Intervention Review

Medicinal herbs for hepatitis C virus infection

  1. Jian Ping Liu1,*,
  2. Eric Manheimer2,
  3. Kiichiro Tsutani3,
  4. Christian Gluud4

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 23 OCT 2001

Assessed as up-to-date: 23 JUL 2001

DOI: 10.1002/14651858.CD003183


How to Cite

Liu JP, Manheimer E, Tsutani K, Gluud C. Medicinal herbs for hepatitis C virus infection. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003183. DOI: 10.1002/14651858.CD003183.

Author Information

  1. 1

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine, Beijing, China

  2. 2

    University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, USA

  3. 3

    Graduate School of Pharmaceutical Sciences, Department of Pharmacoeconomics, Tokyo, Japan

  4. 4

    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet,, Cochrane Hepato-Biliary Group, Copenhagen, Denmark

*Jian Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. jianping_l@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Hepatitis C virus (HCV) infection is a serious health problem world-wide. Medicinal herbs are increasingly being used for hepatitis C.

Objectives

To assess the efficacy and safety of medicinal herbs for hepatitis C virus infection.

Search methods

Searches were applied to The Controlled Trial Registers of The Cochrane Hepato-Biliary Group, The Cochrane Complementary Medicine Field, and The Cochrane Library as well as MEDLINE, EMBASE, BIOSIS, Chinese and Japanese databases (February 2001). Five Chinese and one Japanese journals were handsearched. No language restriction was used.

Selection criteria

Randomised clinical trials comparing medicinal herbs versus placebo, no intervention, general non-specific treatment, other herbal medicine, or interferon and/or ribavirin treatment. Trials of medicinal herbs plus interferon and/or ribavirin versus interferon and/or ribavirin alone were also included.

Data collection and analysis

Two authors extracted data independently. The methodological quality of the trials was evaluated using the generation of allocation sequence, allocation concealment, double blinding, and the Jadad-scale. The outcomes were presented as relative risk or weighted mean difference, both with 95% confidence interval.

Main results

Ten randomised trials, including 517 patients with mainly chronic hepatitis C, evaluated ten different medicinal herbs versus various control interventions (four placebo, four interferon, two other herbs). The methodological quality was considered adequate in four trials and inadequate in six trials. Compared with placebo in four trials, none of the medicinal herbs showed positive effects on clearance of serum HCV RNA or anti-HCV antibody or on serum liver enzymes, except one short-term trial in which a silybin preparation showed a significant effect on reducing serum aspartate aminotransferase and gamma-glutamyltranspeptidase activities. The herbal compound Bing Gan Tang combined with interferon-alpha showed significantly better effects on clearance of serum HCV RNA (relative risk 2.54; 95% confidence interval 1.43 to 4.49) and on normalisation of serum alanine aminotransferase activity (relative risk 2.54; 95% confidence interval 1.43 to 4.49) than interferon-alpha monotherapy. The herbal compound Yi Zhu decoction showed a significant effect on clearance of serum HCV RNA and normalisation of ALT levels compared to glycyrrhizin plus ribavirin. Yi Er Gan Tang showed a significant effect on normalising serum alanine aminotransferase compared to silymarin plus glucurolactone. There was no significant efficacy of the other examined herbs. The herbs were associated with adverse events.

Authors' conclusions

There is no firm evidence of efficacy of any medicinal herbs for HCV infection. Medicinal herbs for HCV infection should not be used outside randomised clinical trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Still awaiting evidence on efficacy of medicinal herbs for viral hepatitis C

Hepatitis C is an infectious disease of the liver caused by hepatitis C virus. Around 170 million people world-wide are chronically infected with this virus. The infection is associated with severe sequelae such as liver cirrhosis, liver cancer, or liver failure. Herbal medicines have been used for treating hepatitis C. This systematic review evaluates the effects of herbal medicines for treating acute and chronic hepatitis C infection.

