Abstract
BackgroundThe studies on the effectiveness of Chinese herbal medicines (CHM) in treating liver fibrosis (LF) were not consistent. This study aims to systematically review the effectiveness of CHM on treating LF patients.MethodsDatabases including MEDLINE, AMED, EMBASE, The Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, TCMOnline, Chinese Biomedical Literature Database, and Chinese Medical Current Contents were searched up to March 2011. Randomized controlled trials (RCTs) involving LF patients receiving CHM, Western medicine, combined CHM and Western medicine compared with placebo, Western medicine or no intervention were included. LF markers including serum hyaluronic acid (HA), laminin (LN), procollagen type III (PC-III), type IV collagen (IV-C), matrix metalloproteinase (MMP), and tissue inhibitors of metalloproteinase (TIMP) were measured as primary outcomes. Liver biochemistry, including alanine aminotransferase (ALT) and aspartarte aminotransferase (AST), and improvement of related clinical symptoms were measured as secondary outcomes. Risk of bias of allocation sequence, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases were assessed.ResultsTwenty-three RCTs with 2123 participants were analyzed in subgroups of types of comparison and study quality. Fifteen studies were graded as good quality. CHM alone and combined with Western medicine showed significant improvements in HA, LN, PC-III and IV-C compared with Western medicine alone. However, there were no significant differences observed between CHM and placebo treatments.ConclusionThe current inconclusive results in determining the effectiveness of CHM treatment on LF, due to the poor methodological quality and high heterogeneity of the studies, suggests that large RCTs using standardized Chinese medicine syndrome diagnosis and CHM formulae with longer follow-up are required for further evaluation.
Highlights
Liver fibrosis (LF), as a result of wound-healing response to recurrent liver injury, is thought to be an early reversible stage of liver cirrhosis [1]
Twenty-three Randomized controlled trials (RCTs) with a total of 2123 participants met the eligibility criteria were included in this review (Table 1)
Subgroup analyses among studies with different quality found substantial significant differences in favor of Chinese herbal medicines (CHM) in the levels of hyaluronic acid (HA), LN, procollagen type III (PC-III) and IV collagen (IV-C), with I2 ranging from 86% to 98%
Summary
Liver fibrosis (LF), as a result of wound-healing response to recurrent liver injury, is thought to be an early reversible stage of liver cirrhosis [1]. It is characterized by the formation of fibrotic scar tissue with abnormal accumulation of fibroblasts and myofibroblasts, and excessive synthesis and deposition of extracellular matrix (ECM) proteins. Categories of current research into Chinese herbal medicine (CHM) treatment of LF include (1) the prevention of anti-fibrosis effects, (2) mechanisms, and (3) clinical efficacy, safety and quality control [3]. The studies on the effectiveness of Chinese herbal medicines (CHM) in treating liver fibrosis (LF) were not consistent. This study aims to systematically review the effectiveness of CHM on treating LF patients
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