丹参联合西药治疗肝纤维化Meta分析

Meta-Analysis of Danshen Combined with Western Medicine in the Treatment of Hepatic Fibrosis

摘要: 目的：采用系统评价方法评价丹参联合西药治疗肝纤维化的疗效。方法：通过计算机检索中国知网、维普、万方及PubMed数据库公开发表文献，检索时间为2013年01月至2023年01月，检索关于丹参联合西药治疗肝炎肝纤维化的随机对照试验(RCT)文献，对纳入文献采用Cochrane评价工具进行偏倚风险评价，采用Revman5.4版软件进行meta分析。结果：最终纳入14个研究，2910例患者，其中治疗组(丹参联合西药) 1455例，对照组(单用西药) 1455例。与对照组比较，治疗组透明质酸[MD = −81.07, 95% CI (−99.69, −62.45), P < 0.00001]、层黏连蛋白[MD = −54.94, 95% CI (−74.75, −35.13), P < 0. 00001]、III型前胶原N端肽[MD = −51. 21, 95% CI (−62.88, −39.54), P< 0.00001]、IV型胶原[MD= −34.34, 95% CI (−72.46, 3.78) ，P < 0.00001]、谷丙转氨酶[MD = −25.29, 95% CI (−35.43, −15.15 ), P < 0.00001]、谷草转氨酶[MD = −26.74, 95% CI (−41.19, −12.29), P < 0. 00001]、门静脉内径[MD = −1.58, 95% CI (−3.13, −0.03), P < 0. 00001]、脾脏厚度[MD = −6.5, 95% CI (−11.91, −1.08), P < 0. 00001]，两组患者在改善IV型胶原方面差异无统计学意义。结论：丹参联合西药可进一步改善肝纤维化患者透明质酸、层黏连蛋白、III型前胶原N端肽以及肝功能指标、影像学指标，提高临床疗效。

Abstract: Objective: To evaluate the efficacy of Danshen combined with Western medicine in the treatment of hepatic fibrosis by systematic evaluation. Methods: The randomized controlled trial (RCTS) of Danshen combined with Western medicine in the treatment of hepatitis and liver fibrosis were searched by computer through the databases of China National Knowledge Network, VIP, Wanfang and PubMed from January 2013 to January 2023. The Cochrane evaluation tool was used for bias risk assessment of the included literatures, and meta-analysis was performed using Revman version 5.4 software. Results: Fourteen studies with 2910 patients were included, including 1455 patients in the treatment group (salvia miltiorrhiza combined with Western medicine) and 1455 patients in the control group (Western medicine alone). Compared with the control group, hyaluronic acid [MD = −81.07, 95% CI (−99.69, −62.45), P < 0.000001], laminin [MD = −54.94, 95% CI (−74.75, −35.13), P < 0.000001], N-terminal peptide of type III procollagen [MD= −51.21, 95% CI (−62.88, −39.54), P < 0.000001], type IV collagen [MD= −34.34, 95%CI (−72.46, 3.78), P < 0.000001], alanine aminotransferase [MD = −25.29, 95% CI (−35.43, −15.15), P < 0.000001], oxalacetic aminotransferase [MD = −26.74, 95% CI (−41.19, −12.29), P < 0. 00001], portal vein diameter [MD = −1.58, 95% CI (−3.13, −0.03), P < 0. 00001], spleen thickness [MD = −6.5, 95% CI (−11.91, −1.08), P < 0. 00001], there was no significant difference in the improvement of type IV collagen between the two groups. Conclusion: Salvia miltiorrhiza combined with Western medicine can further improve hyaluronic acid, laminin, n-terminal peptide of type III procollagen, liver function index and imaging index in patients with hepatic fibrosis, and improve clinical efficacy.