Mayer K E, Myers R P, Lee S S
Liver Unit, Department of Medicine, University of Calgary, Calgary, Canada.
J Viral Hepat. 2005 Nov;12(6):559-67. doi: 10.1111/j.1365-2893.2005.00636.x.
Silymarin from the milk thistle herb (Silybum marianum) is used by many patients with chronic viral hepatitis, but its efficacy remains unknown. We performed a systematic review of silymarin for the treatment of chronic viral hepatitis B and C. An exhaustive search strategy identified 148 papers that studied silymarin compounds in liver disease. Of these, four trials included patients with hepatitis C, one included hepatitis B patients, and two, unspecified chronic viral hepatitis. However, only one trial exclusively studied patients with hepatitis C, and none involved patients with only hepatitis B. Silymarin treatment resulted in a decrease in serum transaminases compared with baseline in four studies, and compared with placebo in only one study. There is no evidence that silymarin affects viral load or improves liver histology in hepatitis B or C. No studies were found that investigated the use of silymarin concomitantly with interferon, nucleoside analogues, or other conventional treatments for hepatitis B or C. In conclusion, silymarin compounds likely decrease serum transaminases in patients with chronic viral hepatitis, but do not appear to affect viral load or liver histology. Nevertheless it may be worthwhile to determine its effects in conjunction with standard antiviral treatment.
许多慢性病毒性肝炎患者使用水飞蓟草（水飞蓟）中的水飞蓟素，但疗效尚不清楚。我们对水飞蓟素治疗慢性乙型和丙型病毒性肝炎进行了系统评价。详尽的检索策略确定了148篇研究水飞蓟素化合物在肝脏疾病中应用的论文。其中，四项试验纳入了丙型肝炎患者，一项纳入了乙型肝炎患者，两项纳入了未明确的慢性病毒性肝炎患者。然而，只有一项试验专门研究了丙型肝炎患者，没有一项试验只涉及乙型肝炎患者。在四项研究中，与基线相比，水飞蓟素治疗使血清转氨酶降低，而与安慰剂相比，仅在一项研究中出现这种情况。没有证据表明水飞蓟素会影响乙型或丙型肝炎的病毒载量或改善肝脏组织学。未发现有研究调查水飞蓟素与干扰素、核苷类似物或其他治疗乙型或丙型肝炎的传统疗法联合使用的情况。总之，水飞蓟素化合物可能会降低慢性病毒性肝炎患者的血清转氨酶，但似乎不会影响病毒载量或肝脏组织学。不过，确定其与标准抗病毒治疗联合使用的效果可能是值得的。
