水飞蓟宾治疗对非酒精性脂肪性肝病患者转氨酶影响的Meta分析
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摘要
目的对水飞蓟宾治疗对非酒精性脂肪性肝病患者转氨酶影响的文献进行Meta分析,探讨水飞蓟宾对脂肪肝患者的护肝作用。方法计算机及手工检索知网、万方、维普网、Sinomed、Pubmed、Medline、Embase、ScienceDirect等数据库,收集关于水飞蓟宾治疗非酒精性脂肪性肝病患者的随机临床对照试验文献,根据纳入排除标准筛选后评价文献质量,并提取数据,采用RevMan 5. 3软件进行Meta分析。结果共纳入8篇文献,共计665例患者,在使用水飞蓟宾治疗8周～3个月后,可明显降低NAFLD患者血清ALT水平[加权均数差(WMD)=-11. 60,95%可信区间(95%CI):-18. 68～-4. 51,P=0. 001]和AST水平[WMD=-11. 56,95%CI:-16. 93～-6. 18,P <0. 001]。结论水飞蓟宾可明确降低非酒精性脂肪性肝病患者血清ALT、AST水平。
Objective To conduct a meta-analysis of the articles on the effect of silibinin on aminotransferases in patients with nonalcoholic fatty liver disease( NAFLD),and to investigate the liver-protecting effect of silibinin in patients with NAFLD. Methods CNKI,Wanfang Data,VIP,SinoMed,PubMed,MEDLINE,Embase,and ScienceDirect were searched for randomized controlled trials( RCTs) on the treatment of NAFLD patients with silibinin,The articles were screened according to inclusion and exclusion criteria,and then quality assessment and data extraction were performed. RevMan 5. 3 was used to perform the meta-analysis. Results A total of 8 articles with 665 patients were included. After 8 weeks to 3 months of silibinin treatment,there were significant reductions in the serum levels of alanine aminotransferase( ALT)( weighted mean difference [WMD]=-11. 60,95% confidence interval [CI]:-18. 68 to-4. 51,P = 0. 001) and aspartate aminotransferase( AST)( WMD =-11. 56,95% CI:-16. 93 to-6. 18,P < 0. 001). Conclusion Silibinin can significantly reduce the serum levels of ALT and AST in patients with NAFLD.
Objective To conduct a meta-analysis of the articles on the effect of silibinin on aminotransferases in patients with nonalcoholic fatty liver disease( NAFLD),and to investigate the liver-protecting effect of silibinin in patients with NAFLD. Methods CNKI,Wanfang Data,VIP,SinoMed,PubMed,MEDLINE,Embase,and ScienceDirect were searched for randomized controlled trials( RCTs) on the treatment of NAFLD patients with silibinin,The articles were screened according to inclusion and exclusion criteria,and then quality assessment and data extraction were performed. RevMan 5. 3 was used to perform the meta-analysis. Results A total of 8 articles with 665 patients were included. After 8 weeks to 3 months of silibinin treatment,there were significant reductions in the serum levels of alanine aminotransferase( ALT)( weighted mean difference [WMD]=-11. 60,95% confidence interval [CI]:-18. 68 to-4. 51,P = 0. 001) and aspartate aminotransferase( AST)( WMD =-11. 56,95% CI:-16. 93 to-6. 18,P < 0. 001). Conclusion Silibinin can significantly reduce the serum levels of ALT and AST in patients with NAFLD.
引文
[1] GEORGE J,ANSTEE Q,RATZIU V,et al. NAFLD:The evolving landscape[J]. J Hepatol,2018,68(2):227-229.
[2] ROSSO C,MEZZABOTTA L,GAGGINI M,et al. Peripheral insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease[J]. Hepatology,2016,63(1):107-116.
[3] CHALASANI N,YOUNOSSI Z,LAVINE JE,et al. The diagnosis and management of nonalcoholic fatty liver disease:Practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology,2018,67(1):328-357.
[4] ZHAO ZH,LIU XL,FAN JG. Research on the natural history of non-alcoholic fatty liver disease should be taken seriously[J]. Chin J Hepatol,2017,25(2):81-84.(in Chinese)赵泽华,刘晓琳,范建高.重视非酒精性脂肪性肝病自然史的研究[J].中华肝脏病杂志,2017,25(2):81-84.
