Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews

doi:10.12998/wjcc.v9.i1.102

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World Journal of Clinical Cases

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Systematic Reviews

World J Clin Cases. Jan 6, 2021; 9(1): 102-117
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.102

Table 4 Quality of evidence in the included systematic reviews based on grading of recommendations assessment, development and evaluation system

Ref.	Intervention vs comparator	Outcomes	Study numbers and sample size	A	B	C	D	E	Quality of evidence
Cai et al[9], 2019	TCM formulas based on HuoXueHuaYu principle vs conventional medications	Ultrasound improvement rate: OR = 2.33; 95%CI: 1.60, 3.40; P < 0.001	7 (590)	0	0	0	0	0	High
		TC: MD = -0.38; 95%CI: -0.48, -0.29; P < 0.001	5 (358)	0	-2¹	0	-1²	0	Very low
		TG: MD = -0.31; 95%CI: -0.37, -0.24; P < 0.001	6 (418)	0	-2¹	0	0	0	Low
		ALT: SMD = -1.69; 95%CI: -2.24, -1.14; P < 0.001	6 (418)	0	-2¹	0	0	0	Low
		AST: MD = -22.53; 95%CI: -33.16, -11.90; P < 0.001	5 (354)	0	-2¹	0	-1²	0	Very low
		Global improvement rate: OR = 3.55; 95%CI: 2.65, 4.76; P < 0.001	12 (1389)	-1³	0	0	0	0	Moderate
Shi et al[8], 2012	TCM formulas vs placebo	ALT normalization rate: OR = 1.73, 95%CI: 1.34, 2.23; P < 0.001	8 (902)	0	0	0	-1⁴	-1⁵	Low
		Blood lipids normalization rate: OR = 1.74, 95%CI: 1.34, 2.26; P < 0.001	8 (922)	0	0	0	0	-1⁵	Moderate
		Hepatic steatosis disappearance rate: OR = 2.43, 95%CI: 1.48, 3.97; P < 0.001	9 (933)	0	-1⁶	0	-1⁴	-1⁵	Very low
	TCM formulas vs UDCA	ALT normalization rate: OR = 1.45, 95%CI: 1.05, 1.98; P = 0.023	7 (702)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 1.57, 95%CI: 0.88, 2.80; P = 0.124	3 (350)	0	0	0	-1⁴	0	Moderate
		Hepatic steatosis disappearance rate: OR = 1.92, 95%CI: 1.20, 3.07; P = 0.006	5 (519)	0	0	0	-1⁴	-1⁵	Low
	TCM formulas + UDCA vs UDCA	ALT normalization rate: OR = 1.55, 95%CI: 1.08, 2.23; P = 0.019	4 (341)	0	0	0	-1⁴	-1⁵	Low
		Blood lipids normalization rate: OR = 1.65, 95%CI: 0.71, 3.87; P = 0.247	1 (60)	-1⁷^,⁸	0	0	-1⁴	0	Low
		Hepatic steatosis disappearance rate: OR = 1.94, 95%CI: 1.28, 2.96; P = 0.002	4 (341)	0	0	0	-1⁴	-1⁵	Low
	TCM formulas vs insulin sensitizers	ALT normalization rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.385	1 (80)	-1⁷^,⁸	0	0	-1⁴	0	Low
		Blood lipids normalization rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.385	1 (80)	-1⁷^,⁸	0	0	-1⁴	0	Low
		Hepatic steatosis disappearance rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.385	1 (80)	-1⁷^,⁸	0	0	-1⁴	0	Low
	TCM formulas + insulin sensitizers vs insulin sensitizers	ALT normalization rate: OR = 3.31, 95%CI: 0.82, 13.42; P = 0.094	1 (61)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 5.51, 95%CI: 0.25, 119.50; P = 0.277	1 (61)	0	0	0	-1⁴	0	Moderate
