辅酶Q_(10)联合他汀类药物治疗冠心病心功能减退患者有效性和安全性的Meta分析
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摘要
目的:系统评价辅酶Q_(10)联合他汀类药物治疗冠心病心功能减退患者的有效性和安全性。方法:计算机检索PubMed、Embase、Medline、The Cochrane Library、CNKI、WanFang Data、VIP、SinoMed数据库,搜集辅酶Q_(10)联合他汀类药物治疗冠心病心功能减退患者的随机对照试验(RCTs),检索时限为建库至2017年11月30日。由两位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入16个RCTs,累计1 432例患者。Meta分析结果显示,联合治疗组患者的左室舒张末期内径(LVEDD)[WMD=-3.88,95%CI(-5.77,-1.99),P<0.000 1],心输出量(CO)[WMD=0.55,95%CI(0.22,0.88),P=0.001],心脏指数(CI)[WMD=0.33,95%CI(0.13,0.53),P=0.001]和每博量(SV)[WMD=5.81,95%CI(3.70,7.91),P<0.000 01]均优于仅用他汀类药物的对照组;而左室收缩末期内径(LVESD)和左心射血分数(LVEF)指标两组间差异无统计学意义(P>0.05)。结论:他汀类药物和辅酶Q_(10)联合应用可以改善冠心病患者的心功能和多项血流动力学指标,而未出现明显不良反应。但受纳入研究的数量和质量限制,上述结论尚需要开展高质量的研究进行进一步验证。
Objective: To systematically evaluate the efficacy and safety of coenzyme Q_(10) combined with statins in patients with cardiac dysfunction of coronary heart disease. Methods: The databases including Pub Med,Embase,Medline,Cochrane Library,CNKI,Wanfang Data,VIP and Sino Med were electronically searched to collect randomized controlled trials( RCTs) on coenzyme Q_(10) combined with statins in cardiac dysfunction of coronary heart disease from inception to November 30,2017. Two reviewers independently screened the literatures,extracted data and assessed the risk of bias of the included studies. Meta-analysis was conducted using Rev Man 5. 3 software. Results: A total of 16 RCTs with 1 432 patients were included. The results of meta-analysis showed that,compared with statins alone,left ventricular end diastolic diameter( LVEDD)( WMD =-3. 88,95% CI-5. 77 to-1. 99,P <0. 000 1),cardiac output( CO)( WMD = 0. 55,95% CI 0. 22 to 0. 88,P = 0. 001),heart index( CI)( WMD = 0. 33,95% CI 0. 13 to 0. 53,P = 0. 001) and stroke volume( SV)( WMD = 5. 81,95% CI 3. 70 to 7. 91,P < 0. 000 01) were higher in the combined treatment with coenzyme Q_(10). There was no significant difference in the left ventricular end systolic diameter( LVESD) and left ventricular ejection fraction( LVEF) between them( P > 0. 05). Conclusion: Compared with statins alone,coenzyme Q_(10) as adjuvant therapy can be more effective in the promotion of cardiac function and multiple hemodynamic indicators in cardiac dysfunction of coronary heart disease with the similar incidence of adverse drug reactions. Due to the limited quality of included studies,the above conclusion still needs to be verified by more high-quality studies.
Objective: To systematically evaluate the efficacy and safety of coenzyme Q_(10) combined with statins in patients with cardiac dysfunction of coronary heart disease. Methods: The databases including Pub Med,Embase,Medline,Cochrane Library,CNKI,Wanfang Data,VIP and Sino Med were electronically searched to collect randomized controlled trials( RCTs) on coenzyme Q_(10) combined with statins in cardiac dysfunction of coronary heart disease from inception to November 30,2017. Two reviewers independently screened the literatures,extracted data and assessed the risk of bias of the included studies. Meta-analysis was conducted using Rev Man 5. 3 software. Results: A total of 16 RCTs with 1 432 patients were included. The results of meta-analysis showed that,compared with statins alone,left ventricular end diastolic diameter( LVEDD)( WMD =-3. 88,95% CI-5. 77 to-1. 99,P <0. 000 1),cardiac output( CO)( WMD = 0. 55,95% CI 0. 22 to 0. 88,P = 0. 001),heart index( CI)( WMD = 0. 33,95% CI 0. 13 to 0. 53,P = 0. 001) and stroke volume( SV)( WMD = 5. 81,95% CI 3. 70 to 7. 91,P < 0. 000 01) were higher in the combined treatment with coenzyme Q_(10). There was no significant difference in the left ventricular end systolic diameter( LVESD) and left ventricular ejection fraction( LVEF) between them( P > 0. 05). Conclusion: Compared with statins alone,coenzyme Q_(10) as adjuvant therapy can be more effective in the promotion of cardiac function and multiple hemodynamic indicators in cardiac dysfunction of coronary heart disease with the similar incidence of adverse drug reactions. Due to the limited quality of included studies,the above conclusion still needs to be verified by more high-quality studies.
