接受维持性血液透析患者中肺动脉高压的患病率及相关因素：一项系统评价与荟萃分析。
完整摘要 · 中文译文
背景：维持性血液透析（MHD）是终末期肾病（ESKD）的主要治疗方法。长期接受MHD的患者常发生心血管并发症，据报道肺动脉高压（PH）患病率高达47%。由于样本量小且研究结果不一致，MHD患者中PH的相关因素仍不明确。 目的：评估MHD患者中PH的患病率及相关因素。 方法：我们系统检索了PubMed、Web of Science、CINAHL、Cochrane Library、Embase、CNKI、CBM、万方和维普数据库中关于MHD患者PH危险因素的文献（从建库至2026年4月20日）。两名评价者独立筛选和提取数据。使用Stata 18.0进行数据合成。 结果：共纳入39项研究，包括6，633名受试者，其中男性3，930名，女性2，703名。合并PH患病率为37%（95% CI：0.32-0.42）。多个因素与PH显著相关（P < 0.05）。显著相关因素包括年龄≥60岁（OR = 1.03，95% CI：1.02-1.05）、血管通路方式（OR = 7.84，95% CI：4.98-12.33）、hs-CRP ≥ 6.0 mg/L（OR = 3.57，95% CI：2.41-5.30）、透析间期体重增长（连续变量：OR = 18.39；二分类：OR = 20.51）、浆膜腔积液（OR = 3.03，95% CI：1.84-4.97）、NT-proBNP升高（OR = 1.07，95% CI：1.02-1.12）、BNP升高（OR = 1.77，95% CI：1.06-2.97）、E/A（OR = 3.00，95% CI：1.89-4.75）、LAD增大（OR = 1.17，95% CI：1.09-1.25）、LVEDD增大（OR = 1.11，95% CI：1.05-1.17）、LVPWTd增加（OR = 1.72，95% CI：1.31-2.26）、en 左心房内径增大（OR = 1.17，95% CI：1.12-1.22）及瓣膜反流（OR = 3.83，95% CI：2.39-6.13）。左心室射血分数（LVEF）降低（OR = 0.92，95% CI：0.87-0.97）与肺动脉高压（PH）呈负相关。 结论：维持性血液透析（MHD）患者中肺动脉高压患病率高，受多种因素影响，需加强临床警惕。管理应侧重于高危患者的早期识别、强化容量管理、炎症控制及心脏监测。该策略对于降低肺动脉高压风险、改善心血管预后至关重要。 系统综述注册号：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378052。
完整摘要 · 英文原文
BACKGROUND: Maintenance hemodialysis (MHD) is a primary treatment for end-stage kidney disease (ESKD). Patients on long-term MHD frequently develop cardiovascular complications, with pulmonary hypertension (PH) prevalence reported as high as 47%. Due to small sample sizes and inconsistent findings, associated factors for PH in MHD patients remain unclear. OBJECTIVE: To evaluate the prevalence and associated factors of PH in MHD patients. METHODS: We systematically searched literature on PH risk factors in MHD patients across PubMed, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, CBM, Wanfang, and VIP (inception to April 20, 2026). Two reviewers independently screened and extracted data. Data were synthesized using Stata 18.0. RESULTS: Thirty-nine studies comprising 6,633 subjects were included, of whom 3,930 were males and 2,703 were females. The pooled PH prevalence was 37% (95% CI: 0.32-0.42). Multiple factors were significantly associated with PH (P < 0.05). Significant associated factors included age ≥ 60 years (OR = 1.03, 95% CI: 1.02-1.05), vascular access modalities (OR = 7.84, 95% CI: 4.98-12.33), hs-CRP ≥ 6.0 mg/L (OR = 3.57, 95% CI: 2.41-5.30), interdialytic weight gain (continuous: OR = 18.39; binary classification: OR = 20.51), serous cavity effusion (OR = 3.03, 95% CI: 1.84-4.97), elevated NT-proBNP (OR = 1.07, 95% CI: 1.02-1.12), BNP increased (OR = 1.77, 95% CI: 1.06-2.97), E/A (OR = 3.00, 95% CI: 1.89-4.75), enlarged LAD (OR = 1.17, 95% CI: 1.09-1.25), enlarged LVEDD (OR = 1.11, 95% CI: 1.05-1.17), Increased LVPWTd (OR = 1.72, 95% CI: 1.31-2.26), enlarged RAD (OR = 1.17, 95% CI: 1.12-1.22), and valvular regurgitation (OR = 3.83, 95% CI: 2.39-6.13). Reduced LVEF (OR = 0.92, 95% CI: 0.87-0.97) was inversely associated with PH. CONCLUSION: The high PH prevalence in MHD patients, influenced by diverse factors, calls for enhanced clinical vigilance. Management should focus on early identification of high-risk patients, strengthened volume management, inflammation control, and cardiac monitoring. This approach is essential to lower PH risk and improve cardiovascular prognosis. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378052.