de Frutos Fernando, Gea Alfredo, Hernandez-Estefania Rafael, Rabago Gregorio
Department of Cardiovascular Surgery, Clinica-University of Navarra, Pamplona, Spain
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):254-9. doi: 10.1093/icvts/ivu334. Epub 2014 Oct 24.
Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. We searched the PubMed Database using the following keywords: Coenzyme Q10, ubiquinone, ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were systematically retrieved, selected, assessed and summarized for this review. We performed separate meta-analyses for different outcomes (inotropic drug requirements after surgery, incidence of ventricular arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and hospital stay), estimating pooled odds ratios (ORs) or mean differences of the association of CoQ10 administration with the risk of these outcomes. Eight clinical trials met our inclusion criteria. Patients with CoQ10 treatment were significantly less likely to require inotropic drugs after surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to develop ventricular arrhythmias after surgery [OR (95% CI) 0.05 (0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better quality randomized, controlled trials are needed to clarify the role of CoQ10 in patients undergoing cardiac surgery with cardiopulmonary bypass.
辅酶Q10（CoQ10）是一种脂溶性抗氧化剂，可能对接受体外循环心脏手术的患者有益。目前尚无关于其临床效果的确切证据，也未发表过系统评价。我们旨在对文献进行系统评价和荟萃分析，以阐明辅酶Q10在预防接受体外循环心脏手术患者并发症中的作用。我们使用以下关键词在PubMed数据库中进行搜索：辅酶Q10、泛醌、泛醇、CoQ10、心脏手术、心脏外科手术。为本次评价系统检索、筛选、评估和总结文章。我们针对不同结局（术后血管活性药物需求、室性心律失常和心房颤动发生率、术后24小时心脏指数和住院时间）进行了单独的荟萃分析，估计辅酶Q10给药与这些结局风险关联的合并比值比（OR）或平均差异。八项临床试验符合我们的纳入标准。接受辅酶Q10治疗的患者术后需要血管活性药物的可能性显著降低{OR [95%置信区间（CI）0.47（0.27 - 0.81）]}，术后发生室性心律失常的可能性也显著降低[OR（95% CI）0.05（0.01 - 0.31）]。然而，辅酶Q10治疗与术后24小时心脏指数[平均差异（95% CI）0.06（-0.30至0.43）]、住院时间（天）[平均差异（95% CI）-0.61（-4.61至3.39）]以及心房颤动发生率[OR（95% CI）1.06（0.19 - 6.04）]无关。由于本评价纳入的临床试验均未报告与辅酶Q10给药相关的任何不良反应，并且在其他研究中已证明辅酶Q10即使在更高剂量下也是安全的，我们得出结论，辅酶Q10应被视为预防接受体外循环心脏手术患者并发症的预防性治疗方法。然而，需要质量更高的随机对照试验来阐明辅酶Q10在接受体外循环心脏手术患者中的作用。
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