[5] CHAN WK,MUSTAPHA RNR,MAHADEVA S. A randomized trial of silymarin for the treatment of nonalcoholic steatohepatitis[J]. Clin Gastroenterol Hepatol,2017,15(12):1940-1949.
[6] LU XL,DONG L,ZHANG KX,et al. Observation on the therapeutic efficacy of silibinin capsules for patients with fatty liver disease[J]. J Pract Hepatol,2008,11(6):398-400.(in Chinese)鲁晓岚,董蕾,张宽学,等.水飞蓟宾治疗脂肪肝的疗效观察[J].实用肝脏病杂志,2008,11(6):398-400.
[7] MA ZQ. Clinical analysis of silibin-phosphatidylcholine treated the 61 cases alcoholicfattyliver[J]. Pract J Card Cereb Pneumal Vasc Dis,2008,4(16):29-30.(in Chinese)马臻奇.水飞蓟宾-磷脂酰胆碱治疗酒精性脂肪肝61例临床分析[J].实用心脑肺血管病杂志,2008,4(16):29-30.
[8] HAJIAGHAMOHAMMADI AA,ZIAEE A,OVEISI S,et al. Effects of metformin,pioglitazone,and silymarin treatment on non-alcoholic fatty liver disease:A randomized controlled pilot study[J].Hepat Mon,2012,12:e6099.
[9] HASHEMI SJ,HAJIANI E,SARDABI EH. A placebo-controlled trial of silymarin in patients with nonalcoholic fatty liver[J]. Hepat Mon,2009,9:265-270.
[10] HUANG HX. Observation of therapeutic effects of Silibinin Capsules to treat sixty cases of nonalcoholic fatty liver disease[J].China Med Herald,2011,8(7):62-63.(in Chinese)黄红霞.水林佳(水飞蓟宾-磷脂复合物)治疗非酒精性脂肪性肝病60例临床疗效观察[J].中国医药导报,2011,8(7):62-63.
[11] MOHESN M,AMIRMANSOOR R,MOHAMMAD P,et al. Effects of silymarin on reducing liver aminotransferases in patients with nonalcoholic fatty liver diseases[J]. Govaresh,2013,18(3):181-185.
[12] SOLHI H,GHAHREMANI R,KAZEMIFAR AM,et al. Silymarin in treatment of non-alcoholic steatohepatitis:A randomized clinical trial[J]. Caspian J Intern Med,2014,5:9-12.
[13] LI Y. The Clinical efficacy of silibinin and its influence to life quality of NAFLD patients[J]. Inf Tradit Chin Med,2017,34(4):88-91.(in Chinese)李颖.水飞蓟宾治疗非酒精性脂肪性肝病的疗效分析及对患者生存质量影响的研究[J].中医药信息,2017,34(4):88-91.
[14] LI J. Epidemiology characteristics of nonalcoholic fatty liver disease in Asia[J]. J Clin Hepatol,2018,34(12):2515-2519.(in Chinese)李婕.亚洲地区非酒精性脂肪性肝病的流行病学特点[J].临床肝胆病杂志,2018,34(12):2515-2519.
[15] GUO ZQ,WANG QY,QI XS,et al. Recommenda tions for the diagnosis and management of nonalcoholic fatty Liver disease:Practice guidance from the American Association for the Study of Liver Diseases(2017)[J]. J Clin Hepatol,2017,33(12):2275-2277.(in Chinese)郭泽淇,王倩怡,祁兴顺,等.《2017年美国肝病学会非酒精性脂肪性肝病诊疗指导》摘译[J].临床肝胆病杂志,2017,33(12):2275-2277.
[16] VECCHIONE G,GRASSELLI E,VOCI A,et al. Silybin counteracts lipid excess and oxidative stress in cultured steatotic hepatic cells[J]. World J Gastroenterol,2016,22(26):6016-6026.
[17] FENG ZM,CHENG SQ. Effects of silibinin combined with lamivudine treating the liver cirrhosis with active hepatitis B[J].Chin Gen Pract,2007,10(8):659-661.(in Chinese)冯自明,程书权.水飞蓟宾联合拉米夫定治疗慢性乙型肝炎活动性肝硬化疗效分析[J].中国全科医学,2007,10(8):659-661.
