmed,EBMASE,Cochrane Library,Wanfang,VIP,CNKI,CBM and other databases were searched,at the same time the information form relevant literatures until December 2013 were searched by hand.To be eligible,studies had to be randomized controlled trials that allocated PD patients to two-compartment peritoneal dialysis fluid with low glucose degradation products （low-GPDs group） or to traditional dialysis fluid （control group）.The qualities of included articles were assessed and then a meta-analysis was conducted by using RevMan 5.2 software.Results A total of 12 documents,11 studies met the inclusion criteria,and 1 059 cases were included.Meta-analysis results were as follows：（1）the low-GPDs group had higher level of CA125 in peritoneal dialysis effluent,higher residual renal function compared with that in the control group and the weighted mean difference were 19.61 （95％CI 12.04-27.18,P ＜ 0.01） and 0.78 （0.14-1.43,P=0.02）,respectively; （2）There was no statistically significant difference between control and low-GPDs group in the ultrafiltration,peritonitis and plasma bicarbonate （all P ＞ 0.05）; （3）Four studies showed no difference in peritoneal dialysis technique survival between the two group （P ＞ 0.05）.Conclusions The two-compartment peritoneal dialysis fluid with low glucose degradation products is effective and safe,has no negative effects on the frequency of peritonitis,patient＇ s peritoneal member transport function and plasma bicarbonate,but it causes less mesothelial damage and has higher residual renal function in patients than conventional ones,and does not affect the technique survival time.