我国维持性血液透析患者疲乏发生率的Meta分析

The prevalence of fatigue in maintenance hemodialysis in China： a Meta-analysis

目的系统研究中国维持性血液透析患者疲乏发生状况和分布特征。方法计算机检索PubMed、The Cochrane Library、Embase、Web of Science、中国期刊全文数据库、中国生物医学文献、万方数据库等公开发表的关于中国血液透析患者疲乏发生率的横断面研究。根据文献纳入和排除标准提取资料，并进行质量评价，采用Statal4．0软件进行单个样本率的Meta分析。结果共纳入19个横断面研究，维持性血液透析患者病例数为3171例，发生疲乏症状的患者2253例。Meta分析显示，总疲乏发生率为72．1％（95％CI63．6％-80．6％）。轻度疲乏发生率为15．8％（95％CI7．0％-24．7％），中度疲乏发生率为43．6％（95％CI40．1％～47．1％），重度疲乏发生率为19．8％（95％CI12．0％～27．6％）。亚组分析显示女性疲乏发生率高于男性。应用Piper疲乏量表检出的疲乏发生率最高，为80．8％。应用健康调查简表SF-36活力维度检出的疲乏发生率最低，为46．8％。中西部地区疲乏发生率高于东部地区，经济负担越重，越易发生疲乏。在透析龄6～10年人群中疲乏发生率较在透析龄≤5年及透析龄〉10年人群中低。敏感性分析显示，合并效应结果具有较好的稳定性和可靠性。结论我国维持性血液透析患者疲乏发生率高，应引起医务人员的高度重视。维持性血液透析患者疲乏症状在不同量表、区域、性别、透析年限、经济负担方面的发生率存在差异。

Objective To evaluate the prevalence and distribution characteristics of fatigue in maintaining hemodialysis in China. Methods Literature search was conducted to collect cross-sectional studies on the prevalence of fatigue in maintenance hemodialysis in PubMed,The Cochrane Library, Embase, Web of Science,China National Knowledge Internet,China Biology Medicine and Wan Fang Data. The studies were selected according to the exclusion and inclusive criteria and the qualities of studies were evaluated. Meta-analysis was performed with software of Stata 14.0. Results A total of 19 studies, including a total size of 3 171 and 2 253 patients of fatigue,were eligible for inclusion in the review.The prevalence of fatigue by analyzing the effect size was 72.1% （95% CI 63.6%-80.6%）,the prevalence of mild to moderate fatigue by analyzing the effect size was 15.8%（95% CI 7.0%-24.7%）, 43.6%（95% CI 40.1%-47.1%） and the prevalence of severe fatigue was 19.8%（95% CI 12.0%-27.6%）.Subgroup analyses indicated that the fatigue rate of female maintenance hemodialysis was higher than male,the prevalence level estimated by the Piper Fatigue revised scale was higher than other tools（80.8%）,the prevalence level estimated by the Vitality Subscale of the SF-36 （SF-36 VS）, Short-Form Health Survey was lower than other tools（46.8%）.The fatigue rate in the central and western areas were higher than that of the eastern region.The harder the economic was,the higher the prevalence of fatigue was.The prevalence of fatigue in the population dialysis aged 6 to 10 years was lower than that in dialysis age ≤5 and dialysis age〉10 years. Sensitivity analysis showed that the pooled effect size had good stability and reliability. ConclusionS The prevalence of fatigue in maintenance hemodialysis in China is high,which suggest that we should pay more attention to this situation.There are differences in the prevalence of fatigue in maintenance hemodialysis patients on different scales, areas, sex, dialysis years, and economic.