柴胡疏肝散治疗非酒精性脂肪肝的系统评价与Meta分析

Systematic Evaluation and Meta Analysis on Nonalcoholic Fatty Liver Disease Treated with Chaihu Shugan San

目的评价柴胡疏肝散治疗非酒精性脂肪肝(NAFLD)的有效性与安全性。方法计算机检索10个中英文数据库(时间均自建库至2013年12月),纳入柴胡疏肝散治疗NAFLD随机对照试验(RCT)的文献,对其方法学质量及终点指标行定性与定量合成分析。结果共纳入10个RCT合计802例NAFLD受试者,其方法学质量均属于高偏倚风险。所有RCT试验组采用柴疏肝散加减或结合西药治疗,对照组采用西药治疗,均未报告主要终点,而仅报告次要终点,只有2个RCT报告不良反应结局。对次要终点行Meta分析结果显示,试验组治疗后总胆固醇、低密度脂蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶及总有效率均优于对照组。结论柴胡疏肝散治疗NAFLD有效且安全,但由于所纳入RCT方法学质量均较低,需要开展更为严格的RCT以提供充分证据支持临床应用柴胡疏肝散治疗NAFLD。

Objective To evaluate the effectiveness and safety of chaihu shugan san in treatment of nonalcoholic fatty liver disease（NAFLD）.Methods Ten databases of Chinese and English versions were retrieved（from the time of database setup till December 2013）.The literatures of randomized controlled trial （RCT） in treatment of NAFLD with chaihu shugan san were included.The qualitative and quantitative synthetic analysis was performed on the methodological quality and endpoints.Results In the paper,totally 802 cases of NAFLD in 10 RCTs were included and their methodological quality referred to high risk of bias.All of RCT groups,the cases were treated with modified chaihu shugan san or integrated with western medicine.In the control group,western medicine was used.The primary endpoints were not reported in either RCT or control group.Only the secondary endpoints were reported and 2 RCTs presented the outcome of adverse reaction.Meta analysis was conduced on the secondary endpoints.The results showed that the levels of total cholesterol,LDL-C,ALT,AST and total effective rate in the RCT group after treatment were better than those in the control group.Conclusion Chaihu shugan san is effective and safe in treatment of NAFLD.But,because of low methodological quality of the included RCTs,the strict RCT is required so as to provide adequate evidence to support the clinical application of chaihu shugan san in treatment of NAFLD.