补充n-3长链多不饱和脂肪酸对尿蛋白排泄和肾功能的影响：临床试验的荟萃分析
The effect of n-3 long-chain polyunsaturated fatty acid supplementation on urine protein excretion and kidney function: meta-analysis of clinical trials.
作者信息
Miller Edgar R, Juraschek Stephen P, Appel Lawrence J, Madala Madhavi, Anderson Cheryl A M, Bleys Joachim, Guallar Eliseo
机构信息
Johns Hopkins School of Medicine, the Johns Hopkins Bloomberg School of Public Health, and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
出版信息
Am J Clin Nutr. 2009 Jun;89(6):1937-45. doi: 10.3945/ajcn.2008.26867. Epub 2009 Apr 29.
BACKGROUND
Chronic kidney disease is a major worldwide problem. Although epidemiologic and experimental studies suggest that n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation may prevent or slow the progression of kidney disease, evidence from clinical trials is inconsistent.
OBJECTIVE
The objective was to combine evidence from controlled clinical trials to assess the effect of n-3 LCPUFA supplementation on the change in urine protein excretion (UPE) and on glomerular filtration rate (GFR).
DESIGN
We performed a meta-analysis of clinical trials that tested the effect of n-3 LCPUFA supplementation on UPE, a marker of kidney damage, and on GFR, a marker of kidney function. A random-effects model was used to pool SD effect size (Cohen's d) across studies.
RESULTS
Seventeen trials with 626 participants were included in the meta-analysis. Most trials focused on patients with a single underlying diagnosis: IgA nephropathy (n = 5), diabetes (n = 7), or lupus nephritis (n = 1). The dose of n-3 LCPUFAs ranged from 0.7 to 5.1 g/d, and the median follow-up was 9 mo. In the pooled analysis, there was a greater reduction in UPE in the n-3 LCPUFA group than in the control group: Cohen's d for all trials was -0.19 (95% CI: -0.34, -0.04; P = 0.01). In a patient with 1 g UPE/d , this corresponds to a reduction of 190 mg/d. Effects on GFR were reported in 12 trials. The decline in GFR was slower in the n-3 LCPUFA group than in the control group, but this effect was not significant (0.11; 95% CI: -0.07, 0.29; P = 0.24).
CONCLUSIONS
In our meta-analysis, use of n-3 LCPUFA supplements reduced UPE but not the decline in GFR. However, small numbers of participants in trials, different methods of assessing proteinuria and GFR, and inconsistent data reporting limit the strength of these conclusions. Large, high-quality trials with clinical outcomes are warranted.
背景
慢性肾脏病是一个全球性的重大问题。尽管流行病学和实验研究表明，补充n-3长链多不饱和脂肪酸（n-3 LCPUFA）可能预防或减缓肾脏疾病的进展，但临床试验的证据并不一致。
目的
综合来自对照临床试验的证据，评估补充n-3 LCPUFA对尿蛋白排泄量（UPE）变化及肾小球滤过率（GFR）的影响。
设计
我们对测试补充n-3 LCPUFA对UPE（肾脏损伤标志物）和GFR（肾功能标志物）影响的临床试验进行了荟萃分析。采用随机效应模型汇总各研究的标准化效应量（科恩d值）。
结果
荟萃分析纳入了17项试验，共626名参与者。大多数试验聚焦于单一潜在诊断的患者：IgA肾病（n = 5）、糖尿病（n = 7）或狼疮性肾炎（n = 1）。n-3 LCPUFA的剂量范围为0.7至5.1 g/天，中位随访时间为9个月。在汇总分析中，n-3 LCPUFA组的UPE降低幅度大于对照组：所有试验的科恩d值为-0.19（95% CI：-0.34，-0.04；P = 0.01）。对于每日尿蛋白排泄量为1 g的患者，这相当于每日减少190 mg。12项试验报告了对GFR的影响。n-3 LCPUFA组的GFR下降速度比对照组慢，但这种影响不显著（0.11；95% CI：-0.07，0.29；P = 0.24）。
结论
在我们的荟萃分析中，使用n-3 LCPUFA补充剂可降低UPE，但不能减缓GFR的下降。然而，试验参与者数量较少、评估蛋白尿和GFR的方法不同以及数据报告不一致，限制了这些结论的力度。有必要开展大型、高质量的临床结局试验。
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