黄连素治疗非酒精性脂肪肝的临床疗效及安全性Meta分析

Meta analysis of clinical efficacy and safety of berberine in the treatment of non-alcoholic fatty liver

目的:评价黄连素治疗非酒精性脂肪肝的临床疗效和安全性。方法:检索中英文数据库中有关的随机对照研究,检索时间为建库至2020年3月30日,文献筛选后进行质量评价,RevMan5.3软件统计分析。结果:纳入9项研究,涉及780例患者。Meta分析结果显示,单独或联合运用黄连素均能降低患者的总胆固醇水平[MD=-0.50,95%CI(-0.73,-0.27)]、低密度脂蛋白水平[MD=-0.34,95%CI(-0.52,-0.15)]和谷氨酰转移酶水平[MD=-20.79,95 CI%(-28.25,-13.34)]。亚组分析发现,联合黄连素治疗能降低糖化血红蛋白水平[MD=-0.68,95%CI(-0.98,-0.38)],而合并糖尿病的患者接受黄连素治疗后,丙氨酸转氨酶[MD=-9.38,95 CI%(-12.10,-6.66)]和谷草转氨酶[MD=-9.03,95 CI%(-11.65,-6.42)]下降明显,差异均有统计学意义(P<0.01)。此外,黄连素还具有下降甘油三酯、空腹血糖、体质指数和改善胰岛素抵抗的趋势。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:黄连素能够调节非酒精性脂肪肝患者的糖脂代谢,具有改善肝功能及胰岛素抵抗的作用趋势。

Objective To evaluate the clinical efficacy and safety of berberine in the treatment of non-alcoholic fatty liver.MethodsAll randomized controlled studies published before were March 30,2020 searched in Chinese and English databases.The quality of the selected literatures were evaluated by RevMan5.3 software.ResultsNine studies were selected,involving 780 patients.Meta-analysis showed that berberine alone or in combination could reduce total cholesterol MD=-0.50,95%CI(-0.73,-0.271),low density lipoprotein(MD=-0.34,95%CI(-0.52,-0.15)and glutamyltransferase(MD=-20.79,95 CI%(-28.25,-13.34).Subgroup analysis showed that other drugscombined with berberine could reduce glycosylated hemoglobin level MD=-0.68,95%CI(-0.98,0.38),while in patients with diabetes treated with berberine,alanine aminotransferase(MD=-9.38,95%CI(-12.10,-6.66)and aspartate oxaloacetic transaminase(MD=-9.03,95%CI(-11.65,-6.42)decreased significantly.The above differences were all statistically significant(P<0.01).In addition,berberine has a tendency to decrease triglyceride,fasting blood glucose,body mass index and improve insulin resistance.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).ConclusionBerberine can regulate glucose and lipid metabolism in patients with non-alcoholic fatty liver and has a tendency to improve liver function and insulin resistance.