Gharekhani Afshin, Khatami Mohammad-Reza, Dashti-Khavidaki Simin, Razeghi Effat, Abdollahi Alireza, Hashemi-Nazari Seyed-Saeed, Mansournia Mohammad-Ali
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Ren Nutr. 2014 May;24(3):177-85. doi: 10.1053/j.jrn.2014.01.014. Epub 2014 Mar 7.
The objective was to determine the effects of omega-3 supplementation on nutritional state and inflammatory markers of hemodialysis patients.
This was a randomized, placebo-controlled trial. Adult patients undergoing maintenance hemodialysis were included. Patients with malignancy, pregnancy, concurrent inflammatory or infectious diseases, or concomitant use of any medication affecting inflammation status were excluded. The omega-3 group received 6 soft-gel capsules of fish oil (180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each) daily for 4 months, and the placebo group received corresponding paraffin oil capsules.Nutrition indices including body mass index; mid-arm muscle circumference; serum concentrations of albumin, prealbumin, and transferrin; and serum levels of inflammatory/anti-inflammatory markers including interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, C-reactive protein, ferritin, parathyroid hormone, and ratios of IL-10 to TNF-α and IL-10 to IL-6 were measured before and after 4 months of intervention.
Twenty patients in the placebo and 25 patients in the omega-3 group completed the study. There were no significant changes in nutritional markers between the omega-3 and placebo groups after 4 months of intervention. Regression analysis adjusting post-treatment values of nutrition markers for baseline values, omega-3 treatment, and patients' baseline demographic and clinical data revealed that omega-3 treatment was a significant independent predictor of increased serum prealbumin level (182.53; 95% confidence interval 21.14, 511.18; P = .11). Although slight reduction of inflammatory state was observed in the omega-3 group, no significant differences were evident in the mean changes of inflammatory and anti-inflammatory markers between the 2 groups with the exception of serum ferritin level and the IL-10 to IL-6 ratio, which significantly changed in favor of omega-3 supplementation (P < .001 and P = .003, respectively).
Omega-3 supplementation in hemodialysis patients produced a slight attenuation in systemic inflammation without any remarkable effects on nutritional markers.
本研究旨在确定补充ω-3对血液透析患者营养状况和炎症标志物的影响。
这是一项随机、安慰剂对照试验。纳入接受维持性血液透析的成年患者。排除患有恶性肿瘤、妊娠、并发炎症或感染性疾病，或同时使用任何影响炎症状态药物的患者。ω-3组患者每天服用6粒鱼油软胶囊（每粒含180毫克二十碳五烯酸和120毫克二十二碳六烯酸），持续4个月，安慰剂组服用相应的石蜡油胶囊。在干预4个月前后测量营养指标，包括体重指数、上臂中部肌肉周长、血清白蛋白、前白蛋白和转铁蛋白浓度，以及炎症/抗炎标志物的血清水平，包括白细胞介素（IL）-6、IL-10、肿瘤坏死因子（TNF）-α、C反应蛋白、铁蛋白、甲状旁腺激素，以及IL-10与TNF-α的比值和IL-10与IL-6的比值。
安慰剂组20例患者和ω-3组25例患者完成了研究。干预4个月后，ω-3组和安慰剂组的营养标志物无显著变化。对营养标志物的治疗后值进行基线值、ω-3治疗以及患者基线人口统计学和临床数据调整的回归分析显示，ω-3治疗是血清前白蛋白水平升高的显著独立预测因素（182.53；95%置信区间21.14，511.18；P = 0.11）。虽然ω-3组的炎症状态略有降低，但除血清铁蛋白水平和IL-10与IL-6的比值外，两组炎症和抗炎标志物的平均变化无明显差异，ω-3补充剂组这两项指标有显著变化（分别为P < 0.001和P = 0.003）。
血液透析患者补充ω-3可使全身炎症略有减轻，但对营养标志物无明显影响。
