Biotechnology Research Center, Mashhad University of Medical Sciences, Iran.
Atherosclerosis. 2013 Sep;230(1):110-20. doi: 10.1016/j.atherosclerosis.2013.06.026. Epub 2013 Jul 12.
Several lines of evidence have indicated the insulin-sensitizing, anti-diabetic and anti-atherosclerotic properties of adiponectin, as well as the inverse association between circulating levels of this adipokine and development of cardiovascular outcomes. Improvement of adiponectin status has been reported as a pleiotropic effect of fibrate therapy, but the findings have not been conclusive.
To systematically review and meta-analyze available evidence from randomized placebo-controlled trials (RCTs) on the impact of fibrate therapy on circulating levels of adiponectin.
A comprehensive literature search in Medline was carried out to identify RCTs comparing the effect of fibrate therapy vs. placebo on circulating concentrations of adiponectin. A meta-analysis of eligible studies was performed using a random-effects model. Quality assessment, sensitivity analysis and publication bias evaluations were conducted using standard methods.
Twelve RCTs comprising 443 cases and 437 controls met the selection criteria for systematic review, out of which 9 RCTs (399 cases and 401 controls) were included in the meta-analysis. Quantitative data synthesis revealed a significant effect for fibrate therapy in increasing circulating adiponectin levels (weighed mean difference: 0.38 μg/mL; 95% confidence interval: 0.13-0.63 μg/mL; p = 0.003). The effect size remained statistically significant when restricting the analysis to fenofibrate trials [0.31 (0.21-0.42) μg/mL; p < 0.00001). The observed effect was robust in sensitivity analyses and independent of fibrate dose. Imputation for potential missing studies led to the estimation of a greater effect size for fibrate therapy [0.53 (0.24-0.82) μg/mL].
The present meta-analysis suggests that fibrate therapy increases circulating levels of adiponectin. Whether increase in adiponectin levels contributes to reduction of cardiovascular effects in subjects with dyslipidemia treated with fibrates merits further investigation.
有多项证据表明脂联素具有胰岛素增敏、抗糖尿病和抗动脉粥样硬化作用，以及这种脂肪因子循环水平与心血管结局发展之间呈负相关。已有报道称贝特类药物治疗可改善脂联素状态，这是其多效性作用，但研究结果尚不一致。
系统评价和荟萃分析随机安慰剂对照试验（RCT）中贝特类药物治疗对脂联素循环水平影响的现有证据。
在 Medline 上进行全面的文献检索，以确定比较贝特类药物治疗与安慰剂对脂联素循环浓度影响的 RCT。使用随机效应模型对合格研究进行荟萃分析。使用标准方法进行质量评估、敏感性分析和发表偏倚评估。
12 项 RCT 共纳入 443 例患者和 437 例对照，符合系统评价的选择标准，其中 9 项 RCT（399 例患者和 401 例对照）纳入荟萃分析。定量数据分析显示，贝特类药物治疗可显著增加脂联素循环水平（加权均数差：0.38 μg/mL；95%置信区间：0.13-0.63 μg/mL；p = 0.003）。当将分析仅限于非诺贝特试验时，该效果大小仍具有统计学意义[0.31（0.21-0.42）μg/mL；p < 0.00001]。敏感性分析和独立于贝特剂量的分析表明，观察到的效果是稳健的。对潜在缺失研究进行插补估计，贝特类药物治疗的效果更大[0.53（0.24-0.82）μg/mL]。
本荟萃分析表明贝特类药物治疗可增加脂联素循环水平。脂联素水平升高是否有助于降低接受贝特类药物治疗的血脂异常患者的心血管作用，值得进一步研究。
