黄倩+吴银莲++康娜玲

[摘要]目的 评价水飞蓟素治疗非酒精性脂肪性肝病的效果与安全性。方法 搜索水飞蓟素治疗NAFLD的RCT文献，检索2016年7月前以下数据库收录的文献：PubMed、Embase、the Cochrane Library、CBM、万方、维普和CNKI，按纳入排除标准对纳入研究进行资料提取和方法学质量评价后，采用RevMan 5.3进行分析。结果 最终纳入14篇文章（1337例）。水飞蓟素组和对照组ALT、AST、TG、BMI的差异有统计学意义，分别为ALT：WMD=-14.16，95%CI（-22.02，-6.30），P=0.0004；AST：WMD=-9.17，95%CI（-14.20，-4.15），P=0.0003；TG：WMD=-0.23，95%CI（-0.42，-0.03），P=0.02；BMI：WMD=-0.84，95%CI（-1.34，-0.34），P=0.001。对疾病谱分别为NAFLD和NASH的ALT、AST水平进行亚组分析，发现仅NAFLD组差异有统计学意义。少数患者发生轻微不良反应。结论 目前有限证据提示水飞蓟素可改善NAFLD患者ALT、AST、TG、BMI水平，且不良反应少。

[关键词]水飞蓟素；非酒精性脂肪肝；Meta分析

[中图分类号] R575.5 [文献标识码] A [文章编号] 1674-4721（2017）09（a）-0008-06

Meta-analysis of the therapeutic effect and safety of silymarin in the treatment of nonalcoholic fatty liver disease

HUANG Qian1 WU Yin-lian2 KANG Na-ling2

1.Department of Infectious，the Xiehe Affiliated Hospital of Fujian Medical University in Fujian Province，Fuzhou 350000，China；2.Department of Liver Center， the First Affiliated Hospital of Fujian Medical University in Fujian Province，Fuzhou 350000，China

[Abstract]Objective To evaluate the therapeutic effect and safety of silymarin in the treatment of nonalcoholic fatty liver disease （NAFLD）.Methods RCT articles about treating NAFLD with silymarin were published in databases including PubMed，Embase，the Cochrane Library，CBM，Wanfang Data，VIP，and CNKI before July 2016 were searched.The included articles were used to extract data and assess the methodology quality according the inclusion/exclusion criteria.Then all the datas were analyzed with RevMan 5.3.Results A total of 14 artilces including 1337 cases were fitted for Meta-analysis.After treatment，ALT，AST，TG and BMI were significant different between silymarin-treated group and control group （ALT：WMD=-14.16，95%CI （-22.02，-6.30），P=0.0004；AST：WMD=-9.17，95%CI （-14.20，-4.15），P=0.0003；TG：WMD=-0.23，95%CI （-0.42，-0.03），P=0.02；BMI：WMD=-0.84，95%CI （-1.34，-0.34），P=0.001.The subgroup analysis showed ALT and AST were significantly different between silymarin-treated group and control group in NAFLD cases，but not in NASH cases.The adverse reactions were low and mild.Conclusion Silymarin can improve ALT，AST，TG and BMI with low adverse reactions according limited evidence for now.

[Key words]Silymarin；Nonalcoholic fatty liver disease；Meta-analysis

非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）是一種与胰岛素抵抗和遗传易感密切相关的代谢应激性肝损伤，肝细胞脂肪变性为主要病理改变，疾病谱包括非酒精性单纯性脂肪肝（nonalcoholic simple fatty liver，NAFL）、非酒精性脂肪性肝炎（nonalcoholic steatohepatitis，NASH）及相关肝硬化和肝细胞癌[1-2]。研究显示，NAFL很少演变为进展性肝病，而NASH可进展为肝硬化[3]。但Soderberg等[4]平均随访NAFL及NASH人群28年，发现两组死亡率相似。据估计，20%～40%西方人群，5%～30%亚洲人群存在脂肪肝[5-6]。在我国，NAFLD已成为第二大肝病，仅次于病毒性肝炎。肥胖、血脂血糖异常、高血压者是NAFLD的高危人群[7]。腹型肥胖与NAFLD关系更密切，腰围比BMI更能准确预测脂肪肝[8-10]。NAFLD发病机制目前尚未明确，普遍认同的为“二次打击”学说，胰岛素抵抗导致肝脏脂肪变性为首次打击；在此基础上的氧化应激和脂质过氧化为“二次打击”，从而导致肝脏炎症[11-12]。……