Milosević Natasa, Milanović Maja, Abenavoli Ludovico, Milić Natasa
Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia.
Rev Recent Clin Trials. 2014;9(3):195-203.
Non-alcoholic fatty liver disease (NAFLD) is a global problem and one of the most common liver diseases in the world. Various pharmacological and non-pharmacological therapies seem to be non-effective and the patients are often advised not to expect a positive outcome. Hence, even in the modern Western society many patients reach for traditional herbal products. Silymarin, a lipophilic extract derived from milk thistle (Silybum marianum) has been used in liver and bile disorders for centuries. Strong antifibrotic, antioxidant, antiviral and anti-inflammatory activities of silymarin joined with its metabolic effect proven in vitro make it ideal as a drug candidate in the therapy of NAFLD. Several recent randomized clinical studies have demonstrated that silymarin versus placebo significantly contributes to amelioration of the liver condition affected by NAFLD since it reduces steatosis severity, liver ballooning and fibrosis, followed by lowered aminotransferase levels in both short and long lasting therapies. Silymarin is also as efficient as an insulin sensitizer in the NAFLD therapy, but with less adverse effects. Phase III clinical trials have confirmed silymarin to be currently the best medication for the NAFLD patients, but the problems associated with its standardization, formulation and dosage are yet to be solved. However, green tea (Camellia sinensis) and licorice (Glycyrrhiza glabra) root extracts have also been studied in the clinical trials in the therapy of NAFLD patients. Some other herbal products, which have been tested on animals and have the potential to be used in clinical trials, are briefly summarized in this paper.
非酒精性脂肪性肝病（NAFLD）是一个全球性问题，也是世界上最常见的肝脏疾病之一。各种药物和非药物疗法似乎都无效，患者通常被告知不要期望有积极的结果。因此，即使在现代西方社会，许多患者也会选择传统草药产品。水飞蓟素是从水飞蓟（Silybum marianum）中提取的亲脂性提取物，几个世纪以来一直用于治疗肝脏和胆汁疾病。水飞蓟素具有强大的抗纤维化、抗氧化、抗病毒和抗炎活性，以及在体外得到证实的代谢作用，使其成为治疗NAFLD的理想候选药物。最近的几项随机临床研究表明，与安慰剂相比，水飞蓟素能显著改善受NAFLD影响的肝脏状况，因为它能降低脂肪变性的严重程度、减轻肝脏气球样变和纤维化，随后在短期和长期治疗中都能降低转氨酶水平。在NAFLD治疗中，水飞蓟素的效果与胰岛素增敏剂相当，但副作用较少。III期临床试验已证实水飞蓟素是目前治疗NAFLD患者的最佳药物，但其标准化、制剂和剂量方面的问题仍有待解决。然而，绿茶（Camellia sinensis）和甘草（Glycyrrhiza glabra）根提取物也已在NAFLD患者治疗的临床试验中进行了研究。本文简要总结了其他一些已在动物身上进行测试并有可能用于临床试验的草药产品。
