Suksomboon N, Poolsup N, Juanak N
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand.
J Clin Pharm Ther. 2015 Aug;40(4):413-8. doi: 10.1111/jcpt.12280. Epub 2015 Apr 25.
CoenzymeQ10 (CoQ10 ), or ubiquinone, is an endogenous enzyme cofactor produced by most human cells. It is a potent antioxidant and is necessary for energy production in mitochondria. Diabetes mellitus is a chronic disease with multiple metabolic abnormalities, principally resulting from the inflammation and oxidative stress associated with mitochondrial dysfunctions. Clinical trials of the effects of supplementary CoQ10 on metabolic control in diabetes have reported inconsistent results. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effects of CoQ10 supplementation on glycaemic control, lipid profile and blood pressure in patients with diabetes.
A systematic search was conducted on MEDLINE, The Cochrane Library, CINAHL, NCCAM, Web of Science, Scopus, ClinicalTrials.gov and historical search of reference lists of relevant articles. The bibliographic databases were searched from inception to February 2015. We included randomized, placebo-controlled trials of CoQ10 in diabetes lasting at least 12 weeks. HbA1c or fasting plasma glucose had to be reported. Primary outcome was glycemic control, and secondary outcomes were lipid profile and blood pressure. Treatment effect was estimated with mean difference.
Seven trials were included in the meta-analysis, involving 356 patients. Neither CoQ10 alone nor CoQ10 plus fenofibrate improved glycemic control. In addition, CoQ10, alone or in combination with fenofibrate, did not alter LDL-C, HDL-C and blood pressure. Triglycerides levels were significantly reduced with CoQ10 (mean difference -0·26 mmol/L, 95% CI -0·05 mmol/L to -0·47 mmol/L, P = 0·02) and CoQ10 plus fenofibrate (mean difference -0·72 mmol/L, 95% CI -0·32 mmol/L to -1·12 mmol/L, P = 0·0004). CoQ10 plus fenofibrate also effectively reduced total cholesterol (mean difference: -0·45 mmol/L, 95% CI -0·06 mmol/L to -0·84 mmol/L, P = 0·02).
CoQ10 supplementation has no beneficial effects on glycemic control, lipid profile or blood pressure in patients with diabetes. However, it may reduce triglycerides levels. Due to limited data availability, well-powered and well-designed randomized controlled trials are needed to clearly determine the effect of CoQ10 on metabolic profile in diabetes. Dosage effects should also be explored.
辅酶Q10（CoQ10），即泛醌，是大多数人体细胞产生的一种内源性酶辅因子。它是一种强效抗氧化剂，是线粒体能量产生所必需的。糖尿病是一种具有多种代谢异常的慢性疾病，主要由与线粒体功能障碍相关的炎症和氧化应激引起。关于补充CoQ10对糖尿病代谢控制影响的临床试验报告结果不一致。我们对随机对照试验进行了系统评价和荟萃分析，以评估补充CoQ10对糖尿病患者血糖控制、血脂谱和血压的影响。
在MEDLINE、考克兰图书馆、护理学与健康领域数据库（CINAHL）、补充与替代医学国家中心（NCCAM）、科学引文索引数据库（Web of Science）、Scopus、临床试验.gov以及相关文章参考文献列表的历史搜索中进行系统检索。检索书目数据库的时间范围为建库至2015年2月。我们纳入了持续至少12周的CoQ10治疗糖尿病的随机、安慰剂对照试验。必须报告糖化血红蛋白（HbA1c）或空腹血糖。主要结局是血糖控制，次要结局是血脂谱和血压。用平均差估计治疗效果。
荟萃分析纳入了7项试验，涉及356例患者。单独使用CoQ10或CoQ10联合非诺贝特均未改善血糖控制。此外，单独使用CoQ10或与非诺贝特联合使用均未改变低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和血压。CoQ10（平均差 -0·26 mmol/L，95%置信区间 -0·05 mmol/L至 -0·47 mmol/L，P = 0·02）和CoQ10联合非诺贝特（平均差 -0·72 mmol/L，95%置信区间 -0·32 mmol/L至 -1·12 mmol/L，P = 0·0004）可显著降低甘油三酯水平。CoQ10联合非诺贝特还能有效降低总胆固醇（平均差：-0·45 mmol/L，95%置信区间 -0·06 mmol/L至 -0·84 mmol/L，P = 0·02）。
补充CoQ10对糖尿病患者的血糖控制、血脂谱或血压无有益影响。然而，它可能降低甘油三酯水平。由于数据有限，需要开展样本量充足且设计良好的随机对照试验，以明确CoQ10对糖尿病患者代谢指标的影响。还应探索剂量效应。
