Dai Yun-Kai, Fan Hai-Na, Hu Yong-Hong, Zhao Zhi-Min, Liu Chenghai
Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China.
Front Pharmacol. 2022 Aug 10;13:943063. doi: 10.3389/fphar.2022.943063. eCollection 2022.
Although different kinds of traditional Chinese medicines could reportedly improve the efficacy of antiviral therapy on liver fibrosis caused by HBV, the problem of clinicians on how to choose the appropriate treatment strategies for the patients fails to be solved. This study aims at comparing and ranking different traditional Chinese medicine (TCM) therapies in the treatment of liver fibrosis due to chronic hepatitis B (CHB). Eight electronic databases were searched from their establishment to 17 Aug 2021. All included data and pooled odds ratio were used for network meta-analysis (NMA) and statistical analysis. The consistency was evaluated by the node-splitting analysis. The stability of results and source of heterogeneity were tested by sensitivity analysis. Different treatment strategies (regimens) in this network meta-analysis were ranked with the aid of surface under the cumulative ranking curve (SUCRA) probability value. A total of 29 articles with 3,106 sufferers were recruited in this NMA. Results of SUCRA value rankings indicated that Fuzheng Huayu therapy or combined with entecavir had preferable effects in improving the clinical efficacy, recovering the level of hyaluronic acid, IV-C, ALT, ALB, and TBil, relieving the TCM symptoms including hypochondriac pain and poor appetite, regaining the width of portal vein and thickness of spleen, and lessening side effects. Apart from these, Ziyin Shugan therapy or combined with ETV could also be suitable to regain the level of laminin, PC-III, and AST, relieve fatigue and HBV-DNA conversion. This NMA confirmed the efficacy and safety of different treatment therapies for improving CHB liver fibrosis, including the serum biomarkers of live fibrosis and serum parameters for liver function, TCM symptoms, imaging indexes, HBV-DNA conversion rate, which offered the TCM practitioners crucial reference value on clinical medication.
据报道，尽管不同种类的中药可以提高抗乙肝病毒治疗对肝纤维化的疗效，但临床医生如何为患者选择合适治疗策略的问题仍未得到解决。本研究旨在比较并排序不同的中医治疗方法在慢性乙型肝炎（CHB）所致肝纤维化治疗中的效果。检索了8个电子数据库，检索时间从建库至2021年8月17日。所有纳入的数据和合并比值比用于网状Meta分析（NMA）和统计分析。通过节点拆分分析评估一致性。通过敏感性分析检验结果的稳定性和异质性来源。借助累积排序曲线下面积（SUCRA）概率值对该网状Meta分析中的不同治疗策略（方案）进行排序。本NMA共纳入29篇文章，涉及3106例患者。SUCRA值排序结果表明，扶正化瘀疗法或联合恩替卡韦在提高临床疗效、恢复透明质酸、IV型胶原、谷丙转氨酶、白蛋白和总胆红素水平、缓解胁肋疼痛和食欲不振等中医症状、恢复门静脉宽度和脾脏厚度以及减轻副作用方面效果较好。除此之外，滋阴疏肝疗法或联合恩替卡韦也适合恢复层粘连蛋白、III型前胶原和谷草转氨酶水平、缓解乏力以及实现乙肝病毒脱氧核糖核酸（HBV-DNA）转阴。本NMA证实了不同治疗方法在改善CHB肝纤维化方面的疗效和安全性，包括肝纤维化血清生物标志物、肝功能血清参数、中医症状、影像学指标、HBV-DNA转阴率等，为中医临床用药提供了关键的参考价值。
