魚油脂肪乳對膿毒癥患者療效的Meta分析_《中國呼吸與危重監護雜志》

作者：

1. 廣州醫科大學附屬第一醫院營養科(廣東廣州 510120);;
2. 廣州醫科大學附屬第一醫院廣州呼吸疾病研究所(廣東廣州 510120);

關鍵詞：

膿毒癥魚油 ω-3脂肪酸脂肪乳 Meta分析

DOI：

10.7507/1671-6205.2014040

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目的系統評價魚油脂肪乳在膿毒癥病程及預后中的作用和地位。方法計算機檢索PubMed、EMBASE、FMJS、Cochrane圖書館臨床對照試驗資料庫、CNKI、萬方、維普等數據庫自1980年至今發表的魚油脂肪乳治療膿毒癥患者的隨機對照試驗相關文獻。兩名評價員獨立篩查文獻及質量評價、提取數據。采用Jadad量表法評估納入文獻的方法學質量。采用RevMan5.2軟件對數據進行Meta分析。結果共納入15篇研究,794例研究對象。魚油組與對照組比較:①明顯降低膿毒癥患者的ICU住院天數[WMD=-5.59,95%CI(-7.65,-3.53)]、總住院天數[WMD=-10.48,95%CI(-14.67,-6.29)]、28 d病死率[RR=0.69,95%CI(0.52,0.93)];②明顯降低腫瘤壞死因子α[WMD=31.78,95%CI(5.63,57.92)],明顯提高氧合指數[WMD=41.95,95%CI(30.80,53.11)];③治療后CRP比較,差異無統計學意義(P＞0.05)。結論魚油脂肪乳能顯著減少膿毒癥患者的ICU住院天數、住院總天數、28天病死率、TNF-α,改善氧合,但對于CRP降低幅度與傳統脂肪乳相比無明顯差別。結果表明魚油脂肪乳治療膿毒癥可獲益。

引用本文： 林婷婷, 江梅, 黃勇波, 毛璞, 劉曉青, 閆鳳, 張容, 黎毅敏. 魚油脂肪乳對膿毒癥患者療效的Meta分析. 中國呼吸與危重監護雜志, 2013, 12(2): 162-169. doi: 10.7507/1671-6205.2014040 復制

1.	盛虹.魚油在膿毒血癥中的應用.上海交通大學學報:醫學版,2010,30: 46-49.
2.	Heller AR,Rossler S,Litz RJ,et al.Omega-3 fatty acids improve the diagnosis-related clinical outcome.Critical care medicine,2006,34: 972-979.
3.	Bone RC,Balk RA,Cerra FB,et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.The ACCP/SCCM Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine.1992.Chest,2009,136(5 Suppl): e28.
4.	Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary? Controlled clinical trials,1996,17:1-12.
5.	趙凱峰,張弘,張穎,等.早期靜脈應用ω-3魚油脂肪乳對膿毒癥所致ARDS的臨床療效觀察.山東醫藥,2011,51:110-111.
6.	曲愛君,徐珞.魚油脂肪乳對膿毒癥患者免疫功能的調節作用觀察.山東醫藥,2009,49:13-15.
7.	趙凱峰,張弘,張坤,等.ω-3魚油脂肪乳對膿毒癥患者抗生素使用的影響,承德醫學院學報,2012,29:148-149.
8.	劉寒.ω-3多不飽和脂肪酸對膿毒癥免疫功能的影響.山東大學; 2011(學位論文).
9.	鄒曰坤,劉于.ω-3脂肪酸對膿毒癥病人治療的影響.腸外與腸內營養,2009,16:222-224.
10.	干朝暉,張立群.ω-3魚油脂肪乳劑對感染性休克患者TNF-α、IL-6水平的影響.浙江中西醫結合雜志,2012,22:785-786.
11.	黃志平.魚油治療感染性休克的臨床療效觀察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12.	熊麗紅,鄭曉英,張憲華,等.ω-3多不飽和脂肪酸在嚴重膿毒癥機械通氣早期的保護作用的研究.國際醫藥衛生導報,2011,17: 142-146.
13.	梁曉,方利洲,張燕,等.ω-3魚油脂肪乳對嚴重膿毒癥的抑制作用觀察.中國實用醫藥,2009,4: 158-159.
14.	Sungurtekin H, De AğG irmenci S, Sungurtekin U,et al.Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis.Nutr Clin Pract,2011,26:665-671.
15.	Khor BS,Liaw SJ,Shih HC,et al.Randomized,double blind,placebo-controlled trial of fish-oil-based lipid emulsion infusion for treatment of critically ill patients with severe sepsis. Asian J Surg,2011; 34:1-10.
16.	Mayer K,Fegbeutel C,Hattar K,et al.Omega-3 vs.omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation.Intensive care medi,2003,29: 1472-1481.
17.	Barbosa VM,Miles EA,Calhau C,et al.Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids,inflammatory markers,and clinical outcomes in septic patients: a randomized,controlled clinical trial.Critical care,2010,14:R5.
18.	Mayer K,Gokorsch S,Fegbeutel C,et al.Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis.Am J Respir Crit Care Med,2003,167:1321-1328.
19.	Grecu I, Mirea L, Grinteseu I.Parenteral fish oil supplementation in patients with abdominal sepsis.Clin Nutr, 2003, 22(suppl 1):S23.
20.	Mayer K,Seeger W.Fish oil in critical illness.Curr opin clin nutr metab care.2008,11: 121-127.
21.	Sijben JW,Calder PC.Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease.Proceed Nutr Soc,2007,66:237-259.
22.	Peterson LD,Jeffery NM,Thies F,et al.Eicosapentaenoic and docosahexaenoic acids alter rat spleen leukocyte fatty acid composition and prostaglandin E2 production but have different effects on lymphocyte functions and cell-mediated immunity.Lipids,1998,33:171-180.
23.	Chapkin RS,Akoh CC,Miller CC.Influence of dietary n-3 fatty acids on macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis.J Lipid Res,1991,32:1205-1213.
24.	Ait-Said F,Elalamy I,Werts C,et al.Inhibition by eicosapentaenoic acid of IL-1beta-induced PGHS-2 expression in human microvascular endothelial cells: involvement of lipoxygenase-derived metabolites and p38 MAPK pathway.Biochim Biophys Acta,2003,1631:77-84.
25.	Tsou SS,Chiu WC,Yeh CL,et al.Effects of omega-3 fatty acids on inflammatory mediators and splenocyte cytokine mRNA expressions in rats with polymicrobial sepsis.Nutrition,2008,24:484-491.
26.	Zhao G,Etherton TD,Martin KR,et al.Anti-inflammatory effects of polyunsaturated fatty acids in THP-1 cells.Biochem Biophys Res Commun,2005,336:909-917.

