左旋肉碱补充对伴有心血管危险因素的成年人血脂谱和血糖控制的影响：随机对照临床试验的系统评价和荟萃分析。
The effect of l-carnitine supplementation on lipid profile and glycaemic control in adults with cardiovascular risk factors: A systematic review and meta-analysis of randomized controlled clinical trials.
机构信息
Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
出版信息
Clin Nutr. 2020 Jan;39(1):110-122. doi: 10.1016/j.clnu.2019.01.020. Epub 2019 Feb 22.
BACKGROUND & AIMS: Several randomized clinical trials (RCTs) have investigated the effect of l-carnitine supplementation on lipid profile and glycaemic control in adults with cardiovascular risk factors; however, the results were conflicting. Therefore, a meta-analysis was performed to assess the effect of l-carnitine on lipid profile and glycaemic control in adults with cardiovascular risk factors.
METHODS
We searched PubMed, Scopus, Cochrane Databases, Google Scholar, ProQuest, Web of Science and Embase for randomized, placebo-controlled human trials that investigated the effect of l-carnitine supplementation on lipid profile and glycaemic control up to April 2017. From the eligible trials, 24 articles were selected for the meta-analysis. The meta-analysis was performed in a random-effects model. Heterogeneity was determined by I statistics and Cochrane Q test.
RESULTS
The result showed significant effect of l-carnitine on TC (WMD: -13.73 [95% CI: -22.28, -5.17] mg/dL; P < 0.001), LDL-C (WMD = - 7.70 [95% CI: - 11.80, -3.61]mg/dL; p < 0.001), HDL-C (WMD = 0.82 [95% CI: 0.44, 1.21] mg/dL; P > 0.001), Lp(a) (WMD = - 7.13 [95% CI: -9.82,- 4.43]mg/dL; P < 0.001), FPG (WMD = -6.25 [95% CI: -10.35, -2.16] mg/dL; P < 0.001), HbA1C (WMD (%) = - 0.35 [95% CI: -0.65,- 0.05]; p = 0.02) and HOMA-IR (WMD (%) = - 0.94 [95% CI: -1.89, -0.00]; P = 0.05). No effect of l-carnitine was detected in TG, Apo A-I and Apo B 100 on pooled effect size. Additionally, sensitivity analysis showed l-carnitine supplementation could improve glycaemic control, particularly along with hypocaloric diet.
CONCLUSION
This meta-analysis showed that l-carnitine supplementation could improve lipid profile levels, particularly in doses more than 1500 mg/day. More RCTs with large sample sizes, focusing on gut microbiome profiles and dietary patterns are needed to better understand the effect of l-carnitine on patients with cardiovascular risk factors.
背景与目的
几项随机临床试验（RCT）研究了左旋肉碱补充剂对心血管危险因素成人的血脂谱和血糖控制的影响；然而，结果存在争议。因此，进行了荟萃分析以评估左旋肉碱对心血管危险因素成人血脂谱和血糖控制的影响。
方法
我们在 PubMed、Scopus、Cochrane 数据库、Google Scholar、ProQuest、Web of Science 和 Embase 中搜索了截至 2017 年 4 月，研究左旋肉碱补充剂对血脂谱和血糖控制影响的随机、安慰剂对照人体试验。从合格的试验中，选择了 24 篇文章进行荟萃分析。荟萃分析采用随机效应模型进行。异质性通过 I 统计量和 Cochrane Q 检验来确定。
结果
结果表明，左旋肉碱对 TC（WMD：-13.73 [95% CI：-22.28，-5.17]mg/dL；P < 0.001）、LDL-C（WMD：-7.70 [95% CI：-11.80，-3.61]mg/dL；p < 0.001）、HDL-C（WMD：0.82 [95% CI：0.44，1.21]mg/dL；P > 0.001）、Lp（a）（WMD：-7.13 [95% CI：-9.82，-4.43]mg/dL；P < 0.001）、FPG（WMD：-6.25 [95% CI：-10.35，-2.16]mg/dL；P < 0.001）、HbA1C（WMD（%）：-0.35 [95% CI：-0.65，-0.05]；p = 0.02）和 HOMA-IR（WMD（%）：-0.94 [95% CI：-1.89，-0.00]；P = 0.05）有显著影响。在汇总效应大小中，未检测到左旋肉碱对 TG、Apo A-I 和 Apo B100 的影响。此外，敏感性分析表明，左旋肉碱补充剂可以改善血糖控制，特别是与低热量饮食相结合时。
结论
这项荟萃分析表明，左旋肉碱补充剂可以改善血脂谱水平，尤其是剂量超过 1500mg/天时。需要更多的 RCT，样本量更大，重点关注肠道微生物组谱和饮食模式，以更好地了解左旋肉碱对心血管危险因素患者的影响。
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