		Hepatic steatosis disappearance rate: OR = 5.51, 95%CI: 0.25, 119.50; P = 0.277	1 (61)	0	0	0	-1⁴	0	Moderate
	TCM formulas vs fibrates	ALT normalization rate: OR = 2.36, 95%CI: 1.55, 3.60; P < 0.001	5 (681)	0	0	0	-1⁴	-1⁵	Low
		Blood lipids normalization rate: OR = 2.13, 95%CI: 1.34, 3.39; P = 0.001	4 (463)	0	0	0	-1⁴	-1⁵	Low
		Hepatic steatosis disappearance rate: OR = 2.35, 95%CI: 1.61, 3.41; P < 0.001	7 (781)	0	0	0	-1⁴	0	Moderate
	TCM formulas + fibrates vs fibrates	ALT normalization rate: OR = 1.47, 95%CI: 0.84, 2.56; P = 0.180	2 (132)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 1.83, 95%CI: 0.89, 3.75; P = 0.102	2 (132)	0	0	0	-1⁴	0	Moderate
		Hepatic steatosis disappearance rate: OR = 1.80, 95%CI: 0.76, 4.29; P = 0.183	1 (70)	-1⁷^,⁸	0	0	-1⁴	0	Low
	TCM formulas vs statins	ALT normalization rate: OR = 1.43, 95%CI: 1.03, 2.00; P = 0.035	5 (456)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 1.26, 95%CI: 0.85, 1.87; P = 0.249	4 (364)	0	0	0	-1⁴	-1⁵	Low
		Hepatic steatosis disappearance rate: OR = 1.76, 95%CI: 1.30, 2.37; P < 0.001	8 (764)	0	0	0	-1⁴	-1⁵	Low
	TCM formulas + statins vs statins	ALT normalization rate: OR = 1.51, 95%CI: 1.11, 2.05; P = 0.009	6 (571)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 1.32, 95%CI: 0.91, 1.93; P = 0.148	5 (504)	0	0	0	-1⁴	0	Moderate
		Hepatic steatosis disappearance rate: OR = 2.13, 95CI: 1.42, 3.19; P < 0.001	6 (601)	0	0	0	-1⁴	0	Moderate
	TCM formulas vs antioxidants	ALT normalization rate: OR = 1.48, 95%CI: 1.15, 1.92; P = 0.003	8 (652)	0	0	0	0	0	High
		Blood lipids normalization rate: OR = 1.53, 95%CI: 0.94, 2.51; P = 0.087	3 (257)	0	0	0	-1⁴	-1⁵	Low
		Hepatic steatosis disappearance rate: OR = 1.81, 95%CI: 1.27, 2.58; P < 0.001	7 (585)	0	0	0	-1⁴	0	Moderate
	TCM formulas + antioxidants vs antioxidants	ALT normalization rate: OR = 1.62, 95%CI: 1.06, 2.46; P = 0.025	4 (267)	0	0	0	-1⁴	0	Moderate
		Blood lipids normalization rate: OR = 1.26, 95%CI: 0.95, 2.94; P = 0.075	2 (143)	0	0	0	-1⁴	0	Moderate
		Hepatic steatosis disappearance rate: OR = 1.77, 95%CI: 1.10, 2.84; P = 0.018	4 (257)	0	0	0	-1⁴	0	Moderate
He et al[16], 2010	TCM formulas vs conventional medications	ALT: MD = -9.55; 95%CI: -12.45, -6.65; P < 0.001	11 (1078)	0	-2¹	0	0	-1⁹	Very low
		AST: MD = -9.40; 95%CI: -12.96, -5.85; P < 0.001	11 (1078)	0	-2¹	0	0	-1⁹	Very low
		GGT: MD = -18.31; 95%CI: -27.06, -9.56; P < 0.001	11 (1078)	0	-2¹	0	0	-1⁹	Very low
		TC: MD = -1.12; 95%CI: -1.80, -0.44; P < 0.001	11 (1078)	0	-2¹	0	0	-1⁹	Very low
		TG: MD = -0.39; 95%CI: -0.64, -0.15; P = 0.002	11 (1078)	0	-2¹	0	0	-1⁹	Very low
		HDL-C: MD = 0.21; 95%CI: 0.14, 0.28; P < 0.001	11 (1078)	0	-2¹	0	0	-1⁹	Very low
Li et al[17], 2011	TCM formulas vs conventional medications	Cure rate: RR = 1.48, 95%CI: 1.12, 1.94; P = 0.005	16 (1644)	0	-1⁶	0	0	-1⁹	Low
		Global improvement rate: RR = 1.29, 95%CI: 1.16, 1.43; P < 0.001	20 (2118)	-1³	-2¹	0	0	-1⁹	Very low
