Fehér János, Lengyel Gabriella
Semmelweis Egyetem, Altalános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088.
Orv Hetil. 2008 Dec 21;149(51):2413-8. doi: 10.1556/OH.2008.28519.
In the treatment of chronic liver diseases adequate therapy can be chosen only in the knowledge of pathogenetic processes. In the liver diseases caused by oxidative stress (alcoholic and non-alcoholic fatty liver and steatohepatitis, drug and compound induced liver toxicity) the antioxidant drugs, like silymarin, in chronic hepatitis caused by hepatitis B and hepatitis C virus, combined peginterferon and nucleosid treatments are the primary therapy modalities to be selected. The main effects of silymarin are the membrane stabilising and antioxidant effects, it is able to help the liver cell regeneration, it can decrease the inflammatory reaction and inhibit the fibrogenesis in the liver. These results have been established by experimental and clinical trials. According to open studies, the long administration of silymarin significantly increased the survival time of patients with alcohol-induced liver cirrhosis. Recently it was demonstrated that high-dosage silibinin infusion treatment could significantly decrease the number of hepatitis C viruses after four-week application. On the basis of the results with the methods of molecular biology, silymarin is able to decrease significantly tumor cell proliferation, angiogenesis as well as insulin resistance. These results support the administration of silymarin preparations in the therapy of chronic liver diseases, especially in alcoholic and non-alcoholic steatohepatitis in current clinical practice, and as it can be awaited, also in the future. In some neoplastic diseases they could also be administered as adjuvant therapy.
在慢性肝病的治疗中，只有了解致病过程才能选择适当的治疗方法。在由氧化应激引起的肝病（酒精性和非酒精性脂肪性肝病及脂肪性肝炎、药物和化合物诱导的肝毒性）中，抗氧化药物如西利马林是主要的治疗选择；在由乙型肝炎和丙型肝炎病毒引起的慢性肝炎中，聚乙二醇干扰素联合核苷治疗是主要的治疗方式。西利马林的主要作用是膜稳定和抗氧化作用，它能够促进肝细胞再生，减少炎症反应并抑制肝脏纤维化。这些结果已通过实验和临床试验得到证实。根据开放性研究，长期服用西利马林可显著延长酒精性肝硬化患者的生存时间。最近有研究表明，高剂量水飞蓟宾输注治疗四周后可显著减少丙型肝炎病毒数量。基于分子生物学方法的结果，西利马林能够显著降低肿瘤细胞增殖、血管生成以及胰岛素抵抗。这些结果支持在慢性肝病治疗中使用西利马林制剂，尤其是在当前临床实践中的酒精性和非酒精性脂肪性肝炎治疗中，并且可以预期，在未来也会如此。在一些肿瘤疾病中，它们也可作为辅助治疗药物使用。
