Chaihu-Shugan-San for patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis.

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease characterized by intrahepatic accumulation and is closely associated with metabolic problems. Some studies have indicated that Chaihu-Shugan-San (CSS) may have a positive effect on NAFLD, but robust evidence-based research to substantiate the application of CSS is scarce. A meta-analysis was conducted to assess the clinical efficacy and safety of CSS in the treatment for NAFLD.

METHODS

The literature reporting CSS in NAFLD was searched from inception to October 2023 in in 7 Chinese or English databases. Studies were screened and incorporated based on predefined criteria. Data were extracted and quality was assessed independently by 2 researchers according to the Cochrane risk of bias tools. The changes in outcomes were analyzed using the mean difference (MD) and 95% confidence intervals (CIs) with a random- or fixed-effects model to examine the effect of CSS. RevMan5.4 software was used to perform meta-analyses, and the meta package of R 4.0.0 software was used for publication bias analysis.

RESULTS

A total 17 studies involving 1576 participants were screened for meta-analysis. There was high heterogeneity among studies for all continuous outcomes. Compared with common treatments, CSS could decrease aspartate-aminotransferase (MD = -12.02, 95% CI [-15.97, -8.07]), alanine-aminotransferase (MD = -10.89, 95% CI [-16.35, -5.43]), triglyceride and total cholesterol levels. In addition, CSS may increase the high-density lipoprotein cholesterol levels. And, CSS was associated with a lower incidence of adverse events (RR = 0.79, 95% CI [0.33, 1.91]).

CONCLUSION

Current evidence shows that single or combined use of CSS is effective for NAFLD liver enzymes and blood lipids. Nevertheless, it is challenging to reach a conclusive determination owing to significant heterogeneity and ambiguous risk of bias in some trials. Therefore, more high-quality evidence is required for the clinical implementation of CSS.