【摘要】目的系统评价终末期肾病(end stage renal disease，ESRD)患者不同肾脏替代治疗方式对认知功能的影响。方法计算机检索中国生物医学文献数据库、中国知网、维普数据库、PubMed、Medline、Embase、Cinahl、Cochrane library、PsycARTICLES 中已发表的不同肾脏替代治疗方式对ESRD 患者的认知功能影响的主题相关的中、英文文献，包括横断面研究、病例对照研究、队列研究。检索时限均为建库至2018 年3 月31 日。由2 名研究员独立筛选文献、提取资料、评价纳入研究的偏倚风险并进行交叉核对后，采用RevMan 5.3 软件进行Meta 分析。结果共纳入研究文献18篇，累计样本量1787例。Meta分析结果显示：①血液透析患者认知功能评分低于腹膜透析患者(SMD=-0.660，95% CI -1.020～-0.290, P＜0.001)；②血液透析患者认知功能评分低于肾移植患者(SMD=-1.510，95% CI -2.990～-0.030,P=0.050)；③腹膜透析患者认知功能评分比肾移植患者的认知功能评分低(SMD =-2.160，95% CI -4.220～-0.090，P=0.040)。结论不同肾脏替代治疗方式的ESRD 患者认知功能存在差异，肾移植患者认知功能评分优于血液透析和腹膜透析患者，腹膜透析患者优于血液透析患者。

【Abstract】Objective To assess the effect of different renal replacement therapy on cognitive function in patients with end-stage renal disease (ESRD). Methods We searched the databases of CBM, CNKI, VIP, PubMed, Medline, Embase, Cinahl and PsycARTICLES from inception to March 31, 2018 for English and Chinese literature including cross-sectional studies, cohort studies and case-control studies that studied the effect of different renal replacement therapy on cognitive function in ESRD patients. Literature screening, data extraction and bias assessment of all eligible studies were conducted independently by two reviewers. Metaanalysis was conducted by using the RevMan 5.3 software. Results A total of 18 studies which included 1, 787 participants were analyzed. Meta-analysis showed that ①the cognitive function score of hemodialysis patients was lower than that of peritoneal dialysis patients (SMD=-0.660, 95% CI -1.020~-0.290, P＜0.001); ② the cognitive function score of hemodialysis patients was lower than that of renal transplantation patients (SMD=-1.510, 95% CI -2.990~-0.030, P=0.050); and ③the cognitive function score of peritoneal dialysis patients was lower than that of renal transplantation patients (SMD=-2.160, 95% CI -4.220~-0.090, P=0.040). Conclusion Our results suggested that the cognitive function was different in ESRD patients treated by different renal replacement therapy. Cognitive function score of renal transplantation patients was greater than that of hemodialysis and peritoneal dialysis patients, and the score of peritoneal dialysis patients was greater than that of hemodialysis patients.