莪术及其有效成分对实验性肝纤维化疗效的Meta分析

Meta-analysis of the Effect of Rhizoma Curcumae and Its Active Ingredients on Experimental Liver Fibrosis

目的:系统评价莪术及其有效成分对实验性肝纤维化(HF)的疗效。方法:检索中国期刊全文数据库、中国学术期刊数据库、中文科技期刊数据库、PubMed、Embase、Cochrane library、中国生物医学数据库(CBM),收集建库起至2020年1月期间所有关于莪术及其有效成分治疗实验性HF的中文随机对照动物实验。干预组干预措施包括莪术水煎剂、醋莪术、莪术提取物、莪术多糖、莪术醇、姜黄素、β-榄香烯等。结局指标包括肝功能、肝纤四项、肝指数及相关理化指标。由2名研究员共同筛选后,用RevMan 5.3进行数据分析。结果:纳入11个随机对照动物实验,样本量196只。Meta分析结果显示:1)与HF模型组比较,干预组可有效降低ALT(MD-0.58,95%Cl为-1.29~-0.04;P=0.33;n=4,I^(2)=12%)、AST(MD-0.83,95%Cl为-1.39~-0.27;P=0.29;n=4,I^(2)=20%),升高TP(MD8.36,95%Cl为6.20~10.51;n=2,I^(2)=0%)、ALB(MD2.19,95%Cl为1.39~2.98;P=0.25;n=4,I^(2)=27%),改善肝功能;2)肝纤四项指标改善优于模型组,HA(MD-177.45,95%Cl为-187.81~-167.09;n=3,I^(2)=0%)、LN(MD-1.57,95%Cl为-2.37~-0.77;n=2,I^(2)=0%)、PCⅢ(MD-4.54,95%Cl为-5.90~-3.18;n=2,I^(2)=0%)、Ⅳ-C(MD-2.23,95%Cl为-3.11~-1.35;n=2,I^(2)=0%);3)有效降低肝指数(MD-6.79,95%Cl为-8.75~-4.83;n=2,I^(2)=0%),并通过调节相关理化因子(α-SMA、HYP、MDA、TGF-β_(1)、SOD)的表达,起到抗实验性HF作用。结论:莪术及其有效成分可有效改善实验性HF,对临床试验有一定指导意义。

Objective:To systematically evaluate the efficacy of Rhizoma Curcumae and its active components on experimental liver fibrosis,and to provide evidence for clinical treatment.Methods:Searching Chinese and English databases such as CNKI,Wanfang,VIP,Pubmed,Embase,Cochrane Library and CBM by computer,the Chinese literature on Rhizoma Curcumae and its active ingredients for the treatment of experimental liver fibrosis using randomized controlled trial was collected from the establishment of the databases till January 2020.The intervention group included Rhizoma curcumae water decoction,vinegar baked Rhizoma curcumae,Rhizoma curcumae extracts,Curcuma polysaccharides,curcuma alcohol,curcumin,β-elemene and so on.The outcome measures included liver function,liver fibrosis,liver index and related physical and chemical indexes.After screening,data were analyzed by two researchers using Review Manager 5.3.Results:A total of 11 RCTs tests were included,including 196 cases.The results of Meta analysis showed that ALT(MD-0.58,95%CI:-1.29 to-0.04;P=0.33;n=4,I^(2)=12%),AST(MD-0.83,95%CI:-1.39 to-0.27;P=0.29;n=4,I^(2)=20%)were significantly lower in the intervention group than in the model group,while increased TP(MD8.36,95%CI:6.20 to 10.51;n=2,I^(2)=0%),ALB(MD2.19,95%CI:1.39 to 2.98;P=0.25;n=4,I^(2)=27%)improved liver function.The improvement of 4 indexes of hepatic fibrosis,HA(MD-177.45,95%CI:-187.81 to-167.09;n=3,I^(2)=0%),LN(MD-1.57,95%CI:-2.37 to-0.77;n=2,I^(2)=0%),PCⅢ(MD-4.54,95%CI:-5.90 to-3.18;n=2,I^(2)=0%),Ⅳ-C(MD-2.23,95%CI:-3.11 to-1.35;n=2,I^(2)=0%),were better than those of the model group in the intervention group.The liver index(MD-6.79,95%CI:-8.75 to-4.83;n=2,I^(2)=0%)was effectively reduced,and the liver fibrosis was inhibited by regulating the expression of related physical and chemical factors(α-SMA、HYP、MDA、TGF-β_(1)、SOD).Conclusion:Rhizoma Curcumae and its effective components have efficacy on experimental liver fibrosis,but it still needs to be validated by large sample and multi-center RCT study.