Seeff Leonard B, Curto Teresa M, Szabo Gyongyi, Everson Gregory T, Bonkovsky Herbert L, Dienstag Jules L, Shiffman Mitchell L, Lindsay Karen L, Lok Anna S F, Di Bisceglie Adrian M, Lee William M, Ghany Marc G
Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
Hepatology. 2008 Feb;47(2):605-12. doi: 10.1002/hep.22044.
Herbal products, used for centuries in Far Eastern countries, are gaining popularity in western countries. Surveys indicate that persons with chronic hepatitis C (CHC) often use herbals, especially silymarin (milk thistle extract), hoping to improve the modest response to antiviral therapy and reduce side effects. The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, involving persons with advanced CHC, nonresponders to prior antiviral therapy but still willing to participate in long-term pegylated interferon treatment, offered the opportunity to examine the use and potential effects of silymarin. Among 1145 study participants, 56% had never taken herbals, 21% admitted past use, and 23% were using them at enrollment. Silymarin constituted 72% of 60 herbals used at enrollment. Among all participants, 67% had never used silymarin, 16% used it in the past, and 17% used it at baseline. Silymarin use varied widely among the 10 participating study centers; men were more frequent users than women, as were non-Hispanic whites than African Americans and Hispanics. Silymarin use correlated strongly with higher education. No beneficial effect of silymarin was found on serum alanine aminotransferase or hepatitis C virus (HCV) RNA levels. Univariate analysis showed significantly fewer liver-related symptoms and better quality-of-life parameters in users than nonusers, but after reanalysis adjusted for covariates of age, race, education, alcohol consumption, exercise, body mass index, and smoking, only fatigue, nausea, liver pain, anorexia, muscle and joint pain, and general health remained significantly better in silymarin users. In conclusion, silymarin users had similar alanine aminotransferase and HCV levels to those of nonusers but fewer symptoms and somewhat better quality-of-life indices. Because its use among these HALT-C participants was self-motivated and uncontrolled, however, only a well-designed prospective study can determine whether silymarin provides benefit to persons with chronic hepatitis C.
草药产品在远东国家已使用了几个世纪，目前在西方国家越来越受欢迎。调查表明，慢性丙型肝炎（CHC）患者经常使用草药，尤其是水飞蓟宾（水飞蓟提取物），希望改善对抗病毒治疗的一般反应并减少副作用。丙型肝炎抗病毒长期治疗预防肝硬化（HALT-C）试验涉及晚期CHC患者，这些患者对先前的抗病毒治疗无反应，但仍愿意参加长期聚乙二醇化干扰素治疗，该试验提供了研究水飞蓟宾的使用情况及其潜在效果的机会。在1145名研究参与者中，56%从未服用过草药，21%承认过去服用过，23%在入组时正在使用。水飞蓟宾占入组时使用的60种草药的72%。在所有参与者中，67%从未使用过水飞蓟宾，16%过去使用过，17%在基线时使用。在10个参与研究的中心中，水飞蓟宾的使用情况差异很大；男性比女性更常使用，非西班牙裔白人比非裔美国人和西班牙裔更常使用。水飞蓟宾的使用与高等教育密切相关。未发现水飞蓟宾对血清丙氨酸氨基转移酶或丙型肝炎病毒（HCV）RNA水平有有益影响。单因素分析显示，使用者的肝脏相关症状明显少于非使用者，生活质量参数也更好，但在对年龄、种族、教育程度、饮酒、运动、体重指数和吸烟等协变量进行重新分析调整后，只有疲劳、恶心、肝痛、厌食、肌肉和关节疼痛以及总体健康状况在水飞蓟宾使用者中仍明显更好。总之，水飞蓟宾使用者的丙氨酸氨基转移酶和HCV水平与非使用者相似，但症状较少，生活质量指数略好。然而，由于这些HALT-C参与者使用水飞蓟宾是出于自身动机且未受控制，因此只有精心设计的前瞻性研究才能确定水飞蓟宾是否对慢性丙型肝炎患者有益。