引文
1 Banach M,Serban C,Ursoniu S,et al.Statin therapy and plasma co-enzyme Q10concentrations-A systematic review and meta-analysis of placebo-controlled trials[J].Pharmacol Research,2015,99:329-336
2 Banach M,Serban C,Sahebkar A,et al.Effects of coenzyme Q10on statin-induced myopathy:a meta-analysis of randomized controlled trials[J].Mayo Clinic Proceedings,2015,90(1):24-34
3 Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.3.0[EB/OL].(2011-03)[2017-11-30]http://www.cochrane-handbook.org
4 刘涛,李论,郭张强,等.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].山东医药,2014,39(54):55-57
5 史凤.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].中西医结合心血管病杂志,2015,26(3):105-106
6 陈捷,章瑾瑜,陆建洪,等.阿托伐他汀、辅酶Q10联合治疗冠心病早期心功能减退患者的临床研究[J].心脑血管病防治,2017,2(17):152-154
7 王文荣,裴彦祯,高静茹,等.阿托伐他汀联合辅酶Q10在改善冠心病早期心功能减退病人心功能中的作用[J].中西医结合心血管病杂志,2016,6(14):625-627
8 闫松改.阿托伐他汀联合辅酶Q10对冠心病患者心功能的改善[J].临床医学,2010,4(30):66-68
9 徐强.阿托伐他汀联合辅酶Q10治疗冠心病早期心功能减退35例临床观察[J].中国民族民间医药,2016,4(25):95-97
10 卢耀军.用阿托伐他汀联合辅酶Q10对冠心病早期心功能减退患者进行治疗的效果研究[J].当代医药论丛,2015,13(22):286-287
11潘海燕,朱健华,顾勇,等.辛伐他汀加辅酶Q10对冠心病心功能改善的价值[J].临床荟萃,2008,2(23):94-97
12 高琳琳.瑞舒伐他汀治疗冠心病早期心功能减退的临床体会[J].中国慢性病预防与控制,2015,8(23):615-618
13 黄慧.瑞舒伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退的效果观察[J].医药前沿,2017,7(13):139-140
14 邵春英.联合应用阿托伐他汀与辅酶Q10治疗冠心病早期心功能减退的疗效[J].中国保健营养,2016,26(30):262-263
15 刘毅.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退疗效观察[J].医学信息,2015,8(28):33
16 刘爽,刘于山.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].中国保健营养,2016,26(27):257-258
17 范波.阿托伐他汀、辅酶Q10联合应用治疗122例冠心病早期心功能减退的临床有效性[J].医药前沿2016,6(22):87-88
18 王洪安.阿托伐他汀结合辅酶Q10治疗冠心病早期心功能减退的效果观察[C].北京:2015临床急重症经验交流第二次高峰论坛,2015
19 程志乾,董立新.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].健康导报,2015,7(20):5-6
20 中华医学会心血管病学分会,中华心血管病杂志编委会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,5(43):380-393
21 Taylor F,Huffman MD,Macedo AF,et al.Statins for the primary prevention of cardiovascular disease[J].Cochrane Database Systematic Reviews,2013,1:CD004816
22 Suzuki T,Nozawa T,Sobajima M,et al.Atorvastatin-induced changes in plasma coenzyme Q1 0and brain natriuretic peptide in patients with coronary artery disease[J].International Heart Journal,2008,49(4):423-433
23 巴艺洁,杨苗,孙毅,等.辅酶Q10辅助治疗心力衰竭有效性的Meta分析[J].中国循证医学杂志,2016,16(3):311-318
