十多年来首个显著改善心衰死亡率的药物
2013-05-28 20:07:20   来源：37度医学网   作者：  评论：0 点击：

First Drug to Significantly Improve Heart Failure Mortalityin Over a Decade
10年来显著改善心衰死亡率的首选药物
Coenzyme Q10 decreases all cause mortality byhalf, according to the results of a multicentre randomised double blind trialpresented today at Heart Failure 2013 congress. It is the first drug to improveheart failure mortality in over a decade and should be added to standardtreatment, according to lead author Professor Svend Aage Mortensen (Copenhagen,Denmark).
根据今天在心衰2013会议上公布的多中心随机双盲实验的结果，辅酶Q10减低一半所有原因的死亡率。根据第一作者SvendAage Mortensen教授说：这是近十年来改善心衰死亡率的第一个要，而且可以加入标准治疗中。
Heart Failure 2013 is being held from 25-28May in Lisbon, Portugal. It is the main annual meeting of the Heart FailureAssociation of the European Society of Cardiology (1).
2013年心衰大会，5月25-28日在土耳其里斯本举行。这是欧洲心脏社区的心衰联盟每年最主要的会议。
Coenzyme Q10 (CoQ10) occurs naturally in thebody and is essential to survival. CoQ10 works as an electron carrier in themitochondria, the powerhouse of the cells, to produce energy and is also apowerful antioxidant. It is the only antioxidant that humans synthesise in thebody.
辅酶Q10在身体中自然生成，而且对生存很重要。辅酶Q10在线粒体（细胞的能量产地）中作为电子的携带者，生产能量而且是强抗氧化剂。它也是唯一人类自己身体中能产生的抗氧化剂
CoQ10 levels are decreased in the heart muscleof patients with heart failure, with the deficiency becoming more pronounced asheart failure severity worsens. Statins are used to treat many patients withheart failure because they block the synthesis of cholesterol, but these drugsalso block the synthesis of CoQ10, which further decreases levels in the body.
辅酶Q10水平在心衰患者的心肌中消耗，而且随着其消耗的增大，心衰也更加严重。他汀类因为能封锁胆固醇的合成而被用于治疗心衰患者，但是这些药物同样也封锁了辅酶Q10的合成，这更加速了辅酶Q10在体内的消耗。
Double blind controlled trials have shown thatCoQ10 improves symptoms, functional capacity and quality of life in patientswith heart failure with no side effects. But until now, no trials have beenstatistically powered to address effects on survival.
双盲控制试验表明辅酶Q10改善心衰患者症状，功能及生活质量且没有副作用。但是直到现在，没有试验能在统计学上有力的标明它对生存率的影响。
The Q-SYMBIO study (2) randomised 420 patientswith severe heart failure (New York Heart Association (NYHA) Class III or IV)to CoQ10 or placebo and followed them for 2 years. The primary endpoint wastime to first major adverse cardiovascular event (MACE) which includedunplanned hospitalisation due to worsening of heart failure, cardiovasculardeath, urgent cardiac transplantation and mechanical circulatory support.Participating centres were in Denmark, Sweden, Austria, Slovakia, Poland,Hungary, India, Malaysia and Australia.
这个Q-SYMBIO研究随机抽取420个心衰患者（纽约心脏联盟分级III-IV）给予辅酶Q10或安慰剂，然后随访2年。主要结果是第一次主要不良心血管事件的发生时间，包括没有在计划内的因心衰症状加重而住院、心血管死亡，紧急心脏置换，以及机械循环支持。参加的人群来自丹麦，瑞典，奥地利，斯洛伐克，波兰，匈牙利，印度，马来西亚，澳大利亚。
CoQ10 halved the risk of MACE, with 29 (14%)patients in the CoQ10 group reaching the primary endpoint compared to 55 (25%)patients in the placebo group (hazard ratio=2; p=0.003). CoQ10 also halved therisk of dying from all causes, which occurred in 18 (9%) patients in the CoQ10group compared to 36 (17%) patients in the placebo group (hazard ratio=2.1;p=0.01).
