慢性肾脏病患者味觉改变的Meta分析和系统性评价

A meta-analysis and systematic review of taste alteration in adult patients with chronic kidney disease

目的 Meta分析慢性肾脏病患者味觉改变的发生风险,整合味觉改变的发生率。方法 计算机检索中国知网、万方数据库、Pubmed、Embase和Web of science数据库,搜集有关慢性肾脏病患者味觉改变的研究,检索时限均从建库至2023年1月31日。由2位研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 17.0软件进行Meta分析。结果 共纳入13个研究,包括4090例患者。Meta分析结果发现慢性肾脏病患者味觉改变较非疾病暴露人群发生风险高(OR=6.262,95%CI:1.556~25.197),总发生率为29.6%(ES=0.296,95%CI:0.209~0.390)。eGFR<20 ml/(min·1.73m2)的患者味觉改变发生率为33.5%(ES=0.335,95%CI:0.285~0.386),高于eGFR≥20 ml/(min·1.73m2)的患者(20.0%,ES=0.200,95%CI:0.047~0.353)。使用客观测评工具的味觉改变筛查结果为43.3%(ES=0.433,95%CI:-0.058~0.923),高于使用主观测评工具(27.9%,ES=0.279,95%CI:0.189~0.368)。发展中国家报道CKD患者味觉改变发生率为46.4%(ES=0.464,95%CI:0.125~0.802),高于发达国家报道的结果(23.6%,ES=0.236,95%CI:0.148~0.324)。汇总文献结果发现年龄、性别、营养相关血生化标志物以及胃肠消化道症状与味觉改变有关。结论 慢性肾脏病患者发生味觉改变的风险高,且随疾病进展报告率增加,不同经济水平国家间报告差异明显。味觉改变的发生影响进食、营养、消化等,结合主客观测评工具开展临床评估,尤其关注高龄、女性和潜在营养不良人群,可为早期识别味觉改变和开展干预提供帮助。

Objective A meta-analysis was performed to analyze the risk of taste alteration and to integrate the prevalence of taste alteration in chronic kidney disease(CKD)patients.Methods CNKI,Wanfang Database,PubMed,Embase,and Web of Science were searched from the date of database establishment to January 31,2023 to collect the studies on taste changes in CKD patients.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias of the included studies.Stata 17.0 software was used for the meta-analysis.Results A total of 13 studies were included,including 4,090 patients.The results of meta-analysis showed that the risk odds ratio of CKD patient with taste alteration was 6.262(95%CI 1.556~25.197),and the overall prevalence of taste alteration in CKD patients was 29.6%(ES=0.296,95%CI 0.209~0.390).The incidence of taste alteration was 33.5%(ES=0.335,95%CI 0.285~0.386)in patients with eGFR<20ml/min/1.73m2,and was 20.0%(ES=0.200,95%CI 0.047~0.353)in patients with eGFR≥20ml/min/1.73m2.The incidence of taste alteration was 43.3%(ES=0.433,95%CI-0.058~0.923)screening by objective assessment tools,and was 27.9%(ES=0.279,95%CI 0.189~0.368)screening by subjective assessment tools.The incidence of taste alteration was 46.4%(ES=0.464,95%CI 0.125~0.802)reported in developing countries,and was 23.6%(ES=0.236,95%CI 0.148~0.324)reported in developed countries.Integration of the literature showed that age,sex,nutrition-related blood biochemical markers and gastrointestinal symptoms were related to taste alteration.Conclusion CKD patients have a high risk of taste alteration.The reported rate increases with disease progression,and is significant different among countries with different economic levels.The taste alteration affects eating,nutrition,digestion,and others.Clinical evaluation of the taste changes should be carried out by combining subjective and objective assessment tools,especially focusing on the elderly,women and potentially malnourished people,to early identify and intervene the taste changes.