维持性血液透析患者消化道出血影响因素的Meta分析

Factors for gastrointestinal bleeding in maintenance hemodialysis patients:a meta-analysis

目的 系统评价维持性血液透析患者消化道出血的危险因素,为早期识别并提供针对性干预提供参考。方法 计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中关于维持性血液透析患者消化道出血的危险因素相关研究,检索时间为建库到2022年10月,采用Rev Man 5.3软件进行Meta分析。结果 共纳入16篇文献,154 234例患者。Meta分析结果显示:年龄(HR=1.209,95%CI:1.010~1.044,P=0.002)、性别(HR=1.210,95%CI:1.063~1.377,P=0.004)、饮酒(OR=4.272,95%CI:1.243~14.679,P=0.020)、刺激性饮食(OR=4.052,95%CI:2.485~6.606,P=0.030)、钙(MD=-0.241,95%CI:-0.315~-0.168,P<0.001)、血小板计数(MD=2.342,95%CI:0.140~4.544,P=0.040)、凝血酶原时间(MD=0.704,95%CI:0.060~1.348,P=0.030)、血浆白蛋白(MD=-3.842,95%CI:-6.361~-1.323,P=0.003)、血红蛋白(MD=-13.484,95%CI:-16.496~-10.471,P<0.001)、血肌酐(MD=85.194,95%CI:22.716~147.671,P=0.008)、血尿素氮(MD=4.540,95%CI:0.426~8.653,P=0.030)、糖尿病(HR=1.395,95%CI:1.257~1.548,P<0.001)、肝硬化(HR=1.763,95%CI:1.561~1.991,P<0.001)、幽门螺杆菌(OR=4.938,95%CI:3.139~7.768,P<0.001)、非甾体抗炎药(HR=1.855,95%CI:1.628~2.113,P<0.001)、每周透析时间(MD=-1.876,95%CI:-2.312~-1.440,P<0.001)是MHD患者消化道出血的影响因素。结论 临床医护人员可依据上述因素识别MHD患者消化道出血高危人群并采取干预措施,以减少消化道出血的发生,提高其医疗质量,降低医疗成本,优化医疗资源。

Objective To systematically evaluate the factors for gastrointestinal bleeding in maintenance hemodialysis(MHD)patients and provide a reference for early identification and intervention.Methods A systematic search of databases,including PubMed,Embase,Web of Science,Cochrane Library,CNKI,WanFang,VIP and CBM,was carried out to collect the risk factors for gastrointestinal bleeding in MHD patients until October 2022.Meta-analysis was performed by Revman5.3 software.Results A total of 16 articles with 154,234 patients were included.Meta-analysis showed that age(HR=1.209,95%CI:1.010~1.044,P=0.002),gender(HR=1.210,95%CI:1.063~1.377,P=0.004),alcohol consumption(OR=4.272,95%CI:1.243~14.679,P=0.020),stimulating diet(OR=4.052,95%CI:2.485~6.606,P=0.030),calcium(MD=-0.241,95%CI:-0.315~-0.168,P<0.001),platelet count(MD=2.342,95%CI:0.140~4.544,P=0.040),prothrombin time(MD=0.704,95%CI:0.060~1.348,P=0.030),plasma albumin(MD=-3.842,95%CI:-6.361~-1.323,P=0.003),hemoglobin(MD=-13.484,95%CI:-16.496~-10.471,P<0.001),blood creatinine(MD=85.194,95%CI:22.716~147.671,P=0.008),blood urea nitrogen(MD=4.540,95%CI:0.426~8.653,P=0.030),diabetes mellitus(HR=1.395,95%CI:1.257~1.548,P<0.001),liver cirrhosis(HR=1.763,95%CI:1.561~1.991,P<0.001),helicobacter pylori infection(OR=4.938,95%CI:3.139~7.768,P<0.001),use of non-steroidal anti-inflammatory drugs(HR=1.855,95%CI:1.628~2.113,P<0.001),and weekly dialysis time(MD=-1.876,95%CI:-2.312~-1.440,P<0.001)were the influencing factors for gastrointestinal bleeding in MHD patients.Conclusion According to the above factors,medical staff can identify the high-risk groups of gastrointestinal bleeding in MHD patients and take intervention measures to reduce the occurrence of gastrointestinal bleeding,improve their medical services,reduce medical costs,and optimize medical resources.