认知行为疗法对血液透析患者治疗效果的Meta分析

Efficacy of cognitive behavioral therapy on the intervention of hemodialysis patients:A meta-analysis

目的:系统评价认知行为疗法对血液透析患者治疗效果的影响。方法:计算机检索PubMed、Cochrane Library、中国知网、万方医学网和中国生物医学文献数据库中有关认知行为疗法应用于血液透析患者治疗的随机对照试验。由2名研究者独立筛选文献、提取数据并评价文献质量,应用RevMan 5.3软件进行Meta分析。结果:共纳入6篇文献,包含661例研究对象。Meta分析结果显示:认知行为疗法能减少血液透析患者营养不良的发生[OR=0.28,95%CI(0.16,0.47),P<0.001];改善患者BMI水平[MD=1.66,95%CI(0.80,2.51),P<0.001]和PA水平[MD=0.05,95%CI(0.03,0.07),P<0.001]。明显降低血清肌酐水平[MD=-54.13,95%CI(-68.28,-39.99),P<0.001]和血尿素氮水平[MD=-1.48,95%CI(-1.90,-1.05),P<0.001]。结论:认知行为疗法可以明显改善血液透析患者的营养状况和肾功能,提高治疗效果。但由于纳入文献质量一般,结论尚需要更高质量的研究进一步证明。

Objective To systematically evaluate application the treatment effect of cognitive behavioral therapy in patients with hemodialysis.Method Database such as Cochrane Library,PubMedCNKI,WANFANG MED ONLINE and SinoMed,were searched to retrieve Randomized Controlled Trials(RCT)related to cognitive behavioral therapy applied in hemodialysis patients.The Meta-analysis was conducted by RevMan 5.3 after data extraction and quality appraisal of the eligible RCTs.Results A total of 6 were included in this study,with a total of 661 subjects.The results of Meta-analysis supported the effectiveness of the cognitive behavioral therapy can reduce the incidence of malnutrition[OR=0.28,95%CI(0.16,0.47),P<0.001];To improve patients with BMI level[MD=1.66,95%CI(0.80,2.51),P<0.001]and PA levels[MD=0.05,95%CI(0.03,0.07),P<0.001];decrease the Scr level[MD=-54.13,95%CI(-68.28,-39.99),P<0.001]and BUN level[MD=-1.48,95%CI(-1.90,-1.05),P<0.001].Conclusion CBT can significantly improve the nutritional status and renal function of hemodialysis patients and improve the treatment effect.However,due to the poor quality of the included literature,the conclusion needs to be further proved by higher quality studies.