Wong Shannon A, Drovandi Aaron, Jones Rhondda, Golledge Jonathan
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia.
The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia.
Biomedicines. 2023 Jun 29;11(7):1859. doi: 10.3390/biomedicines11071859.
This systematic review pooled evidence from randomised controlled trials (RCTs) on the effectiveness of dietary upregulators of nitric oxide (NO) in improving the walking and quality of life of patients with peripheral artery disease (PAD). RCTs examining the effect of dietary upregulators of NO in patients with PAD were included. The primary outcome was the maximum walking distance. Secondary outcomes were the initial claudication distance, the six-minute walking distance, quality of life, the ankle-brachial pressure index (ABI), adverse events and risk of mortality, revascularisation or amputation. Meta-analyses were performed using random effects models. The risk of bias was assessed using Cochrane's ROB-2 tool. Leave-one-out and subgroup analyses were conducted to assess the effect of individual studies, the risk of bias and intervention type on pooled estimates. Thirty-four RCTs involving 3472 participants were included. Seven trials tested NO donors, nineteen tested antioxidants, three tested NO synthase inducers and five tested enhancers of NO availability. Overall, the dietary supplements significantly improved the initial claudication (SMD 0.34; 95%CI 0.04, 0.64; = 0.03) but not maximum walking (SMD 0.13; 95%CI -0.17, 0.43; = 0.39) distances. Antioxidant supplements significantly increased both the maximum walking (SMD 0.36; 95%CI 0.14, 0.59; = 0.001) and initial claudication (SMD 0.58; 95%CI 0.26, 0.90; < 0.001) distances. The dietary interventions did not improve the physical function domain of the Short Form-36 (SMD -0.16; 95%CI -0.32, 0.00; = 0.38), ABI or risk of adverse events, mortality, revascularisation or amputation. Dietary NO upregulators, especially antioxidants, appear to improve the initial claudication distance in patients with PAD. Larger high-quality RCTs are needed to fully examine the benefits and risks of these treatments. PROSPERO Registration: CRD42022256653.
本系统评价汇总了来自随机对照试验（RCT）的证据，以探讨一氧化氮（NO）膳食上调剂对改善外周动脉疾病（PAD）患者步行能力和生活质量的有效性。纳入了研究NO膳食上调剂对PAD患者影响的RCT。主要结局是最大步行距离。次要结局包括初始跛行距离、六分钟步行距离、生活质量、踝臂压力指数（ABI）、不良事件以及死亡、血运重建或截肢风险。采用随机效应模型进行荟萃分析。使用Cochrane的ROB-2工具评估偏倚风险。进行留一法和亚组分析，以评估个体研究、偏倚风险和干预类型对汇总估计值的影响。纳入了34项涉及3472名参与者的RCT。7项试验测试了NO供体，19项测试了抗氧化剂，3项测试了NO合酶诱导剂，5项测试了提高NO可用性的增强剂。总体而言，膳食补充剂显著改善了初始跛行距离（标准化均数差[SMD]0.34；95%置信区间[CI]0.04，0.64；P = 0.03），但未改善最大步行距离（SMD 0.13；95%CI -0.17，0.43；P = 0.39）。抗氧化剂补充剂显著增加了最大步行距离（SMD 0.36；95%CI 0.14，0.59；P = 0.001）和初始跛行距离（SMD 0.58；95%CI 0.26，0.90；P < 0.001）。膳食干预未改善简明健康状况调查量表（Short Form-36）的身体功能领域（SMD -0.16；9,5%CI -0.32，0.00；P = 0.38）、ABI或不良事件、死亡、血运重建或截肢风险。膳食NO上调剂，尤其是抗氧化剂，似乎可改善PAD患者的初始跛行距离。需要更大规模的高质量RCT来全面研究这些治疗的益处和风险。国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42022256653。
