Peng Sihan, Liu Lu, Xie Ziyan, Zhang Xiyu, Xie Chunguang, Ye Sha, Zhang Xiangeng, Liang Xiaoli, Wang Hongyan, Liu Ya
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Pharmacol. 2022 Jun 27;13:863839. doi: 10.3389/fphar.2022.863839. eCollection 2022.
To evaluate the efficacy and safety of Chinese herbal medicine (CHM) for type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD) with current evidence. This study was registered in PROSPERO as CRD42021271488. A literature search was conducted in eight electronic databases from inception to December 2021. The primary outcomes were lipid indices and liver functions, including triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine transaminase (ALT), and aspartate transaminase (AST). Review Manager 5.2 and Stata v14.0 were applied for analysis. The research enrolled 18 RCTs with 1,463 participants. Results showed CHM combined with western medicine (WM) was more effective than WM alone in TG (weighted mean differences (WMD) = -0.35.95% confidence interval (CI) [-0.51, -0.19], < 0.0001), TC (WMD = -0.58.95%CI [-0.80, -0.36], < 0.00001), LDL-C (WMD = -0.37, 95%CI [-0.47, -0.26], < 0.00001), HDL-C (WMD = 0.20, 95%CI [0.10, 0.29], < 0.0001), ALT (WMD = -4.99, 95%CI [-6.64, -3.33], < 0.00001), AST (WMD = -4.76, 95%CI [-6.35, -3.16], < 0.00001), homeostatic model assessment of insulin resistance (WMD = -1.01, 95%CI [-1.22, -0.79], < 0.00001), fasting blood glucose (WMD = -0.87, 95%CI [-1.13, -0.61], < 0.00001), 2-h postprandial glucose (WMD = -1.45.95%CI [-2.00, -0.91], < 0.00001), body mass index (WMD = -0.73.95%CI [-1.35, -0.12], = 0.02), and overall effective rate (risk ratio (RR) = 1.37.95%CI [1.29, 1.46], < 0.00001). The CHM in combination with WM seems to be more beneficial in T2DM with NAFLD patients in improving lipid and glucose metabolism, liver function, and insulin resistance as well as improving overall efficiency and reducing body weight. Given the poor quality of reports from these studies and uncertain evidence, these findings should be interpreted cautiously. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021271488, identifier CRD42021271488.
基于现有证据评估中药治疗2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）的疗效和安全性。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42021271488。从建库至2021年12月，在八个电子数据库中进行了文献检索。主要结局指标为血脂指标和肝功能指标，包括甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、谷丙转氨酶（ALT）和谷草转氨酶（AST）。应用Review Manager 5.2和Stata v14.0进行分析。该研究纳入了18项随机对照试验，共1463名参与者。结果显示，中药联合西药在降低TG（加权均数差（WMD）=-0.35，95%置信区间（CI）[-0.51, -0.19]，P<0.0001））、TC（WMD=-0.58，95%CI[-0.80, -0.36]，P<0.00001）、LDL-C（WMD=-0.37，95%CI[-0.47, -0.26]，P<0.00001）、升高HDL-C（WMD=0.20，95%CI[0.10, 0.29]，P<0.0001）、降低ALT（WMD=-4.99，95%CI[-6.64, -3.33]，P<0.00001）、AST（WMD=-4.76，95%CI[-6.35, -3.16]，P<0.00001）、胰岛素抵抗稳态模型评估（WMD=-1.01，95%CI[-1.22, -0.79]，P<0.00001）、空腹血糖（WMD=-0.87，95%CI[-1.13, -0.61]，P<0.00001）、餐后2小时血糖（WMD=-1.45，95%CI[-2.00, -0.91]，P<0.00001）、体重指数（WMD=-0.73，95%CI[-1.35, -0.12]，P=0.02）以及总有效率（风险比（RR）=1.37，95%CI[1.29, 1.46]）方面均优于单纯西药。中药联合西药似乎对T2DM合并NAFLD患者在改善脂质和糖代谢、肝功能、胰岛素抵抗以及提高总体疗效和减轻体重方面更有益。鉴于这些研究报告质量较差且证据不确凿，对这些结果应谨慎解读。https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021271488，标识符CRD42021271488
