中药配伍减轻雷公藤制剂肝毒性的系统评价

Effects of compatibility of Chinese medicine on reducing hepatotoxicity of Tripterygium wilfordii preparations: A systematic review

目的:系统评价不同中药配伍减轻雷公藤制剂肝毒性的效果。方法:检索中文、英文数据库,纳入有关中药配伍减轻雷公藤制剂肝毒性的大鼠实验研究,提取干预前后血清生化指标丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)的数据,采用Cochrane协作网的风险偏倚评估工具对纳入研究进行方法学质量评价,采用Stata 14.0软件进行Meta分析。结果:共纳入23篇实验研究文献。直接Meta分析结果显示,中药配伍可降低雷公藤制剂所致的大鼠血清ALT[SMD=-2.04,95%CI(-2.39,-1.69),P<0.01]和AST[SMD=-1.68,95%CI(-2.01,-1.36),P<0.01]水平升高。对单味中药配伍的研究进行间接网状Meta分析,结果表明单味中药配伍对雷公藤制剂所致大鼠肝毒性的减毒效应排序为:生地黄>白芍>甘草>三七>菟丝子>黄芪>青风藤>僵蚕。结论:中药配伍可减轻雷公藤制剂所致的大鼠肝毒性,且单味中药生地黄、白芍、甘草、三七、菟丝子配伍的减毒效果较为显著。

Objective:To systematically evaluate the effects of compatibility of different Chinese medicines on reducing hepatotoxicity of Tripterygium wilfordii preparations.Methods:Chinese and English databases were retrieved,and the experiment researches about compatibility of Chinese medicine on reducing hepatotoxicity of Tripterygium wilfordii preparations in rats were included.The data of serum biochemical indicators ALT and AST before and after intervention were extracted.The risk bias assessment tool of Cochrane collaboration network was used to evaluate the methodological quality of the included researches,and Stata 14.0 software was used to carry out Meta analysis.Results:Twenty-three experimental research literatures were included.The results of direct Meta analysis showed that the compatibility of Chinese medicine could reduce the serum levels of ALT[SMD=-2.04,95%CI(-2.39,-1.69),P<0.01]and AST[SMD=-1.68,95%CI(-2.01,-1.36),P<0.01]in rats with Tripterygium wilfordii preparations induced hepatotoxicity.For the compatibility of single Chinese medicine,the results of indirect network Meta analysis showed that,the order of effect of single Chinese medicine compatibility on reducing hepatotoxicity induced by Tripterygium wilfordii preparations in rats was as follows:Rehmanniae Radix>Paeoniae Radix Alba>Glycyrrhizae Radix et Rhizoma>Notoginseng Radix et Rhizoma>Cuscutae Semen>Astragali Radix>Sinomenii Caulis>Bombyx Batryticatus.Conclusion:Compatibility of Chinese medicine can alleviate the hepatotoxicity caused by Tripterygium wilfordii preparations in rats,and the compatibility of Rehmanniae Radix,Paeoniae Radix Alba,Glycyrrhizae Radix et Rhizoma,Notoginseng Radix et Rhizoma and Cuscutae Semen shows significant effects on reducing hepatotoxicity.