Lijuan Zhao, Zixian Yu, Xiayin Li, Jin Zhao, Yunlong Qin, Meilan Zhou, Ming Bai, Guoshuang Xu, Shiren Sun
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引用次数: 0
摘要
背景：本网络荟萃分析（NMA）旨在比较四种常用腹膜透析导管（PDC）的临床优势，包括天鹅颈段带直头（Swan neck + S）、Tenckhoff段带直头（Tenckhoff + S）、天鹅颈段带螺旋头（Swan neck + C）和Tenckhoff段带螺旋头（Tenckhoff + C）：从 PubMed、Embase、Cochrane 临床试验注册中心、中国国家知识基础设施（CNKI）和 ChinaInfo 中检索了从开始到 2022 年 7 月 31 日的随机临床试验。使用Stata 14.0和RevMan 5.3.5软件进行了元分析，以评估四种常用的PDCs：结果：共纳入 17 项研究，涉及 1578 名参与者。NMA显示，与天鹅颈+C相比，天鹅颈+S可显著减少导管尖端移位（OR 0.47 95% CI 0.22-0.99）。Tenckhoff + S 在减少导管功能障碍（OR 0.42，95% CI 0.23-0.79）、导管尖端移位与功能障碍（OR 0.19，95% CI 0.05-0.78）和导管移除（OR 0.56，95% CI 0.34-0.93）方面更为有效，这与成对荟萃分析结果一致。根据累积排名曲线的表面积，在减少导管尖端移位方面，Swan neck + S 是最好的 PDC（83.3%），其次是 Tenckhoff + S（79.4%）。此外，Tenckhoff + S（86.5%，76.3%）和 Swan neck + S（72.3%，86.9%）在 1 年和 2 年技术存活率方面排名第一和第二，明显高于其他两种 PDC：我们的 NMA 显示，在降低机械功能障碍和延长技术存活期方面，Swan neck + S 和 Tenckhoff + S 比 Swan neck + C 和 Tenckhoff + C 更有效，这可能有助于做出更好的临床决策。为了获得更可信的证据，需要更多规模更大、质量更高的随机对照试验。
Comparison of different peritoneal dialysis catheters on complication and catheter survival: A network meta-analysis of randomised controlled trials.
Background: This network meta-analysis (NMA) aimed to compare the clinical advantage of four commonly used peritoneal dialysis catheters (PDCs) including the Swan neck segment with straight tip (Swan neck + S), Tenckhoff segment with straight tip (Tenckhoff + S), Swan neck segment with coiled tip (Swan neck + C) and Tenckhoff segment with coiled tip (Tenckhoff + C).
Methods: Randomised clinical trials were searched from PubMed, Embase, the Cochrane Register of clinical trials, China National Knowledge Infrastructure (CNKI) and ChinaInfo from their inception until July 31, 2022. Meta-analysis was performed using Stata 14.0 and RevMan 5.3.5 software to evaluate the four commonly used PDCs.
Results: Seventeen studies involved 1578 participants were included. NMA showed that compared with Swan neck + C, Swan neck + S significantly reduced catheter tip migration (OR 0.47 95% CI 0.22-0.99). Tenckhoff + S was more effective in reducing catheter dysfunction (OR 0.42, 95% CI 0.23-0.79), catheter tip migration with dysfunction (OR 0.19, 95% CI 0.05-0.78) and catheter removal (OR 0.56, 95% CI 0.34-0.93) which were consistent with the pairwise meta-analysis. According to the surface under the cumulative ranking curve, Swan neck + S emerged as the best PDC in the reduction of catheter tip migration (83.3%), followed by Tenckhoff + S (79.4%). Moreover, Tenckhoff + S (86.5%, 76.3%) and Swan neck + S (72.3, 86.9%) ranked as the first and second PDC for 1 and 2-year technique survival which was significantly higher than those of the other two PDCs.
Conclusion: Our NMA showed Swan neck + S and Tenckhoff + S tended to be more efficacious than Swan neck + C and Tenckhoff + C in lowering the mechanical dysfunction and prolonging the technique survival, which may contribute to better clinical decisions. More randomised controlled trials with larger scales and higher quality are needed in order to obtain more credible evidence.
期刊介绍：
Peritoneal Dialysis International (PDI) is an international publication dedicated to peritoneal dialysis. PDI welcomes original contributions dealing with all aspects of peritoneal dialysis from scientists working in the peritoneal dialysis field around the world.
Peritoneal Dialysis International is included in Index Medicus and indexed in Current Contents/Clinical Practice, the Science Citation Index, and Excerpta Medica (Nephrology/Urology Core Journal). It is also abstracted and indexed in Chemical Abstracts (CA), as well as being indexed in Embase as a priority journal.
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