Jalali Mohammad, Rahimlou Mehran, Mahmoodi Marzieh, Moosavian Seyedeh Parisa, Symonds Michael E, Jalali Ronak, Zare Morteza, Imanieh Mohammad Hadi, Stasi Cristina
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Pharmacol Res. 2020 Sep;159:104799. doi: 10.1016/j.phrs.2020.104799. Epub 2020 Apr 8.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. One treatment is the use of metformin but its efficacy remains to be established.
The present systematic review and meta-analysis aimed to provide a more robust examination of the evidence for the effectiveness of metformin for treating non-diabetic NAFLD patients.
An extensive literature search was undertaken using online databases (PubMed, Embase, Scopus, Web of Science and Cochrane Library) to detect randomized controlled trials (RCTs) investigating the effect of metformin administration on liver enzymes and body composition in non-diabetic NAFLD patients up to 10 December 2019. A random-effects or fixed-effect models were performed to pool weighted mean difference (WMD) and 95% confidence intervals (CI).
Six RCTs involving 307 individuals were included to the present meta-analysis. Compared to controls, metformin significantly reduced body mass index (BMI) (WMD: -0.77 kg/m, 95 % CI = [-1.46, -0.07], P = 0.03, I = 0.0 %) and serum aspartate aminotransferase (AST) (WMD: -5.94 U/L, 95 % CI = [-11.51, -0.38], P = 0.03, I = 67.6 %). Also, body weight (WMD: -2.70 kg, 95 % CI = [-5.49, 0.09], P = 0.05, I = 33.7%) was marginally significant and serum alanine transaminase (ALT) (WMD: -5.04 U/L, 95 % CI = [-13.92, 3.84], P = 0.26, I = 60.9 %) was not statistically significant affected by metformin administration. There was no evidence of publication bias.
In summary, the present study emphasizes the clinical importance of metformin administration for improving liver function and body composition in non-diabetic NAFLD patients. Moreover, the further large-scale and well-designed RCTs are required to confirm these findings.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病。一种治疗方法是使用二甲双胍，但其疗效仍有待确定。
本系统评价和荟萃分析旨在更全面地审视二甲双胍治疗非糖尿病NAFLD患者有效性的证据。
通过在线数据库（PubMed、Embase、Scopus、Web of Science和Cochrane图书馆）进行广泛的文献检索，以查找截至2019年12月10日调查二甲双胍给药对非糖尿病NAFLD患者肝酶和身体成分影响的随机对照试验（RCT）。采用随机效应或固定效应模型汇总加权平均差（WMD）和95%置信区间（CI）。
本荟萃分析纳入了6项涉及307名个体的RCT。与对照组相比，二甲双胍显著降低了体重指数（BMI）（WMD：-0.77kg/m，95%CI=[-1.46，-0.07]，P=0.03，I²=0.0%）和血清天冬氨酸转氨酶（AST）（WMD：-5.94U/L，95%CI=[-11.51，-0.38]，P=0.03，I²=67.6%）。此外，体重（WMD：-2.70kg，95%CI=[-5.49，0.09]，P=0.05，I²=33.7%）有边缘显著性，血清丙氨酸转氨酶（ALT）（WMD：-5.04U/L，95%CI=[-13.92，3.84]，P=0.26，I²=60.9%）受二甲双胍给药影响无统计学显著性。没有发表偏倚的证据。
总之，本研究强调了二甲双胍给药对改善非糖尿病NAFLD患者肝功能和身体成分的临床重要性。此外，需要进一步开展大规模、设计良好的RCT来证实这些发现。