		ALT: MD = -18.90; 95%CI: -26.34, -11.46; P < 0.001	18 (1935)	0	-2¹	0	0	-1⁹	Very low
		AST: MD = -10.59; 95%CI: -15.61, -5.58; P < 0.001	14 (1480)	0	-2¹	0	0	-1⁹	Very low
		GGT cannot be evaluated due to data mistake	\	\	\	\	\	\	\
		TC: MD = -0.68; 95%CI: -1.14, -0.21; P = 0.004	17 (1885)	0	-2¹	0	0	-1⁹	Very low
		TG: MD = -0.48; 95%CI: -0.92, -0.03; P = 0.036	17 (1885)	0	-2¹	0	0	-1⁹	Very low
		HDL-C: MD = 0.07; 95%CI: -0.17, 0.37; P = 0.561	8 (731)	0	-2¹	0	0	-1⁹	Very low
		LDL-C: MD = -0.59; 95%CI: -0.80, -0.37; P < 0.001	7 (776)	0	-2¹	0	0	-1⁹	Very low
Li et al[18], 2014	TCM formulas vs PPC	Global improvement rate: RR = 1.20, 95%CI: 1.12, 1.28; P value not reported	11 (982)	-1³	0	0	0	-1⁹	Low
Li et al[18], 2014	TCM formulas + PPC vs PPC	Global improvement rate: RR = 1.31, 95%CI: 1.20, 1.43; P value not reported	7 (600)	-1³	0	0	0	-1⁹	Low
Yang et al[19], 2019	TCM formulas based on JianPiHuaTan principle vs conventional medications	Global improvement rate: RR = 1.30, 95%CI: 1.16, 1.46; P < 0.001	17 (1344)	-1³	-2¹	0	0	-1⁵	Very low
		ALT: MD = -8.55; 95%CI: -12.76, -4.34; P < 0.001	15 (1151)	0	-2¹	0	0	-1⁹	Very low
		AST: MD = -3.60; 95%CI: -5.83, -1.37; P = 0.002	13 (979)	0	-1⁶	0	0	-1⁹	Low
		TC: MD = -0.88; 95%CI: -1.15, -0.61; P < 0.001	13 (1008)	0	0	0	0	-1⁹	Moderate
		TG: MD = -0.47; 95%CI: -0.65, -0.30; P < 0.001	14 (1088)	0	-2¹	0	0	-1⁹	Very low
		Adverse events: OR = 5.62, 95%CI: 2.02, 15.59; P < 0.001	4 (292)	-1³	-1⁶	0	-1⁴	-1⁹	Very low
	TCM formulas based on JianPiHuaTan principle + conventional medications vs conventional medications	Global improvement rate: RR = 1.33, 95%CI: 1.14, 1.55; P < 0.001	2 (146)	-1³	0	0	0	0	Moderate
Zhang et al[20], 2014	TCM formulas vs conventional medications	Global improvement rate: RR = 1.51, 95%CI: 1.41, 1.62; P < 0.01	10 (1395)	-1³	0	0	0	0	Moderate
Zhang et al[20], 2014	TCM formulas vs conventional medications	Adverse events: No meta-analysis conducted	5 (618)	\	\	\	\	\	\

¹I²> 75%.

²Total cases < 400.

³Serious limitations exist, and the outcomes contained subjective assessments.

⁴The optimal information size was not satisfied.

⁵Asymmetric funnel plot.

⁶I²> 50%.

⁷Unclear information on allocation concealment.

⁸Unclear information on blinding.

⁹Small sample studies accounted for the majority. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transpeptidase; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; MD: Mean difference; OR: Odds ratio; PPC: Polyene phosphatidyl choline; RR: Risk ratio; SMD: Standardized mean difference; TC: Total cholesterol; TCM: Traditional Chinese medicine; TG: Triglyceride; UDCA: Ursodeoxycholic acid.

Citation: Dai L, Zhou WJ, Zhong LLD, Tang XD, Ji G. Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews. World J Clin Cases 2021; 9(1): 102-117
URL: https://www.wjgnet.com/2307-8960/full/v9/i1/102.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i1.102