| ObjectiveThis study aimed to evaluate the efficacy of integrated Chinese and western medicine in the treatment of non-alcoholic fatty liver disease(NAFLD).The randomized controlled trials related to integrated Chinese and western medicine treatment of NAFLD were searched to perform a systematic evaluation and Meta-analysis,therefore providing the scientific evidence-based conclusion for the clinical application of integrated Chinese and western medicine in treating NAFLD.Furthermore,to provide a reference for the selection of drug compatibility in the clinical treatment of NAFLD,the information of Chinese herbal medicines used in the included study was summarized and performed to data mining for exploring the regularity of medication.MethodsRandomized controlled trials related to integrated traditional Chinese and western medicine in the treatment of NAFLD were searched from Pub Med,Embase,Cochrane Library,CBM,CNKI,Wanfang and VIP databases.The retrieval time is limited to December 2020 from self-built databases.References were screened according to inclusion and exclusion criteria,and the quality of the included references was evaluated by the Cochrane bias risk assessment method.Data of the outcome indicators were total effective rate,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltranspeptidase(GGT),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),adverse reactions in the final included literature was extracted.Meta-analysis and sensitivity analysis was performed using Rev Man 5.3.5software.Egger’s and Begg’s methods of Stata12.0 software were used to evaluate publication bias.The drug information of the prescriptions in this study was extracted and standardized.SPSS 21.0 software was used to calculate the frequency of used drugs,and cluster analysis was conducted for the drugs with high-frequency(n≥5).IBM SPSS Modeler 18.0 software was performed to analyze association rules among drugs.Cytoscape 3.6.0 software was used to visualize the association rules.Results1.Basic information of the included literature and the results of Meta-analysis44 references were included in this systematic review after strictly screening,which involved 4,208 patients with NAFLD,including 2,591 male patients and 1,617 female patients.The efficacy of integrated traditional Chinese and western medicine in treating NAFLD was assessed by the total effective rate,biomarkers of liver function,lipid metabolism indicators and adverse reactions.Meta-analysis results showed that:(1)The total effective rate of integrated traditional Chinese and western medicine was significantly higher than than western medicine alone in treating NAFLD.(OR=3.87,95% CI: 3.18～4.71,P<0.01)(2)Compared with western medicine,the levels of ALT,AST and GGT of integrated traditional Chinese and western medicine were significantly decreased in NAFLD patients.ALT(MD=-14.57,95% CI :-16.34～-12.80,P<0.01);AST(MD=-11.02,95%CI:-12.30～-9.74,P<0.01);GGT(MD=-13.89,95% CI:-16.48～-11.30,P<0.01)(3)Compared with western medicine,the integrated traditional Chinese and western medicine could markedly decreased the levels of TC,TG and LDL-C,as well as the increased content of HDL-C.TC(MD=-0.94,95% CI:-1.33～-0.55,P<0.01);TG(MD=-0.59,95% CI:-0.83～-0.35,P<0.01);LDL-C(MD=-0.51,95% CI:-0.64～-0.38,P<0.01);HDL-C(MD=0.23,95% CI:0.16～0.30,P<0.01)(4)Compared with western medicine,the integrated traditional Chinese and western medicine significantly reduced HOMA-IR in NAFLD patients(MD=-0.58,95% CI:-0.73～-0.42,P<0.01).(5)The result of adverse reactions had shown that: OR=1.20,95% CI:0.65～2.24,P=0.56>0.05,which indicates that there was no significant difference in safety between the integrated traditional Chinese and western medicine and western medicine in the treatment of NAFLD.2.Regularity of medicationIn this study,38 copies of traditional Chinese medicine(TCM)prescription were included,98 drugs were used in total and the cumulative frequency was418 times.According to the classification of drug efficacy,the top 1 used category is tonic drugs(24.40%)and then followed by the damp-clearing drugs(18.18%),blood circulation and stasis drugs(13.16%),heat-clearing drugs(11.00%),and qi-regulating drugs(8.61%).The top 10 drugs were tuckahoe,hawthorn,bupleurum,atractylodes,alisma orientalis,salvia miltiorrhiza,cassia seed,licorice,radix curcuma and dried orange peel.The association rule analysis result showed that 725 association rules were obtained from 98 species of TCMs,which also suggested that the high-frequency drugs had a strong correlation.Moreover,cluster analysis result showed that 6 drug combinations were obtained from the top 23 medicines,which were C1: tuckahoe,bupleurum,atractylodes,licorice,dried orange peel and radix codonopsis.C2: hawthorn,alisma orientalis,cassia seed,salvia miltiorrhiza,radix astragali and notoginseng radix;C3: radix curcuma,capillary artemisia,coix seed and rhizoma atractylodis;C4: radix paeoniae alba,immature bitter orange,polygonum multiflorum;C5:angelica sinensis,rhizoma pinellinae praeparata and radix paeoniae rubra;C6:rheum officinale;respectively.ConclusionsTaken together,our analysis results demonstrate that the integration of traditional Chinese and western medicine is more advantageous than western medicine alone in improving the total clinical effective rate,alleviating hepatocyte injury and the disorder of lipid metabolism,reducing the insulin resistance in patients with NAFLD,and there is no significant difference between the two groups in adverse reactions.Through the analysis of the regularity of medication,it is found that the treatment of NAFLD is mainly strengthing to soothe the liver,invigorate the spleen and replenishing qi,which also take care of removing dampness and heat,eliminating phlegm and promoting blood stasis at the same time. |
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