Systematic Evaluation and Meta-analysis of Chinese Medicine Combined with Silymarin in Treatment of NAFLD
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＜0.000 01],1 month＜treatment course ≤2 months[OR=5.90,Z value=5.03,P＜0.000 01],2 months＜treatment course ≤3 months[OR=4.59,Z value=7.62,P＜0.000 01],treatment course ≤6 months[OR=3.05,Z value=3.5,P＜0.000 01];combined administration of traditional Chinese medicine within the test group[OR=3.88,Z-value=9.62,P＜0.000 01],combined administration of traditional Chinese medicine orally and externally[OR=7.82,Z-value=5.23,P＜0.000 01];the test group was administered in combination with granules[OR=3.95,Z-value=7.53,P＜0.000 01];the test group was administered with traditional Chinese patent medicines and simple preparations[OR=3.28,Z-value=4.36,P＜0.000 01],CPD[OR=4.92,Z-value=4.2,P＜0.000 01];EC[OR=3.1,Z-value=4.58,P＜0.000 01],CC[OR=5.33,Z-value=5.65,P＜0.000 01],SC[OR=5.82,Z-value=4.54,P＜0.000 01],NW[OR=4.04,Z-value=5.88,P＜0.000 01],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)],liver controlled attenuation parameter(CAP),TCM score,and inflammatory indicators[inter-leukin-6(IL-6),tumor necrosis factor-α(TNF-α)].There was no statistically significant difference in fasting blood glu-cose(FBG)or ALT(MD=10.88,95％CI:8.94～12.82,P＜0.000 01),AST(MD=10.44,95％CI:8.35～12.53,P＜0.000 01),r-GT(MD=12.69,95％CI:9.17～16.21,P＜0.000 01),TG(MD=0.45,95％CI:0.35～0.56,P＜0.000 01),TC(MD=0.79,95％CI:0.44～1.13,P＜0.000 01),LDL-C(MD=0.78,95％CI:0.43～1.13,P＜0.000 01),HDL-C(MD=-0.27,95％CI:-0.30～-0.24,P＜0.000 01),CAP(MD=29.13,95％CI:22.72～35.53,P＜0.000 01),TCM score(MD=4.95,95％CI:3.43～6.46,P＜0.000 01),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)and FBG(MD=0.2,95％CI:O.01～0.39,P=0.04).Con-clusion Chinese medicine combined with silymarin was effective in the treatment of NAFLD,improving clinical symptoms and some laboratory indices without significant adverse effects.In addition,it is necessary to combine multiple omics,iron death and gut microbiota to explore the NAFLD's observation indicators,standardize traditional Chinese medicine diagnosis and inclusion criteria,and conduct more high-quality clinical experiments to verify.
non-alcoholic fatty liver diseasetraditional Chinese medicinesilymarinmeta analysis
NETL
NSTL
万方数据
