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Effectiveness of Chinese herbal medicine in treating liver fibrosis a systematic review and meta-analysis of randomized controlled trials.doc

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Effectiveness of Chinese herbal medicine in treating liver fibrosis a systematic review and meta-analysis of randomized controlled trials

Cheungetal.ChineseMedicine2012,7:5 /content/7/1/5 REVIEW OpenAccess EffectivenessofChineseherbalmedicinein treatingliverfibrosis:asystematicreviewand meta-analysisofrandomizedcontrolledtrials FanCheung1,YibinFeng1*,NingWang1,Man-FungYuen2,YaoTong1andVivianTaamWong1 Abstract Background:ThestudiesontheeffectivenessofChineseherbalmedicines(CHM)intreatingliverfibrosis(LF)were notconsistent.ThisstudyaimstosystematicallyreviewtheeffectivenessofCHMontreatingLFpatients. Methods:DatabasesincludingMEDLINE,AMED,EMBASE,TheCochraneCentralRegisterofControlledTrials,China NationalKnowledgeInfrastructure,TCMOnline,ChineseBiomedicalLiteratureDatabase,andChineseMedical CurrentContentsweresearcheduptoMarch2011.Randomizedcontrolledtrials(RCTs)involvingLFpatients receivingCHM,Westernmedicine,combinedCHMandWesternmedicinecomparedwithplacebo,Western medicineornointerventionwereincluded.LFmarkersincludingserumhyaluronicacid(HA),laminin(LN), procollagentypeIII(PC-III),typeIVcollagen(IV-C),matrixmetalloproteinase(MMP),andtissueinhibitorsof metalloproteinase(TIMP)weremeasuredasprimaryoutcomes.Liverbiochemistry,includingalanine aminotransferase(ALT)andaspartarteaminotransferase(AST),andimprovementofrelatedclinicalsymptomswere measuredassecondaryoutcomes.Riskofbiasofallocationsequence,allocationconcealment,blinding,incomplete outcomedata,selectiveoutcomereporting,andotherbiaseswereassessed. Results:Twenty-threeRCTswith2123participantswereanalyzedinsubgroupsoftypesofcomparisonandstudy quality.Fifteenstudiesweregradedasgoodquality.CHMaloneandcombinedwithWesternmedicineshowed significantimprovementsinHA,LN,PC-IIIandIV-CcomparedwithWesternmedicinealone.However,therewere nosignificantdifferencesobservedbetweenCHMandplacebotreatments. Conclusion:ThecurrentinconclusiveresultsindeterminingtheeffectivenessofCHMtreatmentonLF,duetothe poormethodologicalqualityandhighheterogeneityofthestudies,suggeststhatlargeRCTsusingstandardized ChinesemedicinesyndromediagnosisandCHMformulaewithlongerfollow-uparerequir