Systematic review and meta-analysis of efficacy of Gexia Zhuyu Decoction in the treatment of nonalcoholic fatty liver disease

Objective:To evaluate the efficacy of Gexia Zhuyu Decoction in the treatment of nonalcoholic fatty liver disease(NAFLD).Methods:Four Chinese databases(CNKI,CMB,Wanfang,VIP)and four English databases(PubMed,Embase,Cochrane Library,Medline)were searched to screen randomized controlled trials(RCTs)of Gexia Zhuyu Decoction in the treatment of NAFLD.The enrollment of RCTs is from the starting date of database establishment till November 2,2022.and clinical registration tests and grey literatures were also searched.RCTs screening and relevant data exreacting were based on preset criteria.RevMan5.4.1 software was used for risk of bias assessment and Meta analysis of the included studies.Results:Eleven RCTs were included finally having 963 patients with NAFLD,including 499 in experimental group and 494 in control group.Meta-analysis results showed that GexiaZhuyu Decoction alone or combining with other medications for the treatment of NFALD was superior to that in control group in terms of total effective rate[RR=1.23,95%CI[1.16,1.31],Z=6.58(P<0.05)].Improve liver function index significantly:ALT[subgroup①WMD=-14.93,95%CI[-18.66,-9.42],Z=7.84(P<0.01);subgroup②WMD=-3.97,95%CI[-8.01,0.07],AST[subgroup①WMD=-13.25,95%CI[-18.10,-8.41],Z=5.36(P<0.05);subgroup②WMD=-2.70,95%CI[-6.94,1.54],Z=1.25(P>0.05)];GGT[WMD=-9.30,95%CI[-15.78,-2.81],Z=2.81(P<0.05)].Moreover,patients with therapy obviously decreased hepatic fibrosis index:桇-C[SMD=-1.15,95CI%[-1.48,-0.81],Z=6.77(P<0.05)],LN[SMD=-1.49,95CI%[-2.23,-0.75],Z=3.97(P<0.05)].Effectively reduce the level of LDL-C[WMD=-0.30,95CI%[-0.54,-0.06],Z=2.48(P<0.05)]and improve the rate of ultrasound renormalization[RR=1.94,95%CI[1.45,2.60],Z=4.48(P<0.05)].However,existing data cannot prove that the effect of reducing TC,TG and BMI in the treatment group is better than that in the control group:TC[WMD=-0.88,95CI%[-1.88,0.11],Z=1.74(P>0.05)],TG[WMD=-0.50,95CI%[-1.05,0.06],Z=1.76(P>0.05)],BMI[WMD=-1.61,95CI%[-4.77,1.54],Z=1.00(P>0.05)].Descriptive analysis results showed that the levels of LDL,HA and PCIII were significantly reduced in the treatment group,and the differences were statistically significant(P<0.05).In addition,no adverse drug reactions related to Gexia Zhuyu Decoction have been reported.Conclusion:Gexia Zhuyu Decoction can significantly improve the liver function,liver fibrosis,and hepatic steatosis in NAFLD patients,thereby improving the clinical efficacy.