Systematic Reviews
Copyright ©The Author(s) 2021.
World J Clin Cases. Jan 6, 2021; 9(1): 102-117
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.102
Table 1 General characteristics of included systematic reviews
Ref.
Included study design, n
Total sample size
Intervention
Comparator
Evaluation of methodological quality
Outcomes
Cai et al[9], 2019RCT, 131429TCM formulas based on HuoXueHuaYu principleConventional medicationsCochrane Risk of Bias ToolUltrasound improvement rate, blood lipid profiles (TC, TG), hepatic function (ALT, AST), global improvement rate
Shi et al[8], 2012RCT, 625904TCM formulas, alone or in combination with conventional medicationsPlacebo or conventional medicationsNot mentionedALT normalization rate, blood lipids normalization rate, hepatic steatosis disappearance rate
He et al[16], 2010RCT, 111078TCM formulas, aloneConventional medicationsJadad ScaleHepatic function (ALT, AST, GGT), blood lipid profiles (TC, TG, HDL-C)
Li et al[17], 2011RCT, 222442TCM formulas, aloneConventional medicationsSchulz and Jadad CriteriaCure rate, global improvement rate, hepatic function (ALT, AST, GGT), blood lipid profiles (TC, TG, HDL-C, LDL-C)
Li et al[18], 2014RCT, 171552TCM formulas, alone or in combination with polyene phosphatidyl cholinePolyene phosphatidyl cholineNot mentionedGlobal improvement rate
Yang et al[19], 2019RCT, 191490TCM formulas based on JianPiHuaTan principle, alone or in combination with conventional medicationsConventional medicationsJadad ScaleGlobal improvement rate, hepatic function (ALT, AST), blood lipid profiles (TC, TG), adverse events
Zhang et al[20], 2014RCT, 101395TCM formulas alonePlacebo or conventional medicationsJadad ScaleGlobal improvement rate, adverse events
Table 2 Methodological quality of included systematic reviews using a measure tool to assess systematic reviews 2
Ref.Cai et al[9], 2019Shi et al[8], 2012He et al[16], 2010Li et al[17], 2011Li et al[18], 2014Yang et al[19], 2019Zhang et al[20], 2014
Item 1YesYesYesYesNoYesYes
Item 2NoNoNoNoNoNoNo
Item 3NoYesNoNoNoNoNo
Item 4Partial YesPartial YesNoNoPartial YesPartial YesPartial Yes
Item 5NoYesYesYesNoNoNo
Item 6YesYesNoYesNoNoYes
Item 7NoNoNoNoNoNoNo
Item 8NoPartial YesNoNoNoNoNo
Item 9YesNoPartial YesPartial YesNoPartial YesPartial Yes
Item 10NoNoNoNoNoNoNo
Item 11YesYesNoNoYesYesYes
Item 12NoNoNoNoNoYesNo
Item 13NoNoNoNoNoYesNo
Item 14YesNoYesNoNoYesYes
Item 15YesYesNoNoYesYesYes
Item 16YesYesNoNoNoNoNo
Overall qualityLowExtremely lowExtremely lowExtremely lowExtremely lowModerateLow
Table 3 Risk of bias of the included systematic reviews evaluated by risk of bias in the systematic review
Ref.Phase 1
Phase 2
Phase 3
Relevance
Study eligibility criteria
Identification and selection of studies
Data collection and study appraisal
Synthesis and findings
Risk of bias in the review
Cai et al[9], 2019YesLow riskHigh riskLow riskLow riskHigh risk
Shi et al[8], 2012YesLow riskHigh riskHigh riskHigh riskHigh risk
He et al[16], 2010YesLow riskHigh riskHigh riskHigh riskHigh risk
Li et al[17], 2011YesHigh riskHigh riskHigh riskHigh riskHigh risk
Li et al[18], 2014YesHigh riskHigh riskHigh riskNot clearHigh risk
Yang et al[19], 2019YesLow riskHigh riskHigh riskLow riskHigh risk