[18] LYU CJ,LI H,YANG ZF. Role of lipid metabolism in nonalcoholic fatty hepatopathy[J]. J Log Univ CAPF:Med Sci,2013,22(2):158-160.(in Chinese)吕成娇,李海,杨占福.脂质代谢在非酒精性脂肪性肝病发病机制中的作用研究现状[J].武警后勤学院学报:医学版,2013,22(2):158-160.
[19] LI QQ,ZHOU Q,NIU JQ. New advances in pharmacological mechanism of silymarin and re-investigation of its clinical values[J]. J Clin Hepatol,2015,31(2):315-316.(in Chinese)李青权,周强,牛俊奇,等.水飞蓟素药理机制新进展及临床价值再探讨[J].临床肝胆病杂志,2015,31(2):315-316.
[20] HE XJ,YANG ZY,DU XL,et al. Clinical effect of Atorvastatin Calcium combined with Silibinin in the treatment of non-alcoholic fatty liver disease[J]. China Med Herald,2017,14(14):123-125,130.(in Chinese)贺小军,杨振宇,杜锡林,等.阿托伐他汀钙联合水飞蓟宾治疗非酒精性脂肪肝的临床效果[J].中国医药导报,2017,14(14):123-125,130.
[21] LIANG MX,CAI XH. Current status of pharmacokinetics and clinical study of silibinin-phospholipid complex[J]. Chin J New Drugs,2010,19(19):1778-1780.(in Chinese)梁明欣,蔡雪虹.水飞蓟宾-磷脂复合物的药动学及临床研究现状[J].中国新药杂志,2010,19(19):1778-1780.
[2] ROSSO C,MEZZABOTTA L,GAGGINI M,et al. Peripheral insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease[J]. Hepatology,2016,63(1):107-116.
[3] CHALASANI N,YOUNOSSI Z,LAVINE JE,et al. The diagnosis and management of nonalcoholic fatty liver disease:Practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology,2018,67(1):328-357.
[4] ZHAO ZH,LIU XL,FAN JG. Research on the natural history of non-alcoholic fatty liver disease should be taken seriously[J]. Chin J Hepatol,2017,25(2):81-84.(in Chinese)赵泽华,刘晓琳,范建高.重视非酒精性脂肪性肝病自然史的研究[J].中华肝脏病杂志,2017,25(2):81-84.
[5] CHAN WK,MUSTAPHA RNR,MAHADEVA S. A randomized trial of silymarin for the treatment of nonalcoholic steatohepatitis[J]. Clin Gastroenterol Hepatol,2017,15(12):1940-1949.
[6] LU XL,DONG L,ZHANG KX,et al. Observation on the therapeutic efficacy of silibinin capsules for patients with fatty liver disease[J]. J Pract Hepatol,2008,11(6):398-400.(in Chinese)鲁晓岚,董蕾,张宽学,等.水飞蓟宾治疗脂肪肝的疗效观察[J].实用肝脏病杂志,2008,11(6):398-400.
[7] MA ZQ. Clinical analysis of silibin-phosphatidylcholine treated the 61 cases alcoholicfattyliver[J]. Pract J Card Cereb Pneumal Vasc Dis,2008,4(16):29-30.(in Chinese)马臻奇.水飞蓟宾-磷脂酰胆碱治疗酒精性脂肪肝61例临床分析[J].实用心脑肺血管病杂志,2008,4(16):29-30.
[8] HAJIAGHAMOHAMMADI AA,ZIAEE A,OVEISI S,et al. Effects of metformin,pioglitazone,and silymarin treatment on non-alcoholic fatty liver disease:A randomized controlled pilot study[J].Hepat Mon,2012,12:e6099.
[9] HASHEMI SJ,HAJIANI E,SARDABI EH. A placebo-controlled trial of silymarin in patients with nonalcoholic fatty liver[J]. Hepat Mon,2009,9:265-270.
