PURPOSE:To report the secondary outcomes in the Carotenoids with Coantioxidants in Age-Related Maculopathy trial. DESIGN:Randomized double-masked placebo-controlled clinical trial (registered as ISRCTN 94557601). PARTICIPANTS:Participants included 433 adults 55 years of age or older with early age-related macular degeneration (AMD) in 1 eye and late-stage disease in the fellow eye (group 1) or early AMD in both eyes (group 2). INTERVENTION:An oral preparation containing lutein (L), zeaxanthin (Z), vitamin C, vitamin E, copper, and zinc or placebo. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), Raman spectroscopy, stereoscopic colour fundus photography, and serum sampling were performed every 6 months with a minimum follow-up time of 12 months. MAIN OUTCOME MEASURES:Secondary outcomes included differences in BCVA (at 24 and 36 months), CS, Raman counts, serum antioxidant levels, and progression along the AMD severity scale (at 12, 24, and 36 months). RESULTS:The differential between active and placebo groups increased steadily, with average BCVA in the former being approximately 4.8 letters better than the latter for those who had 36 months of follow-up, and this difference was statistically significant (P = 0.04). In the longitudinal analysis, for a 1-log-unit increase in serum L, visual acuity was better by 1.4 letters (95% confidence interval, 0.3-2.5; P = 0.01), and a slower progression along a morphologic severity scale (P = 0.014) was observed. CONCLUSIONS:Functional and morphologic benefits were observed in key secondary outcomes after supplementation with L, Z, and coantioxidants in persons with early AMD.

译文

目的:报告年龄相关性黄斑病变试验中类胡萝卜素与抗氧化剂的次要结局。
设计:随机化的双掩蔽安慰剂对照临床试验(注册为ISRCTN 94557601)。
参与者:参与者包括433名55岁或以上的成年人,其中1眼患有早期年龄相关性黄斑变性(AMD),而另一只眼则患有晚期疾病(第1组)或双眼早期AMD(第2组)。
干预措施:一种口服制剂,其中含有叶黄素(L),玉米黄质(Z),维生素C,维生素E,铜和锌或安慰剂。每6个月进行一次最佳矫正视力(BCVA),对比敏感度(CS),拉曼光谱,立体彩色眼底照相和血清采样,最短随访时间为12个月。
主要观察指标:次要结果包括BCVA(在24和36个月时),CS,拉曼计数,血清抗氧化剂水平以及沿AMD严重程度的进展(在12、24和36个月时)的差异。
结果:活动组和安慰剂组之间的差异稳步增加,对于进行了36个月随访的患者,前者的平均BCVA比后者好4.8个字母,这一差异具有统计学意义(P = 0.04)。在纵向分析中,对于血清L升高1个对数单位,视敏度提高1.4个字母(95%置信区间,0.3-2.5; P = 0.01),并且沿形态学严重程度评分的进展更慢(P = 0.014)。
结论:在早期AMD患者中,补充L,Z和辅助抗氧化剂后,在关键的次要结局中观察到了功能和形态学益处。

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