1. 盛虹.魚油在膿毒血癥中的應用.上海交通大學學報:醫學版,2010,30: 46-49.
2. Heller AR,Rossler S,Litz RJ,et al.Omega-3 fatty acids improve the diagnosis-related clinical outcome.Critical care medicine,2006,34: 972-979.
3. Bone RC,Balk RA,Cerra FB,et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.The ACCP/SCCM Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine.1992.Chest,2009,136(5 Suppl): e28.
4. Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary? Controlled clinical trials,1996,17:1-12.
5. 趙凱峰,張弘,張穎,等.早期靜脈應用ω-3魚油脂肪乳對膿毒癥所致ARDS的臨床療效觀察.山東醫藥,2011,51:110-111.
6. 曲愛君,徐珞.魚油脂肪乳對膿毒癥患者免疫功能的調節作用觀察.山東醫藥,2009,49:13-15.
7. 趙凱峰,張弘,張坤,等.ω-3魚油脂肪乳對膿毒癥患者抗生素使用的影響,承德醫學院學報,2012,29:148-149.
8. 劉寒.ω-3多不飽和脂肪酸對膿毒癥免疫功能的影響.山東大學; 2011(學位論文).
9. 鄒曰坤,劉于.ω-3脂肪酸對膿毒癥病人治療的影響.腸外與腸內營養,2009,16:222-224.
10. 干朝暉,張立群.ω-3魚油脂肪乳劑對感染性休克患者TNF-α、IL-6水平的影響.浙江中西醫結合雜志,2012,22:785-786.
11. 黃志平.魚油治療感染性休克的臨床療效觀察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12. 熊麗紅,鄭曉英,張憲華,等.ω-3多不飽和脂肪酸在嚴重膿毒癥機械通氣早期的保護作用的研究.國際醫藥衛生導報,2011,17: 142-146.
13. 梁曉,方利洲,張燕,等.ω-3魚油脂肪乳對嚴重膿毒癥的抑制作用觀察.中國實用醫藥,2009,4: 158-159.
14. Sungurtekin H, De AğG irmenci S, Sungurtekin U,et al.Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis.Nutr Clin Pract,2011,26:665-671.
15. Khor BS,Liaw SJ,Shih HC,et al.Randomized,double blind,placebo-controlled trial of fish-oil-based lipid emulsion infusion for treatment of critically ill patients with severe sepsis. Asian J Surg,2011; 34:1-10.
16. Mayer K,Fegbeutel C,Hattar K,et al.Omega-3 vs.omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation.Intensive care medi,2003,29: 1472-1481.
17. Barbosa VM,Miles EA,Calhau C,et al.Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids,inflammatory markers,and clinical outcomes in septic patients: a randomized,controlled clinical trial.Critical care,2010,14:R5.
18. Mayer K,Gokorsch S,Fegbeutel C,et al.Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis.Am J Respir Crit Care Med,2003,167:1321-1328.
19. Grecu I, Mirea L, Grinteseu I.Parenteral fish oil supplementation in patients with abdominal sepsis.Clin Nutr, 2003, 22(suppl 1):S23.
20. Mayer K,Seeger W.Fish oil in critical illness.Curr opin clin nutr metab care.2008,11: 121-127.
21. Sijben JW,Calder PC.Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease.Proceed Nutr Soc,2007,66:237-259.
22. Peterson LD,Jeffery NM,Thies F,et al.Eicosapentaenoic and docosahexaenoic acids alter rat spleen leukocyte fatty acid composition and prostaglandin E2 production but have different effects on lymphocyte functions and cell-mediated immunity.Lipids,1998,33:171-180.
23. Chapkin RS,Akoh CC,Miller CC.Influence of dietary n-3 fatty acids on macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis.J Lipid Res,1991,32:1205-1213.
24. Ait-Said F,Elalamy I,Werts C,et al.Inhibition by eicosapentaenoic acid of IL-1beta-induced PGHS-2 expression in human microvascular endothelial cells: involvement of lipoxygenase-derived metabolites and p38 MAPK pathway.Biochim Biophys Acta,2003,1631:77-84.
25. Tsou SS,Chiu WC,Yeh CL,et al.Effects of omega-3 fatty acids on inflammatory mediators and splenocyte cytokine mRNA expressions in rats with polymicrobial sepsis.Nutrition,2008,24:484-491.
26. Zhao G,Etherton TD,Martin KR,et al.Anti-inflammatory effects of polyunsaturated fatty acids in THP-1 cells.Biochem Biophys Res Commun,2005,336:909-917.

《中國呼吸與危重監護雜志》

魚油脂肪乳對膿毒癥患者療效的Meta分析

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《中國呼吸與危重監護雜志》

魚油脂肪乳對膿毒癥患者療效的Meta分析

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