降低食盐摄入对慢性肾脏病进展影响的Meta分析

Effects of lowering sodium intake on progression of chronic kidney disease:a meta-analysis

目的探讨降低饮食盐摄入对慢性肾脏病进展的影响。方法系统检索Cochrane Central Register of Controlled Trials、MEDLINE、EMBASE英文数据库以及中国期刊全文数据库(CNKI)、万方数据知识服务平台和中国生物医学文献数据库,同时检索相关原始文献和综述文献中所附参考文献,浏览正在进行的有关研究,收集所有关于降低饮食盐摄入对慢性肾脏病进展影响的随机对照试验以及随机交叉试验。由2名评价员独立对纳入的每篇文献进行数据提取及质量评价,如有不一致则跟第三位作者协商解决。使用Rev Man 5.3软件进行Meta分析。结果共纳入13篇文献,Meta分析结果显示,限盐可引起如下变化:血压下降[收缩压:MD=-7.01,95%CI(-8.84,-5.17),P<0.001;舒张压:MD=-3.33,95%CI(-4.27,-2.38),P<0.001];尿蛋白水平大部分随之降低;GFR轻度下降[MD=-6.66,95%CI(-11.48,-1.84),P=0.010]。结论降低饮食中盐的摄入可以延缓慢性肾脏病的进展,医护人员应加强对患者的健康宣教,并给予个性化饮食指导。

Objective To explore the effects of lowering sodium intake on progression of chronic kidney disease. Methods We searched Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE in English and CNKI, Wanfang data,CBM in Chinese. We also searched bibliographies of relevant papers and the ongoing researches in order to identify appropriate articles. We included all randomized controlled trials and randomized crossover trials of salt reduction in individuals with chronic kidney disease. Two authors independently appraised studies and any disagreement was solved by discussion with the third author. RevMan 5.3 software was used for meta-analysis. Results Thirteen articles were recruited. The meta-ana]ysis results showed that salt restriction would lead to ： ①lowered blood pressure[systolic blood pressure：MD=-7.01,95%Cl（-8.84,-5.17）,P〈0.001;diastolic blood pressure：MD=-3.33,95% CI （ -4.27, -2.38 ）, P〈0.001 ] ; ②diminished proteinuria ; ③reduced GFR [MD=-6.66,95%CI（-11.48, -1.84） ,P=0.010 ]. Conclusion Lowering sodium intake is able to decelerate progression of renal disease.