高截止（HCO）膜片是否比高通量（HF）膜片更有效，用于需要肾脏替代治疗（RRT）的患者仍然存在争议。本系统综述的目的是研究HCO膜片在清除炎症相关介质、β2-微球蛋白和尿素；白蛋白损失和全因死亡率方面的功效。我们在PubMed、Embase、Web of Science、the Cochrane Library和中国国家知识基础设施中搜索了所有相关研究，没有语言或出版年限制。两名评审人员独立使用预先确定的抽取仪器选择研究并提取数据。仅包括随机对照试验（RCT）。采用固定效应或随机效应模型获得标准化平均差异（SMD）或加权平均差异（WMD）和风险比（RR）的汇总估计值。进行敏感性分析和亚组分析以确定异质性的来源。本系统综述包括710名参与者的19项RCT。与HF膜片相比，HCO膜片在降低白细胞介素-6（IL-6）的血浆水平方面更有效（SMD -0.25，95％置信区间（CI）-0.48至-0.01，P = 0.04，I2 = 63.8％）。然而，在肿瘤坏死因子-α（TNF-α）（SMD 0.03，95％ CI -0.27至0.33，P = 0.84，I2 = 4.3％）、IL-10（SMD 0.22，95％ CI -0.12至0.55，P = 0.21，I2 = 0.0％）或尿素（WMD -0.27，95％ CI -2.77至2.23，P = 0.83，I2 = 19.6％）的清除方面没有差异。此外，治疗HCO膜片可以观察到β2-微球蛋白的更高降解率（WMD 14.8，95％ CI 3.78至25.82，P = 0.01，I2 = 88.3％）和白蛋白更明显的丢失（WMD -0.25，95％ CI -0.35至-0.16，P <0.01，I2 = 40.8％）。对于全因死亡率，两组之间没有差异（RR 1.10，95％ CI 0.87至1.40，P = 0.43，I2 = 0.0％）。与HF膜片相比，HCO膜片可能对清除IL-6和β2-微球蛋白具有额外的益处，但对TNF-α、IL-10和尿素没有影响。 HCO膜片的白蛋白损失更加严重。 HCO膜片与HF膜片之间的全因死亡率没有差异。需要更多的大型高质量RCT来加强HCO膜片的效果。版权所有© 2023中国医师协会，由 Wolters Kluwer，Inc.依据CC-BY-NC-ND许可证生产。

Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The aim of this systematic review was to investigate the efficacy of HCO membranes regarding the clearance of inflammation-related mediators, β2-microglobulin and urea; albumin loss; and all-cause mortality in patients requiring RRT.We searched all relevant studies on PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, with no language or publication year restrictions. Two reviewers independently selected studies and extracted data using a prespecified extraction instrument. Only randomized controlled trials (RCTs) were included. Summary estimates of standardized mean differences (SMDs) or weighted mean differences (WMDs) and risk ratios (RRs) were obtained by fixed-effects or random-effects models. Sensitivity analyses and subgroup analyses were performed to determine the source of heterogeneity.Nineteen RCTs involving 710 participants were included in this systematic review. Compared with HF membranes, HCO membranes were more effective in reducing the plasma level of interleukin-6 (IL-6) (SMD -0.25, 95% confidence interval (CI) -0.48 to -0.01, P  = 0.04, I2 = 63.8%); however, no difference was observed in the clearance of tumor necrosis factor-α (TNF-α) (SMD 0.03, 95% CI -0.27 to 0.33, P = 0.84, I2 = 4.3%), IL-10 (SMD 0.22, 95% CI -0.12 to 0.55, P = 0.21, I2 = 0.0%), or urea (WMD -0.27, 95% CI -2.77 to 2.23, P = 0.83, I2 = 19.6%). In addition, a more significant reduction ratio of β2-microglobulin (WMD 14.8, 95% CI 3.78 to 25.82, P = 0.01, I2 = 88.3%) and a more obvious loss of albumin (WMD -0.25, 95% CI -0.35 to -0.16, P < 0.01, I2 = 40.8%) could be observed with the treatment of HCO membranes. For all-cause mortality, there was no difference between the two groups (RR 1.10, 95% CI 0.87 to 1.40, P = 0.43, I2 = 0.0%).Compared with HF membranes, HCO membranes might have additional benefits on the clearance of IL-6 and β2-microglobulin but not on TNF-α, IL-10, and urea. Albumin loss is more serious with the treatment of HCO membranes. There was no difference in all-cause mortality between HCO and HF membranes. Further larger high-quality RCTs are needed to strengthen the effects of HCO membranes.Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.