鱼油脂肪乳对脓毒症患者疗效的Meta分析_《中国呼吸与危重监护杂志》

作者：

1. 广州医科大学附属第一医院营养科(广东广州 510120);;
2. 广州医科大学附属第一医院广州呼吸疾病研究所(广东广州 510120);

关键词：

脓毒症鱼油 ω-3脂肪酸脂肪乳 Meta分析

DOI：

10.7507/1671-6205.2014040

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的系统评价鱼油脂肪乳在脓毒症病程及预后中的作用和地位。方法计算机检索PubMed、EMBASE、FMJS、Cochrane图书馆临床对照试验资料库、CNKI、万方、维普等数据库自1980年至今发表的鱼油脂肪乳治疗脓毒症患者的随机对照试验相关文献。两名评价员独立筛查文献及质量评价、提取数据。采用Jadad量表法评估纳入文献的方法学质量。采用RevMan5.2软件对数据进行Meta分析。结果共纳入15篇研究,794例研究对象。鱼油组与对照组比较:①明显降低脓毒症患者的ICU住院天数[WMD=-5.59,95%CI(-7.65,-3.53)]、总住院天数[WMD=-10.48,95%CI(-14.67,-6.29)]、28 d病死率[RR=0.69,95%CI(0.52,0.93)];②明显降低肿瘤坏死因子α[WMD=31.78,95%CI(5.63,57.92)],明显提高氧合指数[WMD=41.95,95%CI(30.80,53.11)];③治疗后CRP比较,差异无统计学意义(P＞0.05)。结论鱼油脂肪乳能显著减少脓毒症患者的ICU住院天数、住院总天数、28天病死率、TNF-α,改善氧合,但对于CRP降低幅度与传统脂肪乳相比无明显差别。结果表明鱼油脂肪乳治疗脓毒症可获益。

引用本文： 林婷婷, 江梅, 黄勇波, 毛璞, 刘晓青, 闫凤, 张容, 黎毅敏. 鱼油脂肪乳对脓毒症患者疗效的Meta分析. 中国呼吸与危重监护杂志, 2013, 12(2): 162-169. doi: 10.7507/1671-6205.2014040 复制

1.	盛虹.鱼油在脓毒血症中的应用.上海交通大学学报:医学版,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.	赵凯峰,张弘,张颖,等.早期静脉应用ω-3鱼油脂肪乳对脓毒症所致ARDS的临床疗效观察.山东医药,2011,51:110-111.
6.	曲爱君,徐珞.鱼油脂肪乳对脓毒症患者免疫功能的调节作用观察.山东医药,2009,49:13-15.
7.	赵凯峰,张弘,张坤,等.ω-3鱼油脂肪乳对脓毒症患者抗生素使用的影响,承德医学院学报,2012,29:148-149.
8.	刘寒.ω-3多不饱和脂肪酸对脓毒症免疫功能的影响.山东大学; 2011(学位论文).
9.	邹曰坤,刘于.ω-3脂肪酸对脓毒症病人治疗的影响.肠外与肠内营养,2009,16:222-224.
10.	干朝晖,张立群.ω-3鱼油脂肪乳剂对感染性休克患者TNF-α、IL-6水平的影响.浙江中西医结合杂志,2012,22:785-786.
11.	黄志平.鱼油治疗感染性休克的临床疗效观察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12.	熊丽红,郑晓英,张宪华,等.ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用的研究.国际医药卫生导报,2011,17: 142-146.
13.	梁晓,方利洲,张燕,等.ω-3鱼油脂肪乳对严重脓毒症的抑制作用观察.中国实用医药,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.鱼油在脓毒血症中的应用.上海交通大学学报:医学版,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. 赵凯峰,张弘,张颖,等.早期静脉应用ω-3鱼油脂肪乳对脓毒症所致ARDS的临床疗效观察.山东医药,2011,51:110-111.
6. 曲爱君,徐珞.鱼油脂肪乳对脓毒症患者免疫功能的调节作用观察.山东医药,2009,49:13-15.
7. 赵凯峰,张弘,张坤,等.ω-3鱼油脂肪乳对脓毒症患者抗生素使用的影响,承德医学院学报,2012,29:148-149.
8. 刘寒.ω-3多不饱和脂肪酸对脓毒症免疫功能的影响.山东大学; 2011(学位论文).
9. 邹曰坤,刘于.ω-3脂肪酸对脓毒症病人治疗的影响.肠外与肠内营养,2009,16:222-224.
10. 干朝晖,张立群.ω-3鱼油脂肪乳剂对感染性休克患者TNF-α、IL-6水平的影响.浙江中西医结合杂志,2012,22:785-786.
11. 黄志平.鱼油治疗感染性休克的临床疗效观察.Strait Pharmaceutical Journal,2011, 23: 99-101.
12. 熊丽红,郑晓英,张宪华,等.ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用的研究.国际医药卫生导报,2011,17: 142-146.
13. 梁晓,方利洲,张燕,等.ω-3鱼油脂肪乳对严重脓毒症的抑制作用观察.中国实用医药,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.

《中国呼吸与危重监护杂志》

鱼油脂肪乳对脓毒症患者疗效的Meta分析

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《中国呼吸与危重监护杂志》

鱼油脂肪乳对脓毒症患者疗效的Meta分析

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