24 Jerzy J,Katarzyna K,Artur C,et al.Coenzyme Q10-A new player in the treatment of heart failure?[J]Pharmacological Reports,2016,5(68):1015-1019
2 Banach M,Serban C,Sahebkar A,et al.Effects of coenzyme Q10on statin-induced myopathy:a meta-analysis of randomized controlled trials[J].Mayo Clinic Proceedings,2015,90(1):24-34
3 Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.3.0[EB/OL].(2011-03)[2017-11-30]http://www.cochrane-handbook.org
4 刘涛,李论,郭张强,等.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].山东医药,2014,39(54):55-57
5 史凤.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].中西医结合心血管病杂志,2015,26(3):105-106
6 陈捷,章瑾瑜,陆建洪,等.阿托伐他汀、辅酶Q10联合治疗冠心病早期心功能减退患者的临床研究[J].心脑血管病防治,2017,2(17):152-154
7 王文荣,裴彦祯,高静茹,等.阿托伐他汀联合辅酶Q10在改善冠心病早期心功能减退病人心功能中的作用[J].中西医结合心血管病杂志,2016,6(14):625-627
8 闫松改.阿托伐他汀联合辅酶Q10对冠心病患者心功能的改善[J].临床医学,2010,4(30):66-68
9 徐强.阿托伐他汀联合辅酶Q10治疗冠心病早期心功能减退35例临床观察[J].中国民族民间医药,2016,4(25):95-97
10 卢耀军.用阿托伐他汀联合辅酶Q10对冠心病早期心功能减退患者进行治疗的效果研究[J].当代医药论丛,2015,13(22):286-287
11潘海燕,朱健华,顾勇,等.辛伐他汀加辅酶Q10对冠心病心功能改善的价值[J].临床荟萃,2008,2(23):94-97
12 高琳琳.瑞舒伐他汀治疗冠心病早期心功能减退的临床体会[J].中国慢性病预防与控制,2015,8(23):615-618
13 黄慧.瑞舒伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退的效果观察[J].医药前沿,2017,7(13):139-140
14 邵春英.联合应用阿托伐他汀与辅酶Q10治疗冠心病早期心功能减退的疗效[J].中国保健营养,2016,26(30):262-263
15 刘毅.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退疗效观察[J].医学信息,2015,8(28):33
16 刘爽,刘于山.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].中国保健营养,2016,26(27):257-258
17 范波.阿托伐他汀、辅酶Q10联合应用治疗122例冠心病早期心功能减退的临床有效性[J].医药前沿2016,6(22):87-88
18 王洪安.阿托伐他汀结合辅酶Q10治疗冠心病早期心功能减退的效果观察[C].北京:2015临床急重症经验交流第二次高峰论坛,2015
19 程志乾,董立新.阿托伐他汀、辅酶Q10联合应用治疗冠心病早期心功能减退[J].健康导报,2015,7(20):5-6
20 中华医学会心血管病学分会,中华心血管病杂志编委会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,5(43):380-393
21 Taylor F,Huffman MD,Macedo AF,et al.Statins for the primary prevention of cardiovascular disease[J].Cochrane Database Systematic Reviews,2013,1:CD004816
22 Suzuki T,Nozawa T,Sobajima M,et al.Atorvastatin-induced changes in plasma coenzyme Q1 0and brain natriuretic peptide in patients with coronary artery disease[J].International Heart Journal,2008,49(4):423-433
23 巴艺洁,杨苗,孙毅,等.辅酶Q10辅助治疗心力衰竭有效性的Meta分析[J].中国循证医学杂志,2016,16(3):311-318
24 Jerzy J,Katarzyna K,Artur C,et al.Coenzyme Q10-A new player in the treatment of heart failure?[J]Pharmacological Reports,2016,5(68):1015-1019