Zhang et al[20], 2014YesLow riskHigh riskHigh riskHigh riskHigh risk
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], 2019TCM formulas based on HuoXueHuaYu principle vs conventional medicationsUltrasound improvement rate: OR = 2.33; 95%CI: 1.60, 3.40; P < 0.0017 (590)00000High
TC: MD = -0.38; 95%CI: -0.48, -0.29; P < 0.0015 (358)0-210-120Very low
TG: MD = -0.31; 95%CI: -0.37, -0.24; P < 0.0016 (418)0-21000Low
ALT: SMD = -1.69; 95%CI: -2.24, -1.14; P < 0.0016 (418)0-21000Low
AST: MD = -22.53; 95%CI: -33.16, -11.90; P < 0.0015 (354)0-210-120Very low
Global improvement rate: OR = 3.55; 95%CI: 2.65, 4.76; P < 0.00112 (1389)-130000Moderate
Shi et al[8], 2012TCM formulas vs placeboALT normalization rate: OR = 1.73, 95%CI: 1.34, 2.23; P < 0.0018 (902)000-14-15Low
Blood lipids normalization rate: OR = 1.74, 95%CI: 1.34, 2.26; P < 0.0018 (922)0000-15Moderate
Hepatic steatosis disappearance rate: OR = 2.43, 95%CI: 1.48, 3.97; P < 0.0019 (933)0-160-14-15Very low
TCM formulas vs UDCAALT normalization rate: OR = 1.45, 95%CI: 1.05, 1.98; P = 0.0237 (702)000-140Moderate
Blood lipids normalization rate: OR = 1.57, 95%CI: 0.88, 2.80; P = 0.1243 (350)000-140Moderate
Hepatic steatosis disappearance rate: OR = 1.92, 95%CI: 1.20, 3.07; P = 0.0065 (519)000-14-15Low
TCM formulas + UDCA vs UDCAALT normalization rate: OR = 1.55, 95%CI: 1.08, 2.23; P = 0.0194 (341)000-14-15Low
Blood lipids normalization rate: OR = 1.65, 95%CI: 0.71, 3.87; P = 0.2471 (60)-17,800-140Low
Hepatic steatosis disappearance rate: OR = 1.94, 95%CI: 1.28, 2.96; P = 0.0024 (341)000-14-15Low
TCM formulas vs insulin sensitizersALT normalization rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.3851 (80)-17,800-140Low
Blood lipids normalization rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.3851 (80)-17,800-140Low
Hepatic steatosis disappearance rate: OR = 1.67, 95%CI: 0.53, 5.28; P = 0.3851 (80)-17,800-140Low
TCM formulas + insulin sensitizers vs insulin sensitizersALT normalization rate: OR = 3.31, 95%CI: 0.82, 13.42; P = 0.0941 (61)000-140Moderate
Blood lipids normalization rate: OR = 5.51, 95%CI: 0.25, 119.50; P = 0.2771 (61)000-140Moderate
Hepatic steatosis disappearance rate: OR = 5.51, 95%CI: 0.25, 119.50; P = 0.2771 (61)000-140Moderate
TCM formulas vs fibratesALT normalization rate: OR = 2.36, 95%CI: 1.55, 3.60; P < 0.0015 (681)000-14-15Low
Blood lipids normalization rate: OR = 2.13, 95%CI: 1.34, 3.39; P = 0.0014 (463)000-14-15Low
Hepatic steatosis disappearance rate: OR = 2.35, 95%CI: 1.61, 3.41; P < 0.0017 (781)000-140Moderate
TCM formulas + fibrates vs fibratesALT normalization rate: OR = 1.47, 95%CI: 0.84, 2.56; P = 0.1802 (132)000-140Moderate
Blood lipids normalization rate: OR = 1.83, 95%CI: 0.89, 3.75; P = 0.1022 (132)000-140Moderate
Hepatic steatosis disappearance rate: OR = 1.80, 95%CI: 0.76, 4.29; P = 0.1831 (70)-17,800-140Low
TCM formulas vs statinsALT normalization rate: OR = 1.43, 95%CI: 1.03, 2.00; P = 0.0355 (456)000-140Moderate
Blood lipids normalization rate: OR = 1.26, 95%CI: 0.85, 1.87; P = 0.2494 (364)000-14-15Low
Hepatic steatosis disappearance rate: OR = 1.76, 95%CI: 1.30, 2.37; P < 0.0018 (764)000-14-15Low
TCM formulas + statins vs statinsALT normalization rate: OR = 1.51, 95%CI: 1.11, 2.05; P = 0.0096 (571)000-140Moderate
