熊去氧胆酸联合中药治疗非酒精性脂肪肝病临床疗效的系统评价  

A Meta-analysis of Ursodeoxycholic Acid Combined with Traditional Chinese Medicine in the Clinical Treatment of Nonalcoholic Fatty Liver Disease

作　　者：武鹏 李欣语 付裕 臧凌鹤 李良 刘东春[1] WU Peng;LI Xinyu;FU Yu;ZANG Linghe;LI Liang;LIU Dongchun(College of Traditional Chinese Pharmacy,Shenyang Pharmaceutical University,Shenyang 110016,China;School of Life Sciences and Biopharmaceuticals,Shenyang Pharmaceutical University,Shenyang 110016,China;Jiangsu Kanion Pharmaceutical Co.,Ltd.,National Key Laboratory of Pharmaceutical Process Control and Intelligent Manufacturing Technology of Traditional Chinese Medicine,Lianyungang 222047,China)

机构地区：[1]沈阳药科大学中药学院,辽宁沈阳110016 [2]沈阳药科大学生命科学与生物制药学院,辽宁沈阳110016 [3]江苏康缘药业股份有限公司,中药制药过程控制与智能制造技术全国重点实验室,江苏连云港222047

出　　处：《现代中药研究与实践》2024年第2期74-82,共9页Research and Practice on Chinese Medicines

基　　金：国家重点研发计划课题(2022YFE0111600);中国医药教育协会重大科学攻关项目(2022KTZ014);中药制药过程新技术国家重点实验室开放基金(SKL2020Z0207)

摘　　要：目的系统评价熊去氧胆酸(UDCA)联合中药治疗非酒精性脂肪性肝病(NAFLD)的疗效和安全性,并探讨其联用机制。方法从PubMed、The Cochrane Library、Web of Science、CNKI、Wanfang Data电子数据库中检索建库之日到2023年4月关于UDCA联合中药复方或中成药治疗NAFLD的临床随机对照试验(RCT)的文献,利用RevMan 5.4进行Meta分析,并通过对联用的复方中代表性中药单体活性成分及中成药的主要成分进行归纳。结果共纳入10项RCT,分析结果显示,临床有效率[OR=3.40,95%Cl(2.46,4.70),P<0.00001],肝功能指标(AST、ALT、GGT、TBiL)分别为-23.50(-31.32,-15.68,P<0.00001),-27.67(-35.21,-20.13,P<0.00001),-6.85(17.93,4.22,P<0.00001),-3.74(-5.00,-2.49,P<0.00001),血脂水平(TG、TC、HDL-C、LDL-C)分别为-0.56(-0.76,-0.37,P<0.00001),-1.32(-1.63,-1.02,P<0.00001),0.52(0.42,0.62,P<0.00001),-0.49(-0.89,-0.09,P=0.02)。联用的中药包括:柴胡、黄芪、白术、丹参、三七、姜黄、山楂、荷叶、泽泻、甘草等,协同增效的可能机制、作用靶点及通路涉及改善氧化应激、抑制炎症、调节肠道菌群、调节脂肪酸代谢等。结论UDCA与中药联用比单用UDCA对NAFLD治疗效果更佳,尤其在改善患者肝功能及血脂水平方面具有优势。Objective To systematically evaluate the efficacy and safety of ursodeoxycholic acid(UDCA)combined with traditional Chinese medicine in the treatment of non-alcoholic fatty liver disease(NAFLD),and discuss its mechanism.Methods From the date of establishment of ScienceDirect,PubMed,The Cochrane Library,Web of Science,CNKI and Wanfang Data electronic databases to April 2023,the literature associated with clinical randomized controlled trials(RCTs)of UDCA combined with traditional Chinese medicine or proprietary Chinese medicine for the treatment of NAFLD was searched,then using RevMan 5.4 for meta-analysis.And summarizing the representative active components of Chinese medicine monomer and the main components of traditional Chinese patent medicines and simple preparations in the combined compound.Results 10 RCTs were included and the results of showed clinical response[OR=3.40,95%Cl(2.46,4.70),P<0.00001],liver function measures(AST,ALT,GGT,TBiL)were-23.50(-31.32,-15.68,P<0.00001),-27.67(-35.21,-20.13,P<0.00001),-6.85(17.93,4.22,P<0.00001),-3.74(-5.00,-2.49,P<0.00001),lipid levels(TG,TC,HDL-C,LDL-C)were-0.56(-0.76,-0.37,P<0.00001),-1.32(-1.63,-1.02,P<0.00001),0.52(0.42,0.62,P<0.00001),-0.49(-0.89,-0.09,P=0.02).The combination of traditional Chinese medicine includes:Bupleurum chinense DC.,Astragalus membranaceus(Fisch.)Bge.,Atractylodes macrocephala Koidz.,Salvia miltiorrhiza Bge.,Panax notoginseng(Burk.)F.H.Chen,Curcuma longa L.,Crataegus pinnatifida Bge.,Nelumbo nucifera Gaertn.,Alisma orientale(Sam.)Juzep.,Glycyrrhiza uralensis Fisch.,etc.The possible mechanisms,targets,and pathways of synergistic enhancement involve improving oxidative stress,inhibiting inflammation,regulating intestinal flora,and regulating fatty acid metabolism,etc.Conclusion The combination of UDCA and traditional Chinese medicine has a better effect on the treatment of NAFLD than UDCA alone,especially in improving liver function and blood lipid levels.

关 键 词：熊去氧胆酸 中药 非酒精性脂肪性肝病 非酒精性脂肪肝炎 META分析 

分 类 号：R917[医药卫生—药物分析学]