水飛薊素(Silymarin)對於慢性病毒性肝炎治療之實證醫學回顧

Silymarin for the Treatment of Chronic Viral Hepatitis: An Evidence-based Medicine Review

李侑珊(Yu-Shan Lee) ； 郭斐然(Fei-Ran Guo)

《臺灣家庭醫學研究》 5卷2期 (2007/04) Pp. 61-69

https://doi.org/10.29475/TFMR.200704.0002

摘要

背景：水飛薊素(silymarin)是常用於慢性病毒性肝炎病患的肝庇護劑。Silymarin對於慢性病毒性肝炎的效果究竟如何值得探討。
目的：探討silymarin治療慢性病毒性肝炎的效果。
文獻選擇及資料來源：使用PubMed尋找關於silymarin與慢性病毒性肝炎的研究。
文獻分析：共引用兩篇關於silymarin與慢性病毒性肝炎的系統回顧性研究(systematic study)。第一篇比較十三個隨機臨床試驗，發現使用奶薊萃取物的治療組與未使用藥物的安慰組，兩組的死亡率、肝臟相關死亡率、血液生化值及肝功能、肝臟組織學上的變化、及肝併發症都沒有統計學上的差異。第二篇共採納了七個臨床研究，發現silymarin對慢性病毒性肝炎病患血中的肝功能指數有益處。但對死亡率、血中病毒量、肝臟組織學上的變化、及肝炎併發症是沒有影響的。
結論：目前沒有證據支持或反對silymarin可改善慢性病毒性肝炎病患的臨床指標進而降低死亡率。有研究顯示silymarin可以降低慢性病毒性肝炎病患的血中肝功能指標（特別是AST與ALT），只是目前證據並不夠充分。

並列摘要

Context: Silymarin is a hepatoprotectant frequently prescribed for the treatment of chronic viral hepatitis. But is there any evidence to support the use of silymarin for chronic viral hepatitis?
Objective: To assess the effects of administering silymarin for patients with chronic viral hepatitis.
Data Source and Study Selection: A systematic review of silymarin for the treatment of chronic viral hepatitis was performed using PubMed as the literature search engine.
Articles analysis: Two systematic reviews that studied milk thistle (active agent: silymarin compounds) in chronic viral hepatitis were identified. The first review included thirteen randomized clinical trials in patients with alcoholic hepatitis and/or chronic viral hepatitis. There was no significant difference between milk thistle group and placebo group on mortality, liver-related mortality, biochemistry data, liver histology, or complications of liver disease. The second review included seven studies in patients with chronic viral hepatitis and found a decrease in serum transaminases in the treatment groups. However, silymarin had no effect on mortality, viral load, liver histology or complications of liver disease.
Conclusion: There is no strong evidence supporting or refuting silymarin in the treatment of chronic viral hepatitis. Some low quality ratings showed that silymarin treatment resulted in a decrease of liver enzymes (especially aspartateaminotransferase and alanineaminotransferase).

並列關鍵字

silymarin ； chronic viral hepatitis ； systematic review