血液透析患者补充鱼油、维生素B和维生素E与心血管结局及死亡率的关联：一项综述
Associations of fish oil and vitamin B and E supplementation with cardiovascular outcomes and mortality in people receiving haemodialysis: a review.
作者信息
Bessell Erica, Jose Matthew D, McKercher Charlotte
机构信息
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, 7000, Australia.
School of Medicine, University of Tasmania, Hobart, Tasmania, 7000, Australia.
出版信息
BMC Nephrol. 2015 Aug 18;16:143. doi: 10.1186/s12882-015-0142-1.
BACKGROUND
Cardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease. Research indicates that the Mediterranean diet is protective of cardiovascular disease in the general population. Components of this diet have been trialled in haemodialysis patients with the aim of reducing the risk of cardiovascular disease and improving associated risk factors. Components include fish, fruit and vegetables in the form of fish oil supplements and vitamin and antioxidant supplements. This narrative review provides an overview of observational studies, and interventional and randomised controlled trials examining the association of these supplements with cardiovascular outcomes in haemodialysis patients.
METHODS
We reviewed the relevant literature by searching English-language publications in Web of Science and references from relevant articles published since 1992. Eight-seven abstracts were reviewed and 38 relevant articles were included.
RESULTS
The extant literature suggests that risk of mortality is reduced in patients with a higher fish intake and those with higher serum omega-3 fatty acid levels. However, the pathways by which risk of mortality is reduced have not been fully extrapolated. While only a few studies have examined the effect of vitamin B supplementation in haemodialysis patients, these studies suggest that supplementation alone does not reduce the risk of mortality. Finally, studies examining vitamin E supplementation have drawn inconsistent conclusions regarding its pro-oxidant or antioxidant effects. Differences between studies are likely due to methodological variations in regards to dose, route of administration and treatment duration.
CONCLUSIONS
Nutritional and dietary supplementation in haemodialysis patients is an area which requires larger, more methodologically robust randomised controlled trials to determine if risk of cardiovascular outcomes can be improved.
背景
心血管并发症是终末期肾病患者死亡的主要原因。研究表明，地中海饮食对普通人群的心血管疾病具有保护作用。该饮食的组成成分已在血液透析患者中进行试验，目的是降低心血管疾病风险并改善相关危险因素。这些成分包括以鱼油补充剂、维生素和抗氧化剂补充剂形式存在的鱼类、水果和蔬菜。本叙述性综述概述了观察性研究以及干预性和随机对照试验，这些研究探讨了这些补充剂与血液透析患者心血管结局之间的关联。
方法
我们通过检索科学网中的英文出版物以及1992年以来发表的相关文章的参考文献来回顾相关文献。共审查了87篇摘要，纳入了38篇相关文章。
结果
现有文献表明，鱼类摄入量较高和血清ω-3脂肪酸水平较高的患者死亡率降低。然而，死亡率降低的途径尚未完全推断出来。虽然只有少数研究考察了补充维生素B对血液透析患者的影响，但这些研究表明单独补充并不能降低死亡风险。最后，关于补充维生素E的研究在其促氧化或抗氧化作用方面得出了不一致的结论。研究之间的差异可能是由于剂量、给药途径和治疗持续时间等方法学上的差异。
结论
血液透析患者的营养和膳食补充是一个需要更大规模、方法学上更严谨的随机对照试验来确定是否可以改善心血管结局风险的领域。
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