糖尿病肾病中的鱼油

Fish oil in diabetic nephropathy.

作者信息

Rossing P, Hansen B V, Nielsen F S, Myrup B, Hølmer G, Parving H H

机构信息

Steno Diabetes Center, Gentofte, Denmark.

出版信息

Diabetes Care. 1996 Nov;19(11):1214-9. doi: 10.2337/diacare.19.11.1214.

DOI:10.2337/diacare.19.11.1214

PMID:8908382

Abstract

OBJECTIVE

Recent studies in nondiabetic kidney diseases suggest that dietary supplementation with n-3 polyunsaturated fatty acids (fish oil) may have beneficial effects on albuminuria, kidney function, arterial blood pressure, and dyslipidemia. Therefore, we evaluated the long-term effect of fish oil in diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A 1-year double-blind randomized controlled study comparing fish oil (4.6 g n-3 fatty acids/day) with placebo (olive oil) was performed in an outpatient clinic in a tertiary referral center. Thirty-six normotensive IDDM patients with diabetic nephropathy were included; 18 were treated with fish oil. Seven patients dropped out (four received fish oil), and results for the remaining 29 are presented. Albuminuria (enzyme immunoassay), glomerular filtration rate (51Cr-labeled EDTA plasma clearance), 24-h ambulatory blood pressure, and lipid profile were determined every 6 months.

RESULTS

Albuminuria increased by 22% (1-46%) (mean [95% CI]) in the fish oil group vs. 15% (-11-49%) in the placebo group (NS). Glomerular filtration rate decreased from 116 +/- 7 to 105 +/- 7 ml.min-1.1.73 m-2 (mean +/- SE) vs. from 108 +/- 6 to 103 +/- 7, fish oil and placebo, respectively (NS). No significant changes occurred in 24-h ambulatory blood pressure: from 141 +/- 4/82 +/- 2 mmHg to 142 +/- 5/83 +/- 2 vs. from 140 +/- 4/78 +/- 2 to 144 +/- 4/80 +/- 3, fish oil and placebo, respectively (NS). In the fish oil group, serum triglycerides (median [range]) decreased from 0.97 (0.5-4.0) mmol/l to 0.8 (0.4-3.0) vs. from 1.01 (0.4-2.0) to 1.09 (0.4-2.0) in the placebo group (P < 0.05) and VLDL cholesterol decreased from 0.45 (0.23-1.88) to 0.37 (0.21-1.43) mmol/l vs. from 0.44 (0.21-0.94) to 0.41 (0.17-1.94) (P < 0.05), but total and LDL cholesterol rose in the fish oil compared with the placebo group.

CONCLUSIONS

Our study does not suggest that fish oil has beneficial effects on albuminuria, kidney function, blood pressure, and dyslipidemia in normotensive IDDM patients suffering from diabetic nephropathy.

摘要

目的

近期关于非糖尿病肾病的研究表明，饮食中补充n-3多不饱和脂肪酸（鱼油）可能对蛋白尿、肾功能、动脉血压和血脂异常有有益影响。因此，我们评估了鱼油对糖尿病肾病的长期影响。

研究设计与方法

在一家三级转诊中心的门诊进行了一项为期1年的双盲随机对照研究，比较鱼油（4.6克n-3脂肪酸/天）与安慰剂（橄榄油）。纳入36例患有糖尿病肾病的血压正常的1型糖尿病患者；18例接受鱼油治疗。7例患者退出（4例接受鱼油治疗），现报告其余29例的结果。每6个月测定一次蛋白尿（酶免疫测定法）、肾小球滤过率（51Cr标记的乙二胺四乙酸血浆清除率）、24小时动态血压和血脂谱。

结果

鱼油组蛋白尿增加22%（1%-46%）（均值[95%CI]），而安慰剂组增加15%（-11%-49%）（无显著差异）。肾小球滤过率从116±7降至105±7ml·min-1·1.73m-2（均值±标准误），鱼油组和安慰剂组分别从108±6降至103±7（无显著差异）。24小时动态血压无显著变化：鱼油组从141±4/82±2mmHg变为142±5/83±2，安慰剂组从140±4/78±2变为144±4/80±3（无显著差异）。在鱼油组，血清甘油三酯（中位数[范围]）从0.97（0.5-4.0）mmol/l降至0.8（0.4-3.0），而安慰剂组从1.01（0.4-2.0）升至1.09（0.4-2.0）（P<0.0５），极低密度脂蛋白胆固醇从0.45（0.23-1.88）降至0.37（0.21-1.43）mmol/l，而安慰剂组从0.44（0.21-0.94）降至0.41（0.17-1.94）（P<0.0５），但与安慰剂组相比，鱼油组总胆固醇和低密度脂蛋白胆固醇升高。