辅酶Q10治疗帕金森病临床效果的Meta分析

Efficacy and Safety of Coenzyme Q10 for Parkinson's Disease:A Meta-analysis

目的系统评价辅酶Q10治疗帕金森病的安全性及有效性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2015年1期)、CBM、CNKI、VIP和Wan Fang Data数据库,搜集辅酶Q10治疗帕金森病的相关随机对照试验(RCT),检索时限为建库至2015年8月。由2位研究员独立筛选文献、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。结果最终纳入5个研究,共981例患者,其中辅酶Q10组610例,安慰剂对照组371例。Meta分析结果:1近期疗效方面:辅酶Q10 2 400 mg剂量组治疗前后总UPDRS评分变化[MD=1.09,95%CI(0.94,1.24),P<0.000 01]、UPDRS-Ⅰ评分变化[MD=0.19,95%CI(0.17,0.21),P<0.000 01]、UPDRS-Ⅱ评分变化[MD=0.27,95%CI(0.21,0.32),P<0.000 01]、UPDRS-Ⅲ评分变化[MD=0.65,95%CI(0.54,0.76),P<0.000 01]、Hoehn&Yahr评分变化[MD=0.05,95%CI(0.04,0.06),P<0.000 01]和Schwab英格兰评分变化[MD=–0.87,95%CI(–1.02,–0.72),P<0.000 01]均高于安慰剂组;2长期疗效方面:除辅酶Q101 200 mg亚组UPDRS-Ⅱ评分变化高于安慰剂组外,两组差异无统计学意义。3不良反应方面:除辅酶Q10600 mg亚组胆固醇升高发生率和1 200 mg亚组腹泻发生率低于安慰剂组[OR=0.03,95%CI(0.00,0.87),P=0.04;OR=0.42,95%CI(0.19,0.91),P=0.03]外,两组间不良反应发生率差异均无统计学意义。结论现有证据表明,2 400 mg剂量辅酶Q10对早期帕金森病患者是安全有效的。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of CoenzymeQ10 for Parkinson＇s disease. Methods Databases including PubMed, The Cochrane Library （Issue 1, 2015）, EMbase, CBM, CNKI, WanFang Data and VIP were searched from inception to August 2015, to collect randomized controlled trials （RCTs） about CoenzymeQ10 for Parkinson＇s disease. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 981 patients were included. The results of meta-analysis showed that, a） As for recently effectiveness, CoenzymeQ10 2 400 mg group was superior to the placebo group in total UPDRS score change （MD=I.09, 95%CI 0.94 to 1.24, P〈0.000 01）, UPDRS-I score change （MD=0.19, 95%CI 0.17 to 0.21, P〈0.000 01）, UPDRS-II score change （MD=0.27, 95%CI 0.21 to 0.32, P〈0.000 01）, UPDRS-III score change （MD=0.65, 95%CI 0.54 to 0.76, P〈0.000 01）, Hoehn ＆ Yahr score change （MD=0.05, 95%CI 0.04 to 0.06, P〈0.000 01）, and Schwab England score change （MD= -0.87, 95%CI -1.02 to -0.72, P〈0.000 01）. b） As for long-term effectiveness, there were no differences between two groups, except that the UPDRS-II score change of CoenzymeQ10 1 200 mg group was superior to the placebo group, c） As for adverse reactions, there were no statistical differences between two groups except that the incidence of cholesterol of the CoenzymeQ10 600 mg group and incidence of diarrhea of the CoenzymeQ10 2 400 mg group were lower than that of the placebo group. Conclusion Current evidence shows that, the dosage of 2 400 mg/d CoenzymeQ10 is effective and safe for early Parkinson＇s disease. Due to the limited quality and quantity of included studies, more higher quality studies are needed to verify the above conclusion.