辅酶Q10减半了主要不良心血管事件的风险，29（14%）个辅酶Q10组患者达发生了MACE，相比之下安慰剂组哟55（25%）个患者发生了MACE。辅酶Q10同样减半了患者因各种原因引起的死亡。18个（9%）辅酶Q10组的患者死亡，而安慰剂组则有36个（17%）病人死亡。
CoQ10 treated patients had significantly lowercardiovascular mortality (p=0,02) and lower occurrence of hospitalisations forheart failure (p=0.05). There were fewer adverse events in the CoQ10 groupcompared to the placebo group (p=0.073).
接受辅酶Q10治疗的病人显著降低了心血管死亡率以及降低了需要住院治疗的心衰发生率。不良事件的发生率辅酶Q10组也较安慰组少。
Professor Mortensen said: "CoQ10 is thefirst medication to improve survival in chronic heart failure since ACEinhibitors and beta blockers more than a decade ago and should be added tostandard heart failure therapy."
Mortensen教授说：自从十多年前ACEI和β受体阻滞剂出现后，辅酶Q10是第一个能够改善慢性心衰的生存率的药物，而且应该被增加到心衰的标准治疗中。
He added: "Other heart failuremedications block rather than enhance cellular processes and may have sideeffects. Supplementation with CoQ10, which is a natural and safe substance,corrects a deficiency in the body and blocks the vicious metabolic cycle inchronic heart failure called the energy starved heart."
他补充道：其他种类心衰药物可能有副作用，而不是强化细胞加工。补充辅酶Q10可以纠正机体的缺乏同时在慢性心衰（能量紧缺的心）中封锁错误的代谢圈。
CoQ10 is present in food, including red meat,plants and fish, but levels are insufficient to impact on heart failure. CoQ10is also sold over the counter as a food supplement but Professor Mortensensaid: "Food supplements can influence the effect of other medicationsincluding anticoagulants and patients should seek advice from their doctorbefore taking them."
辅酶Q10在食物中也存在，包括在红肉中，植物及鱼。但是其含量对于影响心衰是不够的。辅酶Q10是同样被作为食物的补充在柜台销售。Mortensen教授说：食物补充品能影响其他药物（包括抗凝剂），患者可以在服用前先听医生的意见。
Patients with ischaemic heart disease who usestatins could also benefit from CoQ10 supplementation. Professor Mortensensaid: "We have no controlled trials demonstrating that statin therapy plusCoQ10 improves mortality more than statins alone. But statins reduce CoQ10, andcirculating CoQ10 prevents the oxidation of LDL effectively, so I thinkischaemic patients should supplement statin therapy with CoQ10."
用他汀类药物的缺血性心脏病患者同样会从辅酶Q10的补充中获利。Mortensen剿说：我们有无对照组的研究说明他汀治疗加上辅酶Q10较单独使用他汀类药物在死亡率的改善上明显更好。但是他汀类药物削弱辅酶Q10并且使辅酶Q10流通防止LDL有效氧化。所以我认为缺血性患者应该在应用他汀类药物治疗同时补充辅酶Q10
References: 1. Heart Failure Congress 2013http://www.escardio.org/congresses/hf2013/Pages/welcome.aspx?hit=nav 2. SA Mortensen, A Kumar, P Dolliner, et al.The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure.Results from the Q-SYMBIO study. Presented at Heart Failure Congress 2013 FinalProgramme Number 440. The full title of the Q-SYMBIO study is: "CoenzymeQ10 as adjunctive treatment of chronic heart failure: a randomised double blindmulticentre trial with focus on changes in symptoms, biomarker status with BNPand long term outcome"

参考文献：

1. 心衰会议：2013http://www.escardio.org/congresses/hf2013/Pages/welcome.aspx?hit=nav

2. SA Mortensen, A Kumar, P Dolliner, et al：在慢性心衰中辅酶Q10对发病率和死亡率的影响。Q-SYMBIO研究中得出结论。在2013年心衰会议中提出。项目号440。Q-SYMBIO研究的题目是：辅酶Q10作为慢性心衰的附属治疗:一个关注于症状改变，生物标记物状态BNP以及长期疗效的随机双盲多中心研究。