ω-3 fatty acids, γ-linolenic acid, and antioxidants: immunomodulators or inert dietary supplements?
ω-3 fatty acids, γ-linolenic acid, and antioxidants: immunomodulators or inert dietary supplements?
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DOI：
10.1186/cc11863
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发表时间：
2012-11-23
期刊：
影响因子：
--
通讯作者：
Huang DT
中科院分区：
文献类型：
--
作者：
Schott CK;Huang DT
Rice TW，惠勒AP，Thompson BT，deBoisblanc BP，Steingrub J，Rock，P.肠内欧米茄-3脂肪酸、γ-亚麻酸和急性肺损伤中的抗氧化剂补充。JAMA. 2011; 306（14）：1574 - 1581. PubMed PMID：21976613。ω-3（n-3）脂肪酸二十二碳六烯酸和二十碳五烯酸，沿着γ-亚麻酸和抗氧化剂，可调节全身炎症反应，改善急性肺损伤患者的氧合和结局。目的：确定急性肺损伤患者饮食补充这些物质是否会增加至研究第28天的无呼吸机天数。设计：OMEGA研究，一项随机、双盲、安慰剂对照、多中心试验，于2008年1月2日至2009年2月21日进行。所有参与者都有完整的随访。设置：该试验在国家心肺血液研究所ARDS临床试验网络的44家医院进行。主题：参与者是272名在48小时内发生急性肺损伤需要机械通气的成年人，他们的医生打算开始肠内营养。干预：每日两次肠内补充n-3脂肪酸、γ-亚麻酸和抗氧化剂，与等热量对照组相比。根据方案指导，肠内营养与研究补充剂分开输送。结局：至研究第28天的无呼吸机天数。在n-3组和对照组分别入组143例和129例患者后，研究因无效而提前停止。尽管血浆二十碳五烯酸水平增加了8倍，但接受n-3补充剂的患者的无呼吸机天数（14.0 vs 17.2; P = 0.02）（差异，-3.2 [95%CI，-5.8至-0.7]）和无重症监护室天数（14.0 vs 16.7; P = 0.04）较少。n-3组患者的无非肺器官衰竭天数也较少（12.3 vs 15.5; P = 0.02）。n-3组60天住院死亡率为26.6%，对照组为16.3%（P = 0.054），n-3组和对照组校正60天死亡率分别为25.1%和17.6%（P = 0.11）。使用n-3补充剂导致腹泻天数增加（29% vs 21%; P =.001）。每日两次肠内补充n-3脂肪酸、γ-亚麻酸和抗氧化剂并不能改善急性肺损伤患者的主要终点无呼吸机天数或其他临床结局，可能是有害的。
Rice TW, Wheeler AP, Thompson BT, deBoisblanc BP, Steingrub J, Rock, P. Enteral Omega-3 Fatty Acid, γ-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury. JAMA. 2011; 306(14):1574-1581. PubMed PMID: 21976613. The omega-3 (n-3) fatty acids docosahexaenoic acid and eicosapentaenoic acid, along with γ-linolenic acid and antioxidants, may modulate systemic inflammatory response and improve oxygenation and outcomes in patients with acute lung injury. Objective: To determine if dietary supplementation of these substances to patients with acute lung injury would increase ventilator-free days to study day 28. Design: The OMEGA study, a randomized, double-blind, placebo-controlled, multicenter trial conducted from January 2, 2008, through February 21, 2009. All participants had complete follow-up. Setting: This trial occurred at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Subjects: Participants were 272 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition. Intervention: Twice-daily enteral supplementation of n-3 fatty acids, γ -linolenic acid, and antioxidants compared with an isocaloric control. Enteral nutrition, directed by a protocol, was delivered separately from the study supplement. Outcomes: Ventilator-free days to study day 28. The study was stopped early for futility after 143 and 129 patients were enrolled in the n-3 and control groups. Despite an 8-fold increase in plasma eicosapentaenoic acid levels, patients receiving the n-3 supplement had fewer ventilator-free days (14.0 vs 17.2; P=.02) (difference, −3.2 [95% CI, −5.8 to −0.7]) and intensive care unit-free days (14.0 vs 16.7; P=.04). Patients in the n-3 group also had fewer nonpulmonary organ failure-free days (12.3 vs 15.5; P=.02). Sixty-day hospital mortality was 26.6% in the n 3 group vs 16.3% in the control group (P=.054), and adjusted 60-day mortality was 25.1% and 17.6% in the n-3 and control groups, respectively (P=.11). Use of the n-3 supplement resulted in more days with diarrhea (29% vs 21%; P=.001). Twice-daily enteral supplementation of n-3 fatty acids, γ-linolenic acid, and antioxidants did not improve the primary end point of ventilator-free days or other clinical outcomes in patients with acute lung injury and may be harmful.
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8.8
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