中医药联合水飞蓟宾治疗非酒精性脂肪性肝病(NAFLD)系统评价与Meta分析  

Systematic Evaluation and Meta-analysis of Chinese Medicine Combined with Silymarin in Treatment of NAFLD

作　　者：何婷婷[1] 钱涯邻[1] 方南元[2] 孙静云[1] 张丽君 向晓星[1] HE Tingting;QIAN Yalin;FANG Nanyuan;SUN Jingyun;ZHANG Lijun;XIANG Xiaoxing(Subei People's Hospital,Yangzhou 225001,Jiangsu,China;First Clinical College of Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu,China)

机构地区：[1]苏北人民医院,江苏扬州225001 [2]南京中医药大学第一临床医学院,江苏南京210023

出　　处：《实用中医内科杂志》2024年第1期89-95,I0010-I0014,共12页Journal of Practical Traditional Chinese Internal Medicine

基　　金：江苏省中医药科技发展计划项目(MS2021078)。

摘　　要：目的系统评价中医药联合水飞蓟宾胶囊治疗非酒精性脂肪性肝病(NAFLD)患者的有效性及安全性。方法检索CNKI、VIP、万方、CBM、PubMed、Cochrane Library、EMbase、Web of science数据库,检索时间为建库至2022年2月27日,对纳入的文献进行资料提取和质量评价,采用RevMan5.4、prism8.0、Stata17.0软件进行分析与评价。结果最终纳入31项RCTs,2639例患者。结果显示,(1)治疗疗程、给药方式、药物剂型以及地区分布对治疗有效率均有影响,疗程≤1月[OR=3.68,Z值=4.88,P<0.00001],1月<疗程≤2月[OR=5.90,Z值=5.03,P<0.00001],2月<疗程≤3月[OR=4.59,Z值=7.62,P<0.00001],疗程≤6月[OR=3.05,Z值=3.5,P<0.00001];试验组以内服中药联合给药[OR=3.88,Z值=9.62,P<0.00001],以中医药内服外治联合给药[OR=7.82,Z值=5.23,P<0.00001];试验组以水煎剂联合给药[OR=3.95,Z值=7.53,P<0.00001],试验组以颗粒剂联合给药[OR=3.28,Z值=4.36,P<0.00001],试验组以中成药联合给药[OR=4.92,Z值=4.2,P<0.00001];华东[OR=3.1,Z值=4.58,P<0.00001],华中[OR=5.33,Z值=5.65,P<0.00001],华南[OR=5.82,Z值=4.54,P<0.00001],西北[OR=4.04,Z值=5.88,P<0.00001],试验组与对照组比较有差异;(2)实验室指标方面,肝功能(ALT、AST、r-GT)、血脂(TG、TC、LDL-C、HDL-C)、CAP、TCM Score存在统计学差异,炎症指标(IL-6、TNF-α)、FBG无统计学差异,ALT(MD=10.88,95%CI:8.94~12.82,P<0.00001),AST(MD=10.44,95%CI:8.35~12.53,P<0.00001),r-GT(MD=12.69,95%CI:9.17~16.21,P<0.00001),TG(MD=0.45,95%CI:0.35~0.56,P<0.00001),TC(MD=0.79,95%CI:0.44~1.13,P<0.00001),LDL-C(MD=0.78,95%CI:0.43~1.13,P<0.00001),HDL-C(MD=-0.27,95%CI:-0.30~-0.24,P<0.00001),CAP(MD=29.13,95%CI:22.72~35.53,P<0.00001),TCM Score(MD=4.95,95%CI:3.43~6.46,P<0.00001),IL-6(MD=4.52,95%CI:0.87~8.17,P=0.02),TNF-α(MD=5.21,95%CI:-0.03~10.45,P=0.05),FBG(MD=0.2,95%CI:0.01~0.39,P=0.04)。结论中医药联合水飞蓟宾治疗NAFLD疗效显著,能改善临床症状及部分实验室指标,无明显不良反应。另外有必要联合多组学、铁�Objective To systematically evaluate the effectiveness and safety of Chinese medicine combined with silymarin cap-sules in the treatment of patients with non-alcoholic fatty liver disease(NAFLD).Methods CNKI,Vip,Wanfang,CBM,PubMed,Cochrane Library,EMbase and Web of science databases were searched by computer which were conducted from the pe-riod of building to February 27,2022.The data extraction and quality evaluation of the included literature were performed by u-sing RevMan 5.4,prism 8.0 and Stata 17.0 software for analysis and evaluation.Results The final 31 randomized controlled tri-als(RCTs)with 2639 patients were included.(1)Meta-analysis showed that treatment duration,administration mode,drug dos-age form and regional distribution all had an effect on treatment efficiency,treatment course≤1 month[OR=3.68,Z value=4.88,P<0.00001],1 month<treatment course≤2 months[OR=5.90,Z value=5.03,P<0.00001],2 months<treatment course≤3 months[OR=4.59,Z value=7.62,P<0.00001],treatment course≤6 months[OR=3.05,Z value=3.5,P<0.00001];combined administration of traditional Chinese medicine within the test group[OR=3.88,Z-value=9.62,P<0.00001],combined administration of traditional Chinese medicine orally and externally[OR=7.82,Z-value=5.23,P<0.00001];the test group was administered in combination with granules[OR=3.95,Z-value=7.53,P<0.00001];the test group was administered with traditional Chinese patent medicines and simple preparations[OR=3.28,Z-value=4.36,P<0.00001],CPD[OR=4.92,Z-value=4.2,P<0.00001];EC[OR=3.1,Z-value=4.58,P<0.00001],CC[OR=5.33,Z-value=5.65,P<0.00001],SC[OR=5.82,Z-value=4.54,P<0.00001],NW[OR=4.04,Z-value=5.88,P<0.00001],and there were differences between the test group and the control group.(2)There were statistical differences in la-boratory indicators,liver function[alanine aminotransferase(ALT),glutathione aminotransferase(AST),glutamyl transpeptidase(r-GT)],blood lipids[triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)

关 键 词：非酒精性脂肪性肝病 中医药 水飞蓟宾胶囊 META分析 

分 类 号：R256.4[医药卫生—中医内科学]