[10] HUANG HX. Observation of therapeutic effects of Silibinin Capsules to treat sixty cases of nonalcoholic fatty liver disease[J].China Med Herald,2011,8(7):62-63.(in Chinese)黄红霞.水林佳(水飞蓟宾-磷脂复合物)治疗非酒精性脂肪性肝病60例临床疗效观察[J].中国医药导报,2011,8(7):62-63.
[11] MOHESN M,AMIRMANSOOR R,MOHAMMAD P,et al. Effects of silymarin on reducing liver aminotransferases in patients with nonalcoholic fatty liver diseases[J]. Govaresh,2013,18(3):181-185.
[12] SOLHI H,GHAHREMANI R,KAZEMIFAR AM,et al. Silymarin in treatment of non-alcoholic steatohepatitis:A randomized clinical trial[J]. Caspian J Intern Med,2014,5:9-12.
[13] LI Y. The Clinical efficacy of silibinin and its influence to life quality of NAFLD patients[J]. Inf Tradit Chin Med,2017,34(4):88-91.(in Chinese)李颖.水飞蓟宾治疗非酒精性脂肪性肝病的疗效分析及对患者生存质量影响的研究[J].中医药信息,2017,34(4):88-91.
[14] LI J. Epidemiology characteristics of nonalcoholic fatty liver disease in Asia[J]. J Clin Hepatol,2018,34(12):2515-2519.(in Chinese)李婕.亚洲地区非酒精性脂肪性肝病的流行病学特点[J].临床肝胆病杂志,2018,34(12):2515-2519.
[15] GUO ZQ,WANG QY,QI XS,et al. Recommenda tions for the diagnosis and management of nonalcoholic fatty Liver disease:Practice guidance from the American Association for the Study of Liver Diseases(2017)[J]. J Clin Hepatol,2017,33(12):2275-2277.(in Chinese)郭泽淇,王倩怡,祁兴顺,等.《2017年美国肝病学会非酒精性脂肪性肝病诊疗指导》摘译[J].临床肝胆病杂志,2017,33(12):2275-2277.
[16] VECCHIONE G,GRASSELLI E,VOCI A,et al. Silybin counteracts lipid excess and oxidative stress in cultured steatotic hepatic cells[J]. World J Gastroenterol,2016,22(26):6016-6026.
[17] FENG ZM,CHENG SQ. Effects of silibinin combined with lamivudine treating the liver cirrhosis with active hepatitis B[J].Chin Gen Pract,2007,10(8):659-661.(in Chinese)冯自明,程书权.水飞蓟宾联合拉米夫定治疗慢性乙型肝炎活动性肝硬化疗效分析[J].中国全科医学,2007,10(8):659-661.
[18] LYU CJ,LI H,YANG ZF. Role of lipid metabolism in nonalcoholic fatty hepatopathy[J]. J Log Univ CAPF:Med Sci,2013,22(2):158-160.(in Chinese)吕成娇,李海,杨占福.脂质代谢在非酒精性脂肪性肝病发病机制中的作用研究现状[J].武警后勤学院学报:医学版,2013,22(2):158-160.
[19] LI QQ,ZHOU Q,NIU JQ. New advances in pharmacological mechanism of silymarin and re-investigation of its clinical values[J]. J Clin Hepatol,2015,31(2):315-316.(in Chinese)李青权,周强,牛俊奇,等.水飞蓟素药理机制新进展及临床价值再探讨[J].临床肝胆病杂志,2015,31(2):315-316.
[20] HE XJ,YANG ZY,DU XL,et al. Clinical effect of Atorvastatin Calcium combined with Silibinin in the treatment of non-alcoholic fatty liver disease[J]. China Med Herald,2017,14(14):123-125,130.(in Chinese)贺小军,杨振宇,杜锡林,等.阿托伐他汀钙联合水飞蓟宾治疗非酒精性脂肪肝的临床效果[J].中国医药导报,2017,14(14):123-125,130.
[21] LIANG MX,CAI XH. Current status of pharmacokinetics and clinical study of silibinin-phospholipid complex[J]. Chin J New Drugs,2010,19(19):1778-1780.(in Chinese)梁明欣,蔡雪虹.水飞蓟宾-磷脂复合物的药动学及临床研究现状[J].中国新药杂志,2010,19(19):1778-1780.