Wei Z-h, Wang H, Chen X-y, Wang B-s, Rong Z-x, Wang B-s, Su B-h, Chen H-z
Department of Pharmacology and Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Eur J Clin Nutr. 2009 Jul;63(7):821-7. doi: 10.1038/ejcn.2008.49. Epub 2008 Nov 5.
Evidences from randomized clinical trials and meta-analysis have claimed an association between the use of soluble dietary fiber from psyllium and a cholesterol-lowering effect. However, there is still uncertainty as to the dose-response relationship and its long-term lipid-lowering efficacy. This meta-analysis was primarily conducted to address the dose-response relationship between psyllium and serum cholesterol level and time-dependent effect of psyllium in mild-to-moderate hypercholesterolemic subjects.
Twenty-one studies, which enrolled a total of 1030 and 687 subjects receiving psyllium or placebo, respectively, were included in the meta-analysis. The studies were randomized placebo-controlled trials, double blinded or open label, on subjects with mild-to-moderate hypercholesterolemia. The dose of psyllium was between 3.0 and 20.4 g per day and intervention period was more than 2 weeks. Any type of diet background was permitted. Diet lead-in period was between 0 and 8 weeks.
Compared with placebo, consumption of psyllium lowered serum total cholesterol by 0.375 mmol/l (95% CI: 0.257-0.494 mmol/l), and LDL cholesterol by 0.278 mmol/l (95% CI: 0.213-0.312 mmol/l). With random-effect meta-regression, a significant dose-response relationship were found between doses (3-20.4 g/day) and total cholesterol or LDL cholesterol changes. Regression model of total cholesterol was -0.0222+0.2061 x log (dose+1), and that of LDL cholesterol was 0.0485+0.1390 x log (dose+1). There was a time effect of psyllium on total cholesterol (equation: 6.3640-0.0316 x treatment period) and on LDL cholesterol (equation: 4.3134-0.0162 x treatment period), suggesting that psyllium reduced serum total cholesterol more quickly than LDL cholesterol.
Psyllium could produce dose- and time-dependent serum cholesterol-lowering effect in mild and moderate hypercholesterolemic patients and would be useful as an adjunct to dietary therapy for the treatment of hypercholesterolemia.
随机临床试验和荟萃分析的证据表明，使用车前草中的可溶性膳食纤维与降低胆固醇的效果之间存在关联。然而，关于剂量反应关系及其长期降脂疗效仍存在不确定性。本荟萃分析主要旨在探讨车前草与血清胆固醇水平之间的剂量反应关系，以及车前草在轻度至中度高胆固醇血症患者中的时间依赖性效应。
共有21项研究纳入了本荟萃分析，其中分别有1030名和687名受试者接受了车前草或安慰剂治疗。这些研究均为针对轻度至中度高胆固醇血症患者的随机安慰剂对照试验，采用双盲或开放标签设计。车前草的剂量为每天3.0至20.4克，干预期超过2周。允许任何类型的饮食背景。饮食导入期为0至8周。
与安慰剂相比，食用车前草可使血清总胆固醇降低0.375毫摩尔/升（95%可信区间：0.257-0.494毫摩尔/升），低密度脂蛋白胆固醇降低0.278毫摩尔/升（95%可信区间：0.213-0.312毫摩尔/升）。通过随机效应荟萃回归分析，发现剂量（3-20.4克/天）与总胆固醇或低密度脂蛋白胆固醇变化之间存在显著的剂量反应关系。总胆固醇的回归模型为-0.0222+0.2061×log（剂量+1），低密度脂蛋白胆固醇的回归模型为0.0485+0.1390×log（剂量+1）。车前草对总胆固醇（方程：6.3640-0.0316×治疗期）和低密度脂蛋白胆固醇（方程：4.3134-0.0162×治疗期）有时间效应，这表明车前草降低血清总胆固醇的速度比低密度脂蛋白胆固醇更快。
车前草可在轻度和中度高胆固醇血症患者中产生剂量和时间依赖性的血清胆固醇降低效应，可作为饮食疗法治疗高胆固醇血症的辅助手段。
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