Blood lipids normalization rate: OR = 1.32, 95%CI: 0.91, 1.93; P = 0.1485 (504)000-140Moderate
Hepatic steatosis disappearance rate: OR = 2.13, 95CI: 1.42, 3.19; P < 0.0016 (601)000-140Moderate
TCM formulas vs antioxidantsALT normalization rate: OR = 1.48, 95%CI: 1.15, 1.92; P = 0.0038 (652)00000High
Blood lipids normalization rate: OR = 1.53, 95%CI: 0.94, 2.51; P = 0.0873 (257)000-14-15Low
Hepatic steatosis disappearance rate: OR = 1.81, 95%CI: 1.27, 2.58; P < 0.0017 (585)000-140Moderate
TCM formulas + antioxidants vs antioxidantsALT normalization rate: OR = 1.62, 95%CI: 1.06, 2.46; P = 0.0254 (267)000-140Moderate
Blood lipids normalization rate: OR = 1.26, 95%CI: 0.95, 2.94; P = 0.0752 (143)000-140Moderate
Hepatic steatosis disappearance rate: OR = 1.77, 95%CI: 1.10, 2.84; P = 0.0184 (257)000-140Moderate
He et al[16], 2010TCM formulas vs conventional medicationsALT: MD = -9.55; 95%CI: -12.45, -6.65; P < 0.00111 (1078)0-2100-19Very low
AST: MD = -9.40; 95%CI: -12.96, -5.85; P < 0.00111 (1078)0-2100-19Very low
GGT: MD = -18.31; 95%CI: -27.06, -9.56; P < 0.00111 (1078)0-2100-19Very low
TC: MD = -1.12; 95%CI: -1.80, -0.44; P < 0.00111 (1078)0-2100-19Very low
TG: MD = -0.39; 95%CI: -0.64, -0.15; P = 0.00211 (1078)0-2100-19Very low
HDL-C: MD = 0.21; 95%CI: 0.14, 0.28; P < 0.00111 (1078)0-2100-19Very low
Li et al[17], 2011TCM formulas vs conventional medicationsCure rate: RR = 1.48, 95%CI: 1.12, 1.94; P = 0.00516 (1644)0-1600-19Low
Global improvement rate: RR = 1.29, 95%CI: 1.16, 1.43; P < 0.00120 (2118)-13-2100-19Very low
ALT: MD = -18.90; 95%CI: -26.34, -11.46; P < 0.00118 (1935)0-2100-19Very low
AST: MD = -10.59; 95%CI: -15.61, -5.58; P < 0.00114 (1480)0-2100-19Very low
GGT cannot be evaluated due to data mistake\\\\\\\
TC: MD = -0.68; 95%CI: -1.14, -0.21; P = 0.00417 (1885)0-2100-19Very low
TG: MD = -0.48; 95%CI: -0.92, -0.03; P = 0.03617 (1885)0-2100-19Very low
HDL-C: MD = 0.07; 95%CI: -0.17, 0.37; P = 0.5618 (731)0-2100-19Very low
LDL-C: MD = -0.59; 95%CI: -0.80, -0.37; P < 0.0017 (776)0-2100-19Very low
Li et al[18], 2014TCM formulas vs PPCGlobal improvement rate: RR = 1.20, 95%CI: 1.12, 1.28; P value not reported11 (982)-13000-19Low
TCM formulas + PPC vs PPCGlobal improvement rate: RR = 1.31, 95%CI: 1.20, 1.43; P value not reported7 (600)-13000-19Low
Yang et al[19], 2019TCM formulas based on JianPiHuaTan principle vs conventional medicationsGlobal improvement rate: RR = 1.30, 95%CI: 1.16, 1.46; P < 0.00117 (1344)-13-2100-15Very low
ALT: MD = -8.55; 95%CI: -12.76, -4.34; P < 0.00115 (1151)0-2100-19Very low
AST: MD = -3.60; 95%CI: -5.83, -1.37; P = 0.00213 (979)0-1600-19Low
TC: MD = -0.88; 95%CI: -1.15, -0.61; P < 0.00113 (1008)0000-19Moderate
TG: MD = -0.47; 95%CI: -0.65, -0.30; P < 0.00114 (1088)0-2100-19Very low
Adverse events: OR = 5.62, 95%CI: 2.02, 15.59; P < 0.0014 (292)-13-160-14-19Very low
TCM formulas based on JianPiHuaTan principle + conventional medications vs conventional medicationsGlobal improvement rate: RR = 1.33, 95%CI: 1.14, 1.55; P < 0.0012 (146)-130000Moderate
Zhang et al[20], 2014TCM formulas vs conventional medicationsGlobal improvement rate: RR = 1.51, 95%CI: 1.41, 1.62; P < 0.0110 (1395)-130000Moderate
Adverse events: No meta-analysis conducted5 (618)\\\\\\