维持性血液透析患者并发脑卒中危险因素的Meta分析

Meta-analysis of risk factors for stroke in patients with maintenance hemodialysis

目的 系统评价维持性血液透析(maintenance hemodialysis, MHD)患者并发脑卒中的危险因素。方法 计算机检索中国知网(CNKI)、维普(VIP)、万方、CMB、The Cochrane Library、Web of science、PubMed和Embase中关于MHD患者并发脑卒中的危险因素的研究,采用RevMan 5.4软件进行meta分析。检索时限为建库至2022年5月31日。结果 最终共纳入27篇文献,总样本量为12 247例。meta分析结果显示:糖尿病[OR=2.52,95%CI(1.95,3.27),P<0.001]、年龄[OR=1.15,95%CI(1.08,1.21),P<0.001]、高血压[OR=2.15,95%CI(1.61,2.88),P<0.001]、血脂异常[OR=1.88,95%CI(1.43,2.46),P<0.001]、透析前收缩压升高[OR=1.16,95%CI(1.07,1.25),P<0.001]、透析龄[OR=1.67,95%CI(1.18,2.35),P=0.004]、透析前舒张压升高[OR=1.23,95%CI(1.06,1.43),P=0.007]、心房颤动[OR=2.17,95%CI(1.83,2.58),P<0.001]、冠心病[OR=7.38,95%CI(4.22,12.91),P<0.001]、透后氨基末端脑钠肽前体升高[OR=3.88,95%CI(1.60,9.40),P=0.030]、同型半胱氨酸Hcy≥15μmol/L [OR=3.10,95%CI(1.62,5.92),P<0.001]、既往脑血管事件[OR=3.22,95%CI(1.26,8.26),P=0.010]是MHD患者并发脑卒中的危险因素。结论 MHD患者并发脑卒中的危险因素较多,医护人员应熟知脑卒中的危险因素及预防措施,尽早给予个体化的干预手段,以降低透析患者脑卒中发生风险。

Objective To systematically evaluate the risk factors of stroke in maintenance hemodialysis(MHD)patients.Methods Researches on the risk factors of stroke in MHD patientswere searched by computer in CNKI,VIP,Wanfang,CMB,The Cochrane Library,Web of Science,PubMed,and Embase databases,and meta-analysis was performed using RevMan 5.4 software,and the search period was from the establishment of the database up to May 31,2022.Results A total of 27 literatures were finally included,with the sample size of 12,247 cases.The results of meta-analysis showed that diabetes mellitus(OR=2.52,95%CI was 1.95-3.27,P<0.05),age(OR=1.15,95%CI was 1.08-1.21,P<0.05),hypertension(OR=2.15,95%CI was 1.61-2.88,P<0.05),dyslipidemia(OR=1.88,95%CI was 1.43-2.46,P<0.05),increased systolic blood pressure before dialysis(OR=1.16,95%CI was 1.07-1.25,P<0.05),age of dialysis(OR=1.67,95%CI was 1.18-2.35,P<0.05),increased diastolic blood pressure before dialysis(OR=1.23,95%CI was 1.06-1.43,P<0.05),atrial fibrillation(OR=2.17,95%CI was 1.83-2.58,P<0.05),coronary heart disease(OR=7.38,95%CI was 4.22-12.91,P<0.05),amino terminal brain natriuretic peptide precursors increased after transdialysis(OR=3.88,95%CI was 1.60-9.40,P<0.05),homocysteine Hcy≥15μmol/L(OR=3.10,95%CI was 1.62-5.92,P<0.05),and previous cerebrovascular events(OR=3.22,95%CI was 1.26-8.26,P<0.05)were risk factors for stroke in MHD patients.Conclusion There are many risk factors for stroke in MHD patients,and medical staff should be familiar with the risk factors and preventive measures of stroke,and give individualized intervention as soon as possible to reduce the risk of stroke in dialysis patients.