Berson Eliot L, Rosner Bernard, Sandberg Michael A, Weigel-DiFranco Carol, Moser Ann, Brockhurst Robert J, Hayes K C, Johnson Chris A, Anderson Ellen J, Gaudio Alexander R, Willett Walter C, Schaefer Ernst J
Berman-Gund Laboratory for the Study of Retinal Degenerations, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Arch Ophthalmol. 2004 Sep;122(9):1306-14. doi: 10.1001/archopht.122.9.1306.
To determine whether docosahexaenoic acid will slow the course of retinal degeneration in subgroups of patients with retinitis pigmentosa who are receiving vitamin A.
A cohort of 208 patients with retinitis pigmentosa, aged 18 to 55 years, were randomly assigned to 1200 mg of docosahexaenoic acid plus 15 000 IU/d of vitamin A given as retinyl palmitate (DHA + A group) or control fatty acid plus 15 000 IU/d of vitamin A (control + A group) and followed up over 4 years. Seventy percent of the patients in each group were taking vitamin A, 15 000 IU/d, prior to entry. We compared rates of decline in ocular function in the DHA + A vs control + A groups among the subgroups defined by use or nonuse of vitamin A prior to entry. We also determined whether decline in ocular function was related to red blood cell phosphatidylethanolamine docosahexaenoic acid level, dietary omega-3 fatty acid intake, or duration of vitamin A use. Main outcome measures were Humphrey Field Analyzer visual field sensitivity, 30-Hz electroretinogram amplitude, and visual acuity.
Among patients not taking vitamin A prior to entry, those in the DHA + A group had a slower decline in field sensitivity and electroretinogram amplitude than those in the control + A group over the first 2 years (P =.01 and P =.03, respectively); these differences were not observed in years 3 and 4 of follow-up or among patients taking vitamin A prior to entry. In the entire cohort, red blood cell phosphatidylethanolamine docosahexaenoic acid level was inversely related to rate of decline in total field sensitivity over 4 years (test for trend, P =.05). This was particularly evident over the first 2 years among those not on vitamin A prior to entry (test for trend, P =.003). In the entire control + A group, dietary omega-3 fatty acid intake was inversely related to loss of total field sensitivity over 4 years (intake, <0.20 vs > or =0.20 g/d; P =.02). The duration of vitamin A supplementation prior to entry was inversely related to rate of decline in electroretinogram amplitude (P =.008).
For patients with retinitis pigmentosa beginning vitamin A therapy, addition of docosahexaenoic acid, 1200 mg/d, slowed the course of disease for 2 years. Among patients on vitamin A for at least 2 years, a diet rich in omega-3 fatty acids (> or =0.20 g/d) slowed the decline in visual field sensitivity.
确定二十二碳六烯酸是否会减缓正在接受维生素A治疗的视网膜色素变性患者亚组的视网膜变性进程。
208例年龄在18至55岁的视网膜色素变性患者被随机分为两组，一组每天服用1200毫克二十二碳六烯酸加15000国际单位维生素A（以棕榈酸视黄酯形式给药）（DHA+A组），另一组服用对照脂肪酸加15000国际单位/天的维生素A（对照+A组），并随访4年。每组70%的患者在入组前就已每天服用15000国际单位的维生素A。我们比较了DHA+A组与对照+A组在入组前是否使用维生素A所定义的亚组中的眼功能下降率。我们还确定了眼功能下降是否与红细胞磷脂酰乙醇胺二十二碳六烯酸水平、膳食ω-3脂肪酸摄入量或维生素A使用时长有关。主要结局指标为汉弗莱视野分析仪视野敏感度、30赫兹视网膜电图振幅和视力。
在入组前未服用维生素A的患者中，DHA+A组在前两年的视野敏感度和视网膜电图振幅下降速度比对照+A组慢（分别为P = 0.01和P = 0.03）；在随访的第3年和第4年以及入组前服用维生素A的患者中未观察到这些差异。在整个队列中，红细胞磷脂酰乙醇胺二十二碳六烯酸水平与4年总视野敏感度下降率呈负相关（趋势检验，P = 0.05）。这在入组前未服用维生素A的患者的前两年中尤为明显（趋势检验，P = 0.003）。在整个对照+A组中，膳食ω-3脂肪酸摄入量与4年总视野敏感度损失呈负相关（摄入量，<0.20克/天与≥0.20克/天；P = 0.02）。入组前维生素A补充的时长与视网膜电图振幅下降率呈负相关（P = 0.008）。
对于开始维生素A治疗的视网膜色素变性患者，每天添加1200毫克二十二碳六烯酸可使疾病进程减缓2年。在服用维生素A至少2年的患者中，富含ω-3脂肪酸（≥0.20克/天）的饮食可减缓视野敏感度的下降。
