中成药联合西药治疗非酒精性脂肪性肝病临床疗效的网状Meta分析

A network Meta-analysis of the clinical efficacy of Chinese patent medicines plus Western medicines on non-alcoholic fatty liver disease

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摘要目的:通过网状Meta分析的方法评价中成药联合常规西药治疗非酒精性脂肪性肝病的疗效,为临床选药用药提供循证医学证据。方法:检索PubMed、Web of Science、中国知网、维普和万方数据库,收集关于中成药联合常规西药治疗非酒精性脂肪性肝病的随机对照试验,检索日期为各数据库建库至2025年4月25日,使用R 4.4.3软件进行统计学分析。结果:最终筛选出31篇随机对照试验,其中包含患者2911例,涉及7种治疗方案。研究结果显示,在提高总有效率、降低丙氨酸氨基转移酶(Alanine Aminotransferase,ALT)、降低血清γ-谷氨酰转移酶(γ-glutamyl Transferase,GGT)方面,强肝胶囊联合西医治疗为最优方案[OR=4.73,95%CI(2.29,9.97)][MD=-17.64,95%CI(-32.36,-2.86)]、[MD=-20.42,95%CI(-29.62,-9.88)]。在降低天门冬氨酸氨基转移酶(Aspartate Aminotransferase,AST)方面,壳脂胶囊联合西医治疗为最优方案[MD=-17.34,95%CI(-31.30,-4.13)]。在降低三酰甘油(Triglyceride,TG)方面,逍遥丸联合西医治疗为最优方案[MD=-1.05,95%CI(-1.38,-0.72)]。在降低总胆固醇(Total Cholesterol,TC)方面,保和丸联合西医治疗为最优方案[MD=-1.8,95%CI(-3.02,-0.58)]。结论:中成药联合西医治疗非酒精性脂肪性肝病的治疗中展现出较常规西医治疗更显著的疗效优势。然而,由于目前纳入的文献质量和样本量有限,仍需通过更多高质量、大样本的临床研究进一步验证。 Objective:Through the method of network Meta-analysis,the efficacy of traditional Chinese patent medicines with conventional Western medicines on non-alcoholic fatty liver disease was evaluated to provide evidence-based medical evidence for clinical drug selection.Methods:The databases of PubMed,Web of Science,CNKI,VIP,and Wangfang were retrieved to collect randomized controlled trial(RCT)studies on the treatment of non-alcoholic fatty liver disease with Chinese patent medicines combined with conventional Western medicines.The retrieval dates ranged from the establishment of each database to April 25,2025.Statistical analysis was performed using R 4.4.3 software.Results:A total of 31 RCT studies were ultimately screened out,involving 2911 patients and 7 treatment regimens.The research results showed that in terms of improving the overall effective rate,reducing ALT,and lowering GGT,the Qianggan capsules(强肝胶囊)With western medicine was the optimal solution(OR=4.73,95%CI(2.29,9.97)],[MD=-17.64,95%CI(-32.36,-2.86)],[MD=-20.42,95%CI(-29.62,-9.88)].In terms of reducing AST,the combination of the Kezhi capsules(壳脂胶囊)and Western medicine treatment was the optimal option[MD=-17.34,95%CI(-31.30,-4.13)].In terms of reducing TG,the combination of Xianyao Wan(逍遥丸)and Western medicine was the optimal option[MD=-1.05,95%CI(-1.38,-0.72)].In terms of reducing TC,the combination of Baohe Wan(保和丸)and Western medicine was the optimal option[MD=-1.8,95%C I(-3.02,-0.58)].Conclusion:The combination of traditional Chinese patent medicines and Western medicine in the treatment of non-alcoholic fatty liver disease shows more significant therapeutic advantages than conventional Western medicine.However,due to the limited quality and sample size of the currently included literature,further verification is still needed through more high-quality and large-sample clinical studies.