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目的系统评价抗氧化剂辅酶Q10(coenzyme Q10,Co Q10)治疗特发性少弱畸形精子症(idiopathic oligoasthenoteratozoospermia,i OAT)的有效性及安全性。方法计算机检索Pub Med、MEDLINE、EMbase、The Cochrane Library、CBM、CNKI、VIP和Wan Fang Data数据库,搜集Co Q10治疗i OAT的相关随机对照试验(RCT),检索时限均为从建库至2016年5月31日。由2位研究者独立进行文献筛选、资料提取,并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7个RCT,共803例患者。Meta分析结果显示:与对照组相比,Co Q10组可明显提高i OAT患者的精子浓度[MD=3.37,95%CI(0.68,6.05),P=0.01]、a级精子百分率[MD=5.06,95%CI(3.84,6.28),P<0.000 01]、(a+b)级精子百分率[MD=7.72,95%CI(4.19,11.26),P<0.000 1]、正常形态精子百分率[MD=1.89,95%CI(0.63,3.16),P=0.003]和精液中Co Q10的水平[MD=40.02,95%CI(24.73,55.31),P<0.000 01];但不能明显改善血浆性激素水平[FSH:MD=–3.48,95%CI(–5.17,–1.79),P<0.000 1;LH:MD=–3.23,95%CI(–7.55,1.08),P=0.14;T:MD=0.45,95%CI(–3.31,4.20),P=0.82];此外,两组均未出现与药物相关的明显不良反应。结论抗氧化剂Co Q10可明显提高特发性男性不育症患者的精子浓度和精子活力,未见明显不良反应,但由于纳入研究存在较大的偏倚风险,证据强度较低,本研究结论尚需进一步开展设计严格的临床对照试验进行验证。
Objective To evaluate the efficacy and safety of coenzyme Q10 (Co Q10) in the treatment of idiopathic oligoasthenoic acid (OAT). Methods The databases of Pub Med, MEDLINE, EMbase, The Cochrane Library, CBM, CNKI, VIP and Wan Fang Data were searched by computer. The related randomized controlled trials (RCTs) of Co Q10 for treatment of i OAT were collected. May 31st. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias included in the study. Meta-analysis was performed using Rev Man 5.3 software. The results eventually included 7 RCTs, a total of 803 patients. Meta-analysis showed that compared with the control group, Co Q10 group significantly increased the sperm concentration of i OAT patients [MD = 3.37, 95% CI (0.68, 6.05), P = 0.01] , 95% CI (3.84,6.28), P <0.000 01], percentage of sperm of (a + b) grade [MD = 7.72,95% CI 4.19,11.26, P <0.0001] = 1.89, 95% CI (0.63, 3.16), P = 0.003] and the level of Co Q10 in semen [MD = 40.02,95% CI (24.73,55.31), P <0.000 01]; however, LH: MD = -3.23, 95% CI (-7.55, 1.08), P = 0.14; T: MD = 0.45 (FSH: MD = -3.48, 95% CI , 95% CI (-3.31, 4.20), P = 0.82]. In addition, no obvious drug-related adverse reactions occurred in both groups. Conclusions Antioxidant Co Q10 can significantly increase the sperm concentration and sperm motility in idiopathic male infertility patients with no obvious adverse reactions. However, the risk of bias is high due to the risk of bias and the evidence strength is low in this study To further carry out the design of rigorous clinical controlled trials to verify.