慢性肾脏病3~5期营养干预现状证据图分析

Evaluating nutritional interventions of chronic kidney disease stage 3-5 using evidence mapping methodology

目的 慢性肾脏病(chronic kidney disease, CKD)3~5期患者蛋白质能量消耗发生率远高于CKD1~2期患者。营养干预作为一种非药物治疗,有效改善CKD3~5期患者的蛋白质能量消耗情况,成为近年研究的热点。方法 构建证据图,以系统梳理目前CKD营养干预的临床研究文献,了解该领域证据分布情况,寻找营养干预,探究CKD3~5期营养干预研究趋势。检索Pubmed、Cochrane、Embase、中国知网、维普、万方、Clinicaltrials、Chictr及其参考文献数据库,时限由建库至2020年4月。纳入CKD营养干预临床研究与系统评价。采用文字描述结合图表分析的方法,展示证据的分布特征。结果 共纳入文献773篇,从年度发表趋势、地区分布、研究类型、临床研究规模和结果等方面进行分析。结论 (1)CKD3~5期营养干预临床研究数量整体呈增长趋势,主要以中美为主;(2)CKD3~5期营养干预方式以单一营养素干预为主,占比达98%,少量研究涉及饮食结构干预;(3)就疗效指标的选择而言,酮酸辅助蛋白饮食研究的疗效指标有43个,需要进行研究时间更长、规模更大的研究进一步统一疗效评价指标;限制钠饮食干预的疗效指标涉及血压、肾功能、依从性等,临床研究质量有待商榷,需要进一步规范,以提供更可靠的研究证据;饮食结构干预的疗效指标涉及肾功能、血压、营养状况等;(4)饮食结构干预的研究可能是未来的研究方向。

Objective To systematically summarize the trends of clinical trials of CKD stage 3-5 nutritional interventions through evidence mapping.Methods From the inception of database until April 2020,clinical trials and systemic reviews related to CKD stage 3-5 nutrition interventions were retrieved from such databases as CNKI,Wangfang, VIP,PubMed, Cochrane, Embase, Clinicaltrials and Chictr.The distribution of evidence was examined by texted description, tables and graphs.Results A total of 773 literatures were examined by annual trend of publication, regional distribution, trial type, scale of clinical trial and outcomes.Conclusions Quantity of CKD stage 3-5 related researches on nutritional interventions showed a growing trend in both China and the United States.Type of nutritional interventions for CKD stage 3-5 was dominated by single-nutrient intervention(98%)and a few studies involved dietary structural interventions.For selecting efficacy parameters, ketoacid-assisted protein dietary intervention had 43 efficacy parameters.Longer and larger studies are required for further standardizing efficacy evaluations.Efficacy parameters of sodium restriction dietary intervention involved blood pressure, renal function and compliance, etc.The quality of clinical studies remained to be improved.Further standardization is necessary to provide more reliable evidence.Efficacy parameters of dietary structural interventions include renal function, blood pressure and nutritional status, etc.Dietary structure intervention shall be the direction of future research.