Impact of Silymarin Supplementation on Liver Function and Enzyme Profiles in Diverse Chronic Liver Disease Etiologies.

AIM AND BACKGROUND

This study aimed to evaluate the efficacy of silymarin in improving liver function and reducing liver stiffness in chronic liver disease (CLD) patients. Silymarin, a hepatoprotective agent, has shown potential benefits in non-alcoholic fatty liver disease (NAFLD) and liver fibrosis, but evidence in CLD with varied etiologies remains limited. This study addresses the gap by assessing its impact across diverse etiological subgroups.

MATERIAL AND METHOD

A non-randomized clinical trial was conducted at Lahore General Hospital, Lahore, over 18 months. Out of 148 enrolled chronic liver disease (CLD) patients, 141 completed the 12-week follow-up. Patients were stratified into two groups: silymarin (200 mg twice daily) plus standard care and standard care alone. Baseline and follow-up data, including clinical, biochemical, and FibroScan (EchoSens, Ivry-sur-Seine, France) was collected and stratified analysis based on etiology was performed using Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY).

RESULTS

This study evaluated 141 chronic liver disease (CLD) patients who completed the three-month follow-up, 68 in the standard treatment group and 73 in the silymarin group. Baseline characteristics were comparable except for age and body mass index (BMI). Alanine aminotransferase (ALT) levels significantly reduced in the silymarin group (63.04 ± 22.38 U/L) compared to the standard group (78.49 ± 22.93 U/L, p=0.000), with higher ALT normalization in the silymarin group (35.6% vs. 22.1%, p=0.076). Aspartate aminotransferase (AST) levels were also significantly lower in the silymarin group (57.08 ± 20.94 U/L vs. 65.90 ± 24.18 U/L, p=0.022). Improvements in hepatic encephalopathy, ascites, and Child-Turcotte-Pugh (CTP) class were similar across groups (p > 0.05). The stratified analysis highlighted greater ALT and AST reductions for hepatitis B virus (HBV) and non-alcoholic fatty liver disease (NAFLD) in the silymarin group. FibroScan (EchoSens, France) scores, bilirubin, albumin, international normalized ratio (INR), and prothrombin time (PT) showed no significant differences between groups. These findings suggest silymarin's potential in improving liver enzymes, particularly in metabolic etiologies.

CONCLUSION

This study demonstrates that silymarin effectively reduces ALT and AST levels and achieves higher ALT normalization compared to standard treatment in CLD patients. While improvements in hepatic encephalopathy, ascites, and CTP class were comparable between groups, silymarin showed greater efficacy in metabolic conditions like NAFLD.