乙酰左旋肉碱补充治疗与抑郁症状：系统评价和荟萃分析。
Acetyl-L-Carnitine Supplementation and the Treatment of Depressive Symptoms: A Systematic Review and Meta-Analysis.
机构信息
From the National Research Council, Neuroscience Institute (Veronese, Maggi), Aging Branch, Padova, Italy; South London and Maudsley NHS FoundationTrust (Stubbs), Denmark Hill; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (Stubbs, Ajnakina), De Crespigny Park, London; Faculty of Health, Social Care and Education, Anglia Ruskin University (Stubbs), Chelmsford, United Kingdom; Department of Neurosciences, University of Padova (Solmi), Padova, Italy; and Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara (Carvalho), Fortaleza, CE, Brazil.
出版信息
Psychosom Med. 2018 Feb/Mar;80(2):154-159. doi: 10.1097/PSY.0000000000000537.
OBJECTIVE
Deficiency of acetyl-L-carnitine (ALC) seems to play a role in the risk of developing depression, indicating a dysregulation of fatty acid transport across the inner membrane of mitochondria. However, data about ALC supplementation in humans are limited. We thus conducted a systematic review and meta-analysis investigating the effect of ALC on depressive symptoms across randomized controlled trials (RCTs).
METHODS
A literature search in major databases, without language restriction, was undertaken from inception until 30 December 2016. Eligible studies were RCTs of ALC alone or in combination with antidepressant medications, with a control group taking placebo/no intervention or antidepressants. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used for summarizing outcomes with a random-effect model.
RESULTS
Twelve RCTs (11 of which were ALC monotherapy) with a total of 791 participants (mean age = 54 years, % female = 65%) were included. Pooled data across nine RCTs (231 treated with ALC versus 216 treated with placebo and 20 no intervention) showed that ALC significantly reduced depressive symptoms (SMD = -1.10, 95% CI = -1.65 to -0.56, I = 86%). In three RCTs comparing ALC versus antidepressants (162 for each group), ALC demonstrated similar effectiveness compared with established antidepressants in reducing depressive symptoms (SMD = 0.06, 95% CI = -0.22 to 0.34, I = 31%). In these latter RCTs, the incidence of adverse effects was significantly lower in the ALC group than in the antidepressant group. Subgroup analyses suggested that ALC was most efficacious in older adults.
CONCLUSIONS
ALC supplementation significantly decreases depressive symptoms compared with placebo/no intervention, while offering a comparable effect with that of established antidepressant agents with fewer adverse effects. Future large scale trials are required to confirm/refute these findings.
目的
乙酰左旋肉碱（ALC）的缺乏似乎与抑郁风险有关，这表明脂肪酸跨线粒体内膜的转运出现了失调。然而，目前关于人体补充 ALC 的数据有限。因此，我们进行了一项系统评价和荟萃分析，旨在研究 ALC 对随机对照试验（RCT）中抑郁症状的影响。
方法
我们对主要数据库进行了无语言限制的文献检索，检索时间截至 2016 年 12 月 30 日。合格的研究为单独使用 ALC 或与抗抑郁药联合使用的 RCT，对照组服用安慰剂/不干预或抗抑郁药。使用随机效应模型汇总结果的标准化均数差（SMD）和 95%置信区间（CI）。
结果
纳入了 12 项 RCT（其中 11 项为 ALC 单药治疗），共 791 名参与者（平均年龄=54 岁，女性%=65%）。9 项 RCT（231 例接受 ALC 治疗，216 例接受安慰剂治疗，20 例不干预）的汇总数据显示，ALC 显著降低抑郁症状（SMD=-1.10，95%CI=-1.65 至-0.56，I=86%）。在 3 项比较 ALC 与抗抑郁药的 RCT（每组 162 例）中，ALC 在降低抑郁症状方面与已确立的抗抑郁药具有相似的疗效（SMD=0.06，95%CI=-0.22 至 0.34，I=31%）。在这些 RCT 中，ALC 组的不良反应发生率明显低于抗抑郁药组。亚组分析表明，ALC 对老年人最有效。
结论
与安慰剂/不干预相比，ALC 补充剂可显著降低抑郁症状，且与已确立的抗抑郁药物具有相当的疗效，不良反应更少。需要进一步开展大规模试验来证实或反驳这些发现。
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