n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials
n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials
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DOI：
10.2459/jcm.0b013e32834a13c1
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发表时间：
2013-02-01
影响因子：
3
通讯作者：
Sinatra, Riccardo
中科院分区：
文献类型：
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作者：
Benedetto, Umberto;Angeloni, Emiliano;Sinatra, Riccardo
背景n-3多不饱和脂肪酸（n-3 PUFA）已被提议作为预防性治疗，用于预防心脏手术患者术后房颤（POAF）。我们对随机对照试验进行了荟萃分析，以更好地阐明这一问题。方法对电子数据库进行了搜索，以寻找关于n-3 PUFA对POAF影响的随机对照试验，仅限于2010年12月之前的英语出版物。对于每项研究，POAF发生率的数据用于生成风险比（< 1，有利于n-3 PUFA; > 1，有利于安慰剂）。根据异质性，通过固定或随机效应计算汇总汇总效应估计值。采用Meta回归分析研究二十碳五烯酸（EPA）/二十二碳六烯酸（DHA）比值和术前β受体阻滞剂对n-3 PUFA对POAF的影响。POAF的总体发生率范围为24 - 54%。汇总数据，n-3 PUFA未显示对POAF风险的显著影响[风险比0.89; 95%置信区间（CI）0.55-1.44; P = 0.63]。然而，荟萃回归分析显示，当EPA/DHA比例为1：2时，n-3 PUFA补充剂有获益的趋势（Q模型= 7.4; p模型= 0.02）和术前β受体阻滞剂率较低时（Q模型= 8.0; p模型= 0.01）。结论综上所述，目前随机对照试验的荟萃分析结果表明，术前n-3 PUFA治疗可能不会减少接受心脏手术的患者的POAF。然而，有几个方面可能影响了这一负面结果，需要进行调查。
Background n-3 Polyunsaturated fatty acids (n-3 PUFAs) have been proposed as prophylactic therapy in the prevention of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to better clarify this issue.Methods An electronic database search for randomized controlled trials on the effect of n-3 PUFAS on POAF was conducted, limited to English language publications until December 2010. For each study, data regarding the incidence of POAF were used to generate risk ratio (< 1, favors n-3 PUFA; > 1, favors placebo). Pooled summary effect estimate was calculated by means of a fixed or random effect according to heterogeneity. Meta-regression was used to investigate the effect of eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) ratio and preoperative beta-blockers on the effect of n-3 PUFA on POAF.Results Three publications were included in the analysis, enrolling a total of 431 patients. Overall incidence of POAF ranged from 24 to 54%. Pooling data, n-3 PUFA did not show a significant effect on the risk of POAF [risk ratio 0.89; 95% confidence interval (CI) 0.55-1.44; P = 0.63]. However, meta-regression analysis showed a trend toward a benefit from n-3 PUFA supplementation when the EPA/DHA ratio was 1:2 (Q model = 7.4; p model = 0.02) and when preoperative beta-blocker rate was lower (Q model = 8.0; p model = 0.01).Conclusion In conclusion, the results of the present meta-analysis of randomized controlled trials suggest that preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing cardiac surgery. However, several aspects may have influenced this negative result, which need to be investigated.