Saller Reinhard, Brignoli Reto, Melzer Jörg, Meier Rémy
Institute of Complementary Medicine, Department of Internal Medicine, University Hospital Zurich, Switzerland.
Forsch Komplementmed. 2008 Feb;15(1):9-20. doi: 10.1159/000113648.
The potential benefit of silymarin (special extract from the fruits of Silybum marianum) in the treatment of liver diseases remains a controversial issue.
For this systematic review electronic databases identified 65 papers for the search terms silymarin, silibinin, silicristin or milk thistle and clinical trial. Only 19 complied with the criteria'double-' or 'single-blind'. These publications were analysed from a clinical point of view and meta-analytic calculations were performed.
The clinical evidence ofa therapeutic effect of silymarin in toxic liver diseases is scarce. There is no evidence of a favourable influence on the evolution of viral hepatitis, particularly hepatitis C. In alcoholic liver disease, comparing with placebo, aspartate aminotransferase was reduced in the silymarin-treated groups (p = 0.01) while alkaline phosphatase was not. In liver cirrhosis, mostly alcoholic, total mortality was 16.1% with silymarin vs. 20.5% with placebo (n.s.); liver-related mortality was 10.0% with silymarin vs. 17.3% with placebo(p = 0.01).
Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child 'A') liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome.
水飞蓟素（水飞蓟果实的特殊提取物）在肝病治疗中的潜在益处仍是一个有争议的问题。
在本次系统评价中，电子数据库通过搜索词“水飞蓟素”“水飞蓟宾”“水飞蓟亭”或“水飞蓟”以及“临床试验”，共识别出65篇论文。只有19篇符合“双盲”或“单盲”标准。从临床角度对这些出版物进行了分析，并进行了荟萃分析计算。
水飞蓟素对中毒性肝病有治疗作用的临床证据不足。没有证据表明其对病毒性肝炎尤其是丙型肝炎的病程有有利影响。在酒精性肝病中，与安慰剂相比，水飞蓟素治疗组的天冬氨酸转氨酶降低（p = 0.01），而碱性磷酸酶没有降低。在肝硬化（主要是酒精性肝硬化）中，水飞蓟素组的总死亡率为16.1%，安慰剂组为20.5%（无统计学差异）；与肝脏相关的死亡率，水飞蓟素组为10.0%，安慰剂组为17.3%（p = 0.01）。
基于现有临床证据可以得出结论——关于可能的风险/潜在益处——在毒蝇伞中毒以及（酒精性和Child A级）肝硬化的治疗中，将水飞蓟素作为辅助药物使用是合理的。一个整合现有证据并探索新潜在用途的连贯研究计划将非常受欢迎。
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