不同腹膜透析开始时机对病人预后影响的Meta分析

Different influences on the prognosis of patients with peritoneal dialysis initiation time:a Meta-analysis

目的:通过Meta分析比较不同腹膜透析(PD)开始时机对PD病人预后的影响。方法:计算机检索PubMed、the Cochrane Library、EMbase、MedLine、Web of Science、Up To Date、中国知网(CNKI)、万方(WanFang Database),以及查阅文献的参考文献,检索时间为建库到2021年3月30日。运用RevMan 5.3、Stata 12.0软件对数据进行Meta分析。结果:根据试验组为紧急开始PD组(PD开始时间≤14 d),对照组为常规开始PD组(PD开始时间>14 d)的分组方法,结合纳入和排除标准,最终符合要求的文献共10篇,涉及2552例病人。Meta分析结果显示,两组间相关感染并发症发生率、出口感染率、机械相关并发症总的发生率、导管堵塞发生率、导管移位发生率、导管渗漏发生率、1年的技术存活率差异均无统计学意义(P>0.05),而试验组腹膜炎发生率较高[OR=1.58,95%CI(1.15,2.16),P=0.004],渗漏发生率高[OR=3.02,95%CI(1.49,6.12),P=0.002],且差异有统计学意义(P<0.05)。经Begg′s test法和Egger′s test法分析,文献可能存在发表偏倚。结论:试验组相对来说较安全,腹膜炎、渗漏发生率虽比对照组高,但是1年的技术存活率方面没有差异,因此从长期来看是可以接受的。

Objective:To compare the effects of the different initiation time of peritoneal dialysis on the prognosis of peritoneal dialysis patients by Meta-analysis.Methods:The references of articles were retrieved from PubMed,the Cochrane Library,EMbase,MedLine,Web of Science,Up To Date,CNKI,and WanFang Database.The retrieval time was from the establishment of each database to March 30,2021.The Meta-analysis was performed using RevMan 5.3 statistical software and Stata12.0 software.Results:A total of 10 articles were included,including 2552 patients.According to the grouping method,the experimental group was the emergency start peritoneal dialysis group(PD start time≤14 days),and the control group was the routine start peritoneal dialysis group(PD start time>14 days).Combined with the inclusion and exclusion criteria,Meta-analysis results showed that the correlation between the two groups was the incidence of infection complications,export infection rate,mechanical or related complications,the total incidence,catheter jam,catheter displacement,pipe leakage,1-year technical survival difference has no statistical significance(P>0.05).And the incidence of peritonitis was high[OR=1.58,95%CI(1.15,2.16),P=0.004]and the leakage rate was high[OR=3.02,95%CI(1.49,6.12),P=0.002]in the experimental group.The difference was statistically significant(P<0.05).After analysis by Begg′s test method and Egger′s test method,there was no publication bias.Conclusion:Emergency peritoneal dialysis is relatively safe,the incidence of peritonitis and leakage is higher than that of the control group,but there is no difference in 1-year technical survival rate,so it is acceptable in the long term.