Ten different herbal medicines were tested in ten randomised trials in patients with chronic hepatitis C. The present systematic review found no significant antiviral effect of the herbal medicines when compared with placebo, but the data suggest that some herbal medicines in combination with interferon may have effects on the clearance of HCV RNA and on normalisation of liver enzymes. However, there is no strong evidence for any efficacy of these medicinal herbs for chronic hepatitis C due to the fact that most positive effects came from clinical trials with low methodological quality. Medicinal herbs for hepatitis C virus infection should not be used outside well-designed, randomised clinical trials.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用中草藥治療C型肝炎

C肝病毒 (HCV)感染是一種世界性嚴重的健康問題。越來越多的中草藥用於治療C肝。

目標

評估中草藥治療C肝病毒感染的結果和安全性。

搜尋策略

搜尋The Controlled Trial Registers of The Cochrane HepatoBiliary Group, The Cochrane Complementary Medicine Field, Cochrane Library as,MEDLINE, EMBASE、BIOSIS、中國和日本資料庫(所有最新的研究,2001年2月)等資料庫。手動搜索5份中國期刊和一份日本期刊。 沒有語言限制。

選擇標準

比較中草藥(單一草藥或草藥複方)和安慰劑,無干預法,一般非特異性療法,其他中草藥,干擾素和ribavirin療法的隨機臨床試驗。試驗比較(1)中草藥加干擾素(和/或ribavirin)與(2)干擾素和/或ribavirin也被納入。

資料收集與分析

兩位回顧作者單獨摘錄數據。使用分配順序、分配方案的隱藏、雙盲法和 Jadad量表評估試驗的研究方法品質。結果表示為相對風險度或加權平均差,兩者有95% 信賴區間。

主要結論

納入10個隨機試驗,共517位慢性C肝病人,評估10種中草藥對照控制干預法(4種安慰劑、4種干擾素、兩種其他草藥)。其中4個試驗的研究方法品質充足,6個不充足。在4個試驗中,和安慰劑比較, 沒有一種中草藥對於清除血清中的HCV RNA或抗C肝抗體,血清中的肝指數有正面療效,除了一個'短期試驗指出silybin對於降低血清中的天門冬氨酸氨基轉移?和γ穀氨?轉移?活性有顯著作用。和干擾素α單一療法相比,草藥複方C肝糖結合干擾素α一起使用,對清除血清中HCV RNA (相對風險度2.54; 95% 信賴區間 1.43 4.49)和使得血清丙氨酸轉氨?活性變為正常化 (相對風險度2.54; 95% 信賴區間 1.43 – 4.49) 具有更加顯著的療效。比較甘草酸(glycyrrhizin)加ribavirin,草藥複方Yi Zhu湯對清除血清中的HCV RNA ,及肝指數正常化具有明顯療效。比較水飛薊素(silymarin)加葡萄糖醛酸內酯(glucurolactone),Yi Er Gan Tang湯對於血清中肝指數正常化具有明顯療效。 其他檢驗的草藥沒有明顯效果。此類草藥和不良事件相關。

作者結論

沒有可靠證據指出中草藥治療HCV感染的療效。.不建議在隨機臨床試驗以外的領域使用中草藥來治療C肝。

翻譯人

本摘要由臺中榮民總醫院張崇信翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中草藥治療病毒性C肝仍有待證據的查證。C型肝炎是由於C肝病毒的引起的疾病。大約全世界有1億7千萬的人慢性C肝患者。此類感染和嚴重的後遺症相關,例如,肝硬化、肝癌或肝衰竭。中草藥被用於治療C肝。本次系統性文獻回顧評估了中草藥治療急性和慢性C肝感染的療效。10個隨機試驗對慢性C肝病人檢驗了10種不同的中草藥。 目前系統性文獻回顧顯示和安慰劑比較,中草藥不具有顯著抗病毒療效,但是研究顯示,一些中草藥結合干擾素使用之後,具有清除HCV RNA ,使肝指數正常的療效。但是由於發表正面療效的研究多來自于方法學質量低的臨床試驗,沒有可靠證據指出這些中草藥治療慢性C肝的療效。不建議在研究設計合理的隨機臨床試驗以外,使用中草藥治療C肝病毒感染。