CMAJ：鱼油对人的作用因人而异
生物谷报道：大卫·詹金斯（David Jenkins）博士和保罗·道连（Paul Dorian）博士给带有植入式心律转复除颤器（implantable cardioverter defibrillators ）的患者使用鱼油补充剂，然后进行系统的检验，发现不同病人的试验结果间有重大的差异。这表明，鱼油可能有助于部分病人，对其他人则有负面作用。
多伦多大学医学院的教授、圣迈克尔医院临床营养与危险因子改造中心（Clinical Nutrition and Risk Factor）的主要负责人詹金斯说，鱼油对心脏有复杂多样的影响。“这些影响包括：阻断心脏离子通道从而减少纤维化带来的机械应力，降低血液凝固，并可能改变免疫功能” 。
从多个大规模的人口（流行病学）的研究和随机对照试验（以膳食鱼类或鱼油补充剂的形式摄入推荐值的DHA和EPA）得到的结果显示，鱼油可以减少心血管疾病患者死亡的危险，心脏病发作的危险和不正常的心脏节律，以及可能减缓动脉血管的硬化和轻微地降低血压。
但证据还显示，高剂量的鱼油会产生负面影响，如增加出血的风险。虽然有人提出了α -亚麻酸对人有益处，但没有令人信服科学证据，益处可能也不太显著。
综合分析发现，在具有不同病理生理学和实施不同治疗方案的病人群体中，鱼油都产生了不同的结果。然而，最近的数据显示，要特别注意分析从某些亚群，如男性稳定型心绞痛得到的数据。对有植入式心律转复除颤器、有室性心动过速史和那些没有服用抗心律失常药物的患者也要仔细分析。
米迦勒医院和多伦多大学医学院的教授道连说，“鱼油是心血管疾病的良好补充剂，但我们的研究工作，表明了我们的理解还有不足，需要进行更多的研究”。
这篇刊发在1月15日的Canadian Medical Association Journal杂志上的论文，也表明还需要进一步的研究和大量的随机对照试验，才能确定心力衰竭和心绞痛患者是否可以服用长链omega-3脂肪酸。
生物谷推进原始出处：
CMAJ • January 15, 2008; 178 (2). doi:10.1503/cmaj.070261.
Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis
David J.A. Jenkins, MD PhD, Andrea R. Josse, MSc, Joseph Beyene, PhD, Paul Dorian, MD MSc, Michael L. Burr, MD DSc (Med), Roxanne LaBelle, BSc, Cyril W.C. Kendall, PhD and Stephen C. Cunnane, PhD
From the Clinical Nutrition and Risk Factor Modification Centre (Josse, LaBelle, Kendall) and the Department of Medicine and Divisions of Endocrinology and Metabolism (Jenkins) and Cardiology (Dorian), St. Michael's Hospital, Toronto, Ont.; the Departments of Nutritional Sciences (Jenkins, Josse, LaBelle, Kendall) and Biostatistics (Beyene), University of Toronto, Toronto, Ont.; Department of Primary Care and Public Health (Burr), Cardiff University, Wales, United Kingdom; and the Research Centre on Aging (Cunnane), Université de Sherbrooke, Sherbrooke, Que.
Correspondence to: Dr. David J.A. Jenkins, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, 61 Queen St. East, Toronto ON M5C 2T2; fax 416 978-5310; cyril.kendall@utoronto.ca
Background: A recent Cochrane meta-analysis did not confirm the benefits of fish and fish oil in the secondary prevention of cardiac death and myocardial infarction. We performed a meta-analysis of randomized controlled trials that examined the effect of fish-oil supplementation on ventricular fibrillation and ventricular tachycardia to determine the overall effect and to assess whether heterogeneity exists between trials.
Methods: We searched electronic databases (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, CINAHL) from inception to May 2007. We included randomized controlled trials of fish-oil supplementation on ventricular fibrillation or ventricular tachycardia in patients with implantable cardioverter defibrillators. The primary outcome was implantable cardioverter defibrillator discharge. We calculated relative risk [RR] for outcomes at 1-year follow-up for each study. We used the DerSimonian and Laird random-effects methods when there was significant heterogeneity between trials and the Mantel-Hanzel fixed-effects method when heterogeneity was negligible.
Results: We identified 3 trials of 1–2 years' duration. These trials included a total of 573 patients who received fish oil and 575 patients who received a control. Meta-analysis of data collected at 1 year showed no overall effect of fish oil on the relative risk of implantable cardioverter defibrillator discharge. There was significant heterogeneity between trials. The second largest study showed a significant benefit of fish oil (relative risk [RR] 0.74, 95% confidence interval [CI] 0.56–0.98). The smallest showed an adverse tendency at 1 year (RR 1.23, 95% CI 0.92–1.65) and significantly worse outcome at 2 years among patients with ventricular tachycardia at study entry (log rank p = 0.007).
Conclusion: These data indicate that there is heterogeneity in the response of patients to fish-oil supplementation. Caution should be used when prescribing fish-oil supplementation for patients with ventricular tachycardia.
全文链接：http://www.cmaj.ca/cgi/content/full/178/2/157
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