基于中医清热泻下法治疗非酒精性脂肪性肝病的疗效：一项系统评价与Meta分析
Efficacy of traditional Chinese medicine-based clearing heat and laxative method against nonalcoholic fatty liver disease: A systematic review and meta-analysis.
作者信息
Qu Ya-Nan, Liu Yan-Jing, Sun Jia-Tong, Chu Li-Yuan, Liu Jin-Lin, Jing Jing, Bi Chao-Ran
机构信息
College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China.
Department of Endocrinology, Metabolism and Gastroenterology, The Third Affiliated Clinical Hospital to Changchun University of Chinese Medicine, Changchun, Jilin Province, China.
出版信息
Medicine (Baltimore). 2025 Apr 25;104(17):e42189. doi: 10.1097/MD.0000000000042189.
BACKGROUND
Increasing evidences support the effectiveness of traditional Chinese medicine (TCM) in the treatment of nonalcoholic fatty liver disease (NAFLD), but it involves a wide variety of therapeutic methods. We aimed to evaluate the efficacy and safety of the TCM-based clearing heat and laxative (CHL) Method for intervention in NAFLD.
METHODS
Randomized controlled trials (RCTs) of CHL method for NAFLD were included. We searched Pubmed, Scopus, Web of science, CNKI, CBM, VIP, Wanfang databases from the inception to October 2023. We performed separate meta-analyses of clinical outcomes for liver enzymes, lipid profile, and total efficiency. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on INPLASY, number INPLASY2022100002.
RESULTS
Nine trials involving 856 participants were included in this meta-analysis. The meta-analysis showed that compared with the control group, the experimental group was more conducive to ameliorating the levels of ALT [MD = -8.00, 95% CI (-9.43, -6.56), P < .00001], AST [MD = -7.41, 95% CI (-8.75, -6.07), P < .00001], GGT [MD = -29.41, 95% CI (-42.25, -16.56), P < .00001], TC [MD = -0.76, 95% CI (-1.18, -0.35), P = .0003], TG [MD = -0.54, 95% CI (-0.82, -0.27), P = .0001], HDL-C [MD = 0.15, 95% CI (-0.01, 0.31), P = .07], LDL-C [MD = -0.47, 95% CI (-0.62, -0.32), P < .00001], and the total effective rate [OR = 3.11, 95% CI (1.94, 4.99), P < .00001]. Adverse events were observed in 2 trials, mainly milder gastrointestinal symptoms.
CONCLUSION
Significant differences in the clinical efficacy were found between the experimental and control groups in treating NAFLD. Thus, the TCM-based CHL method brings significant advantages in treating NAFLD. Further, it is recommended that patients in NAFLD with abnormal liver enzymes be treated with CHL for at least 3 months, and the proportion of laxatives in TCM prescription can be appropriately increased to improve the overall curative effect.
背景
越来越多的证据支持中医在治疗非酒精性脂肪性肝病（NAFLD）方面的有效性，但涉及多种治疗方法。我们旨在评估基于中医清热泻下法（CHL）干预NAFLD的疗效和安全性。
方法
纳入CHL法治疗NAFLD的随机对照试验（RCTs）。我们检索了从创刊至2023年10月的Pubmed、Scopus、Web of science、CNKI、CBM、VIP、万方数据库。我们对肝酶、血脂谱和总有效率的临床结局进行了单独的荟萃分析。证据质量用Cochrane偏倚风险工具进行评估。本研究已在INPLASY注册，注册号为INPLASY2022100002。
结果
本荟萃分析纳入了9项试验，共856名参与者。荟萃分析表明，与对照组相比，试验组更有利于改善谷丙转氨酶（ALT）水平[MD = -8.00，95%CI（-9.43，-6.56），P <.00001]、谷草转氨酶（AST）水平[MD = -7.41，95%CI（-8.75，-6.07），P <.00001]、γ-谷氨酰转肽酶（GGT）水平[MD = -29.41，95%CI（-42.25，-16.56），P <.00001]、总胆固醇（TC）水平[MD = -0.76，95%CI（-1.18，-0.35），P =.0003]、甘油三酯（TG）水平[MD = -0.54，95%CI（-0.82，-0.27），P =.0001]、高密度脂蛋白胆固醇（HDL-C）水平[MD = 0.15，95%CI（-0.01，0.31），P =.07]、低密度脂蛋白胆固醇（LDL-C）水平[MD = -0.47，95%CI（-0.62，-0.32），P <.00001]以及总有效率[OR = 3.11，95%CI（1.94，4.99），P <.00001]。在2项试验中观察到不良事件，主要为较轻的胃肠道症状。
结论
试验组和对照组在治疗NAFLD的临床疗效上存在显著差异。因此，基于中医的CHL法在治疗NAFLD方面具有显著优势。此外，建议肝酶异常的NAFLD患者采用CHL法治疗至少3个月，并且可适当增加中药方剂中泻下药的比例以提高总体疗效。
Zotero 插件