水飞蓟宾在非酒精性脂肪性肝病/非酒精性脂肪性肝炎中的应用：系统评价和荟萃分析。
Administration of silymarin in NAFLD/NASH: A systematic review and meta-analysis.
机构信息
The Second Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou 450000, China.
The First Affiliated Hospital of Henan University of TCM Zhengzhou 450000, China.
出版信息
Ann Hepatol. 2024 Mar-Apr;29(2):101174. doi: 10.1016/j.aohep.2023.101174. Epub 2023 Oct 29.
INTRODUCTION AND OBJECTIVES
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease with a high prevalence worldwide and poses serious harm to human health. There is growing evidence suggesting that the administration of specific supplements or nutrients may slow NAFLD progression. Silymarin is a hepatoprotective extract of milk thistle, but its efficacy in NAFLD remains unclear.
MATERIALS AND METHODS
Relevant studies were searched in PubMed, Embase, the Cochrane Library, Web of Science, clinicaltrails.gov, and China National Knowledge Infrastructure and were screened according to the eligibility criteria. Data were analyzed using Revman 5.3. Continuous values and dichotomous values were pooled using the standard mean difference (SMD) and odds ratio (OR). Heterogeneity was evaluated using the Cochran's Q test (I statistic). A P<0.05 was considered statistically significant.
RESULTS
A total of 26 randomized controlled trials involving 2,375 patients were included in this study. Administration of silymarin significantly reduced the levels of TC (SMD[95%CI]=-0.85[-1.23, -0.47]), TG (SMD[95%CI]=-0.62[-1.14, -0.10]), LDL-C (SMD[95%CI]=-0.81[-1.31, -0.31]), FI (SMD[95%CI]=-0.59[-0.91, -0.28]) and HOMA-IR (SMD[95%CI]=-0.37[-0.77, 0.04]), and increased the level of HDL-C (SMD[95%CI]=0.46[0.03, 0.89]). In addition, silymarin attenuated liver injury as indicated by the decreased levels of ALT (SMD[95%CI]=-12.39[-19.69, -5.08]) and AST (SMD[95% CI]=-10.97[-15.51, -6.43]). The levels of fatty liver index (SMD[95%CI]=-6.64[-10.59, -2.69]) and fatty liver score (SMD[95%CI]=-0.51[-0.69, -0.33]) were also decreased. Liver histology of the intervention group revealed significantly improved hepatic steatosis (OR[95%CI]=3.25[1.80, 5.87]).
CONCLUSIONS
Silymarin can regulate energy metabolism, attenuate liver damage, and improve liver histology in NAFLD patients. However, the effects of silymarin will need to be confirmed by further research.
介绍和目的
非酒精性脂肪性肝病（NAFLD）是一种全球高发的慢性肝病，对人类健康构成严重威胁。越来越多的证据表明，特定补充剂或营养素的管理可能会减缓 NAFLD 的进展。水飞蓟素是奶蓟草的一种保肝提取物，但它在 NAFLD 中的疗效仍不清楚。
材料和方法
在 PubMed、Embase、Cochrane 图书馆、Web of Science、clinicaltrails.gov 和中国国家知识基础设施中搜索相关研究，并根据纳入标准进行筛选。使用 Revman 5.3 分析数据。连续值和二分类值分别采用标准均数差（SMD）和比值比（OR）进行汇总。使用 Cochran's Q 检验（I 统计量）评估异质性。P<0.05 被认为具有统计学意义。
结果
本研究共纳入 26 项随机对照试验，涉及 2375 名患者。水飞蓟素治疗可显著降低 TC（SMD[95%CI]=-0.85[-1.23, -0.47]）、TG（SMD[95%CI]=-0.62[-1.14, -0.10]）、LDL-C（SMD[95%CI]=-0.81[-1.31, -0.31]）、FI（SMD[95%CI]=-0.59[-0.91, -0.28]）和 HOMA-IR（SMD[95%CI]=-0.37[-0.77, 0.04]）水平，并增加 HDL-C 水平（SMD[95%CI]=0.46[0.03, 0.89]）。此外，水飞蓟素可减轻肝损伤，表现为 ALT（SMD[95%CI]=-12.39[-19.69, -5.08]）和 AST（SMD[95%CI]=-10.97[-15.51, -6.43]）水平降低。脂肪肝指数（SMD[95%CI]=-6.64[-10.59, -2.69]）和脂肪肝评分（SMD[95%CI]=-0.51[-0.69, -0.33]）也降低。干预组的肝组织学显示肝脂肪变性明显改善（OR[95%CI]=3.25[1.80, 5.87]）。
结论
水飞蓟素可调节能量代谢，减轻 NAFLD 患者的肝损伤，改善肝组织学。然而，水飞蓟素的疗效仍需要进一步研究证实。
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