Liu Jianping, Manheimer Eric, Tsutani Kiichiro, Gluud Christian
The Cochrane Hepatobiliary Group, Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark.
Am J Gastroenterol. 2003 Mar;98(3):538-44. doi: 10.1111/j.1572-0241.2003.07298.x.
The aim of this study was to assess beneficial and harmful effects of medicinal herbs for hepatitis C virus (HCV) infection.
The databases of the Cochrane Collaboration, MEDLINE, EMBASE, and BIOSIS were searched combined with manual searches of five Chinese and one Japanese journals. We included randomized trials comparing medicinal herbs with placebo, no intervention, nonspecific treatment, other herbs, or interferon and/or ribavirin. Trials of herbs with or without other drug(s) were included. Methodological quality of the trials was evaluated by randomization, double blinding, and the Jadad scale.
Thirteen randomized trials (n = 818) evaluated 14 medicinal herbs. Four trials had adequate methodology. Compared with placebo, none of the herbs showed effects on HCV RNA or liver enzyme, except for silybin, which showed a significant reduction of serum AST and gamma-glutamyltranspeptidase levels in one trial. Oxymatrine showed effects on clearance of HCV RNA (relative risk = 9.20, 95% CI = 1.26-67.35) compared with vitamins. The herbal mixture Bing Gan Tang plus interferon-alpha showed better effects on clearance of HCV RNA (relative risk = 2.54, 95% CI = 1.43-4.49) and on normalization of serum ALT (relative risk = 2.54, 95% CI = 1.43-4.49) than interferon-alpha alone. The herbal mixture Yi Zhu decoction showed better effects on clearance of HCV RNA and normalization of ALT compared with glycyrrhizin plus ribavirin. Yi Er Gan Tang showed effects on normalizing serum ALT compared with silymarin plus glucurolactone. The herbs were associated with adverse events.
There is no firm evidence supporting medicinal herbs for HCV infection, and further randomized trials are justified.
本研究旨在评估草药对丙型肝炎病毒（HCV）感染的有益和有害影响。
检索了Cochrane协作网、MEDLINE、EMBASE和BIOSIS数据库，并结合对5种中文期刊和1种日文期刊的手工检索。我们纳入了比较草药与安慰剂、无干预、非特异性治疗、其他草药或干扰素和/或利巴韦林的随机试验。纳入了使用或未使用其他药物的草药试验。通过随机化、双盲法和Jadad量表评估试验的方法学质量。
13项随机试验（n = 818）评估了14种草药。4项试验方法学充分。与安慰剂相比，除水飞蓟宾在一项试验中使血清AST和γ-谷氨酰转肽酶水平显著降低外，其他草药均未显示对HCV RNA或肝酶有影响。与维生素相比，苦参碱对HCV RNA清除有影响（相对危险度= 9.20，95%可信区间= 1.26 - 67.35）。草药合剂丙肝汤加α干扰素在HCV RNA清除（相对危险度= 2.54，95%可信区间= 1.43 - 4.49）和血清ALT正常化（相对危险度= 2.54，95%可信区间= 1.43 - 4.49）方面比单独使用α干扰素效果更好。草药合剂益术汤在HCV RNA清除和ALT正常化方面比甘草酸加利巴韦林效果更好。益二肝汤在血清ALT正常化方面比水飞蓟素加葡萄糖醛酸内酯效果更好。这些草药与不良事件有关。
没有确凿证据支持草药用于HCV感染，进一步的随机试验是合理的。
