摘要
目的采用荟萃分析的方法探讨不同水平BMI对血液透析患者全因死亡率的影响。方法以“hemodialvsis／haemodialysis”和“obese／bodymassindex／overweight”和“mortality／survival／reverseepidemiology／obesityparadox”为关键词，检索1966--2012年PubMed、Embase、ScienceDirect、Wiley、Scopus和Ovid数据库的临床研究文献。2位评价者独立评价每个研究的质量并且对其提取数据。结果4个观察性研究共计81423例患者纳入本研究，入选研究没有异质性（I2=0％，P=0．45）。与BMI非升高组相比，BMI升高组（BMI≥25kg／m2）有较低水平的全因死亡率（OR0．67，95％CI 0．65～0．68）。校正相关风险因素后的研究结果仍显示高水平BMI能较好地改善血液透析患者生存率（校正后HR0．94，95％CI 0．92～0．96）。结论血液透析患者BMI水平与全因死亡率呈负相关，提示高水平BMI对血液透析患者具有保护作用，血流动力学状态、细胞因子和神经内分泌因子的变化以及营养状态等因素可能是其保护作用的潜在机制，但还需多中心随机对照研究的进一步证实。
[ Objective To explore the relationship between the different body mass index （BMI） ranges and all cause mortality in hemodialysis （ HD ） patients. Methods Eligible studies assessing the effects of BMI ranges on all-cause mortality （published from 1966 to 2012） were searched, using ＂hemodialysis/haemodialysis＂ and ＂ obese/body mass index/overweight＂ and ＂ mortality/survival/reverse epidemiology/obesity paradox＂ in PubMed, Embase, ScieneeDireet, Wiley, Seopus and Ovid. Inclusion criteria were that trials reported mortality in HD patients according to the traditional WHO/NIH BMI classification, and BMI levels were acceptable within 2 kg/m2. The quality of the trials was evaluated using the assessing risk of bias in studies included in Cochrane reviews. The mortality rate in HD patients was the prima＇y endpoint of the study. Results With no significant heterogeneity （ I2 = 0% , P = 0.45 ）, a fixed- effects model was used for analysis. Four studies with a total of 81 423 patients met final inclusion criteria. Compared to individuals with non-elevated BMI levels, the elevated group （BMI≥25 kg/m2） was associated with lower all-cause mortality （ OR 0. 67, 95% CI 0. 65-0. 68 ）. In a risk-adjusted sensitivity analysis, elevated BMI levels remained protective against mortality （ adjusted HR 0. 94, 95% CI 0. 92-0. 96 ）. Conclusions High BMI levels are associated with lower all-cause mortality rate in HD patients. More stable hemodynamie status, eytokine and neurohormonal alternations, and nutritional status maybe contribute to the protective effects of BMI on the mortality of HD patients. There is a need for more prospective studies to elucidate underlying mechanisms.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第9期702-707,共6页
Chinese Journal of Internal Medicine
