维持性血液透析患者发生缺血性卒中影响因素的Meta分析

Risk factors for ischemic stroke in maintenance hemodialysis patients:a meta-analysis

目的系统分析维持性血液透析(maintenance haemodialysis,MHD)患者发生缺血性卒中(ischemic stroke,IS)的影响因素。方法检索CNKI、Wanfangdata、VIP、CBM、PubMed、EMbase、The Cochrane Library、Web of science数据库的相关文献,检索时间均从建库至2023年3月。由2名研究者独立筛选文献、提取资料,并对文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇队列研究,样本量6876例,文献质量均为高质量。14项研究共发现6种危险因素,1种保护因素,IS病史和糖尿病肾病对MHD患者发生IS的影响尚无定论。Meta分析结果显示:年龄(HR=1.04,95%CI:1.03~1.06,P<0.001)、糖尿病(HR=1.88,95%CI:1.38~2.58,P<0.001)、心房颤动病史(HR=2.71,95%CI:1.73~4.27,P<0.001)、脑血管病史(HR=4.97,95%CI:3.16~7.82,P<0.001)、氨基末端脑钠肽前体(HR=4.43,95%CI:1.66~11.80,P=0.003)、血小板计数(HR=1.01,95%CI:1.00~1.02,P=0.001)、血清磷酸盐(HR=0.57,95%CI:0.44~0.74,P<0.001)是MHD患者发生IS的影响因素。结论医护人员可依据上述因素识别MHD合并IS高危人群并进行早期干预,以提高MHD患者生活质量。

Objective To systematically summarize the factors influencing the occurrence of ischemic stroke(IS)in maintenance hemodialysis(MHD)patients.Methods The relevant literature in the databases of CNKI,Wanfang data,VIP,CBM,PubMed,EMbase,The Cochrane Library,and web of science from establishment of the database to February 2023 were searched for.Two investigators independently screened the literature,extracted information,and evaluated quality of the literature.Meta-analysis was performed using the RevMan 5.3 software.Results Atotal of 14 cohort studies with a sample size of 6,876 cases were included,and the quality of the literature was high.The 14 studies identified a total of 6 risk factors and one protective factor.The effect of IS history and diabetic nephropathy on the development of IS in MHD patients was inconclusive.Meta-analysis showed that age(HR=1.040,95%CI:1.030~1.060,P<0.001),diabetes(HR=1.880,95%CI:1.380~2.580,P<0.001),history of atrial fibrillation history(HR=2.710,95%CI:1.730~4.270,P<0.001),history of cerebrovascular disease(HR=4.970,95%CI:3.160~7.820,P<0.001),NT-proBNP(HR=4.430,95%CI:1.660~11.800,P=0.003),platelet count(HR=1.010,95%CI 1.000~1.020,P=0.001),and serum phosphate(HR=0.570,95%CI:0.440~0.740,P<0.001)were the influential factors for the development of IS in MHD patients.Conclusions Healthcare professionals can identify MHD patients at risk for IS based on these factors,and then intervene earlier to improve their quality of life.