n-3多不饱和脂肪酸补充治疗改善儿童非酒精性脂肪肝代谢指标的Meta分析

背景　非酒精性脂肪肝（NAFLD）现成为发达国家儿童的慢性肝病之一，随着经济的全球化，全球有1.55亿超重和肥胖儿童，导致儿童NAFLD患病率也呈上升趋势。近年来，治疗儿童NAFLD未找到有效药物，且用药仍存在一定争议。目的　系统分析n-3多不饱和脂肪酸（n-3PUFA）补充治疗对儿童NAFLD代谢指标的影响。方法　计算机检索PubMed、the Cochrane Library、EMBase、Web of Science等数据库，检索时间为建库至2019-05-15。筛选n-3PUFA补充治疗对NAFLD患儿代谢指标影响的随机对照试验（RCT），分为干预组与对照组，采用RevMan 5.2软件进行Meta分析。结果　共纳入6篇文献，378例患儿。Meta分析结果显示，干预组NAFLD患儿丙氨酸氨基转移酶（ALT）〔标准化均数差（SWD）=-0.34，95%CI（-0.55，-0.13）〕、天冬氨酸氨基转移酶（AST）〔SWD=-0.27，95%CI（-0.51，-0.03）〕、三酰甘油（TG）〔SWD=-0.43，95%CI（-0.64，-0.22）〕、空腹血糖（FBG）〔SWD=-0.22，95%CI（-0.44，0）〕、空腹胰岛素〔SWD=-0.38，95%CI（-0.60，-0.16）〕、稳态模型胰岛素抵抗指数（HOMA-IR）〔SWD=-0.31，95%CI（-0.52，-0.11）〕、体质指数（BMI）〔SWD=-0.71，95%CI（-1.13，-0.30）〕低于对照组，高密度脂蛋白胆固醇（HDL-C）〔SWD=0.55，95%CI（0.10，1.00）〕高于对照组（P≤0.05）。结论　n-3PUFA补充治疗可改善NAFLD患儿的ALT、AST、TG、HDL-C、FBG、空腹胰岛素、HOMA-IR、BMI等代谢指标。

Supplementary Therapy with Omega-3 Polyunsaturated Fatty Acids Improves Metabolic Indices in Children with Non-alcoholic Fatty Liver Disease:a Meta-analysis

Background Non-alcoholic fatty liver disease(NAFLD)has become one of the chronic liver diseases in children in developed countries.With the globalization of economy,there are 155 million overweight and obese children globally with an increasing prevalence of NAFLD.However,no effective drugs for NAFLD in children have been found,and the use of drugs is still controversial.Objective To systematically evaluate the effect of omega-3 polyunsaturated fatty acids(n-3PUFA)as an supplementary therapy on metabolic indices in children with NAFLD.Methods Databases of PubMed,the Cochrane Library,EMBase,and Web of Science were searched from inception to May 152019 for RCTs about improvement in metabolic indices in NAFLD children treated with an supplementary therapy with n-3PUFA(intervention group)versus that in those with placebo as the supplementary therapy or without supplementary therapy(control group).Meta-analysis was conducted by using RevMan 5.2.Results A total of 6 studies were included,with a total of 378 patients.Meta-analysis showed that the intervention group showed lower mean levels of alanine aminotransferase〔SWD=-0.34,95%CI(-0.55,-0.13)〕,aspartate aminotransferase〔SWD=-0.27,95%CI(-0.51,-0.03)〕,triglyceride〔SWD=-0.43,95%CI(-0.64,-0.22)〕,fasting blood glucose〔SWD=-0.22,95%CI(-0.44,0.00)〕,fasting insulin〔SWD=-0.38,95%CI(-0.60,-0.16)〕,homeostatic model assessment for insulin resistance(HOMA-IR)〔SWD=-0.31,95%CI(-0.52,-0.11)〕,and body mass index〔SWD=-0.71,95%CI(-1.13,-0.30)〕,and higher mean high-density lipoprotein cholesterol〔SWD=0.55,95%CI(0.10,1.00)〕compared with the control group(P≤0.05).Conclusion The meta-analysis demonstrated that supplementary treatment with n-3PUFA may improve metabolic indices such as alanine aminotransferase,aspartate aminotransferase,triglyceride,high-density lipoprotein cholesterol,fasting blood glucose,fasting insulin,HOMA-IR,and body mass index in children with NAFLD.