目的 系统评价高通量血液透析与血液透析滤过对维持性血液透析患者毒素清除、钙代谢的影响.方法 计算机检索2000年1月—2017年12月收录在同方、万方、维普、Cochrane图书馆临床对照试验中心注册库、OVID、Pubmed、Medline、EBSCO、EMBASE、SpringerLink、Science Direct等数据库中关于高通量血液透析和血液透析滤过治疗维持性血液透析患者的临床对照研究, 用RevMan5.3软件对符合标准的临床试验数据进行分析.结果 共纳入10个临床试验 (患者1403例) , 其中7篇为随机对照试验.高通量血液透析患者703例, 血液透析滤过治疗患者700例.研究结果显示两种治疗方式对患者Kt/V、血肌酐、血钙、甲状旁腺激素的影响差异无统计学意义.高通量血液透析组和血液透析滤过组在尿素氮上差异有统计学意义, 血液透析滤过组优于高通量血液透析组.对血β2微球蛋白的清除上, 高通量血液透析也要弱于血液透析滤过.结论 血液透析滤过在尿素和血β2微球蛋白清除上要优于高通量血液透析, 在对其他物质的清除差异无统计学意义.%Objective A systematic review to evaluate the influence of high-flux hemodialysis (HFHD) and hemodiafiltration (HDF) on toxin clearance and calcium metabolism of maintenance hemodialysis patients. Methods CNKI、Wanfang data、VIP、Cochrane Central Register of Controlled Trials of The Cochrane Library、OVID、Pubmed、Medline、EBSCO、EMBASE、Springer Link、Science Direct were searched for all the clinical controlled trials about the influence of HFHD and HDF on maintenance hemodialysis patients published from January 2000 to December 2017. Revman 5.3 software were used to analyze the data. Results 10 controlled trials (1403 patients) were included, in which seven studies were randomized controlled trials (RCT) . 703 patients treated with HFHD and 700 patients treated with HDF were included. The meta-analysis found that there were no significant differences in Kt/V, serum creatinine, calcium and parathyroid hormone (PTH) between the two methods. As for urea nitrogen, HDF group were significantly better than HFHD group.As for theβ2microglobulin level, HDF group were significantly better than HFHD group. Conclusion High-flux hemodialysis was superior to hemodiafiltration in the clearance of urea andβ2microglobulin and there was no significant difference in the clearance of other substances.
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