鱼油预防心血管疾病的系统评价

Effects of Fish Oil on Prevention of Cardiovascular Events:A Systematic Review

目的系统评价鱼油(n-3多不饱和脂肪酸)防治心血管疾病的效果。方法计算机检索PubMed、Cochrane图书馆临床对照试验资料库(2009年第1期)、CBM、CNKI、万方等数据库,同时筛检了纳入文献的参考文献,按纳入与排除标准纳入鱼油在心血管疾病防治方面的随机对照试验。由两名评价员独立评价文献质量、提取资料并交叉核对,如遇分歧讨论解决。而后采用RevMan4.2软件对资料进行Meta分析。结果共纳入5项研究,包括37689例研究对象。Meta分析结果显示:①与安慰剂组比较,鱼油可降低心血管性死亡事件[RR=0.91,95%CI(0.84,0.98)]、总心血管事件[RR=0.95,95%CI(0.91,0.98)]、心肌梗死[RR=0.79,95%CI(0.65,0.96)]和心绞痛[RR=0.79,95%CI(0.64,0.96)]的发生率;②在降低心血管疾病住院率、全因死亡事件、猝死及心衰发生率方面,与安慰剂比较差异无统计学意义(P>0.05);③在心律失常[RR=1.14,95%CI(0.80,1.62)]和卒中发生率[RR=1.12,95%CI(0.97,1.30)]方面,与安慰剂比较有轻度升高,但差异均无统计学意义(P>0.05)。结论鱼油能降低总心血管事件、总心血管性死亡、心肌梗死及心绞痛的发生率。在全因死亡事件、猝死、心衰及心血管疾病住院事件方面疗效不明显,而在心律失常及卒中方面发生率有轻度升高但无统计学意义。结果表明鱼油在高危人群中防治心血管疾病可获益。

Objective To evaluate the efficacy of n-3 PUFAs （fish oil） for prevention of cardiovascular events. Methods Randomized controlled trials （RCTs） were searched from the following electronic databases： PubMed, EMbase, The Cochrane Library （Issue 1, 2009）, CBM, and CNKI. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using Review Manager 4.2 software. Results Five studies involving 37 689 participants met the inclusion criteria. Meta-analysis results showed that： 1） Compared with placebo, the incidence rates of the cardiovascular death （RR=0.91, 95% CI 0.84 to 0.98）, cardiovascular events （RR=0.95, 95%CI 0.91 to 0.98）, angina （RR=0.79, 95%CI 0.64 to 0.96）, and myocardial infarction （RR=0.79, 95%CI 0.65 to 0.96） could be reduced by n-3 PUFAs （fish oil）. 2） There were no significant differences in death from any cause, the hospitalization rates of cardiovascular disease, sudden death, and heart failure （RR=0.95, 95%CI 0.90 to 1.00; RR=0.97, 95%CI 0.93 to 1.02; RR=0.90, 95%CI 0.79 to 1.01; RR=0.98, 95%CI 0.91 to 1.06）. 3） Compared with placebo, the incidence rates of the arrhythmia and stroke could he increased, but there were no significant differences （RR= 1. 14, 95%CI： 0.80 to 1.62; RR=1. 12, 95%CI 0.97 to 1.30）. Conclusion Compared with placebo, n-3 PUFAs （fish oil） has good effects on reducing the incidence rates of total cardiovascular events, cardiovascular death, myocardial infarction, and angina pectoris, and it has the same efficacy in death from all cause, sudden death, heart failure, and the hospitalization rates of cardiovascular disease. There are no significant differences in the increased rates of arrhythmia and stroke.