대한한방내과학회지 (The Journal of Internal Korean Medicine)

대한한방내과학회 (The Society of Internal Korean Medicine)
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B형 및 C형 간염에 대한 한약 치료의 효과 - 체계적 고찰 연구

Herbal Medicine for the Treatment of Viral Hepatitis B and C: A Systematic Review of Randomized Controlled Trials

  • 김승모 (대구한의대학교 간계내과학교실) ;
  • 이유리 (대구한의대학교 간계내과학교실) ;
  • 조나경 (대구한의대학교 간계내과학교실) ;
  • 최홍식 (대구한의대학교 간계내과학교실) ;
  • 김경순 (대구한의대학교 간계내과학교실)
  • Kim, Seung-mo (Dept. of Korean Internal Medicine of Hepatology, College of Korean Medicine, Daegu Haany University) ;
  • Lee, Yu-ri (Dept. of Korean Internal Medicine of Hepatology, College of Korean Medicine, Daegu Haany University) ;
  • Cho, Na-kyung (Dept. of Korean Internal Medicine of Hepatology, College of Korean Medicine, Daegu Haany University) ;
  • Choi, Hong-sik (Dept. of Korean Internal Medicine of Hepatology, College of Korean Medicine, Daegu Haany University) ;
  • Kim, Kyung-soon (Dept. of Korean Internal Medicine of Hepatology, College of Korean Medicine, Daegu Haany University)
  • 투고 : 2021.06.08
  • 심사 : 2021.09.29
  • 발행 : 2021.09.30
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초록

본 연구는 B형 및 C형 간염에 대한 한약 치료의 효과를 평가하기 위해 무작위 임상연구를 대상으로 체계적 문헌고찰 및 메타분석을 시행하였다. 검색엔진은 EMBASE, Pubmed, NDSL, KMBASE, KISS, KISTI, Koreamed, Koreantk, Oasis database를 이용하였으며 국내의 검색 엔진 키워드는 '간염' 또는 '바이러스성간염', '한약', '무작위 배정 임상시험'을, 국외 검색 엔진 키워드는 'hepatitis' or 'viral hepatitis' and 'herbal medicine' or 'traditional chinese medicine' and 'randomized controlled trial'을 이용하였다. 연구 결과 15개의 무작위배정 임상시험을 선택되었으며, 그 중 통계적으로 유의미한 결과를 나타낸 연구는 한약과 양약 복합치료군이 양약을 투여한 대조군에 비해 HBV DNA loss에서 높은 효과를 보였다. 한약과 양약 복합치료군이 양약을 투여한 대조군에 비해 HBeAg loss에서 통계적으로 유의한 효과를 보였으며, 한약과 양약 복합치료군이 양약을 투여한 대조군에 비해 ALT가 감소하였다. 본 연구는 B형 및 C형 간염환자를 대상으로 한약의 효과를 확인하기 위해 기존에 시행된 RCT 연구를 대상으로 체계적 문헌고찰을 시행하였으며, 한약과 양약의 복합치료가 양약 단독치료에 비해 치료효과가 더 높은 것으로 나타났다.

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that applied herbal medicine to treat viral hepatitis B and C in order to determine the therapeutic efficacy of herbal medicine. EMBASE, Pubmed, NDSL, KMBASE, KISS, KISTI, Koreamed, Koreantk, and Oasis databases were searched to identify RCTs. The selected studies were assessed by the Cochrane group's risk of bias tool. A total of 15 RCTs were selected, and the hepatitis B virus (HBV) DNA reduction was significantly higher in patients treated with herbal medicine combined with Western medicine than in patients treated with herbal medicine. Herbal medicine combined with Western medicine was also superior to Western medicine alone in achieving hepatitis B e-antigen (HBeAg) and alanine aminotransferase [ALT] reduction. Only herbal medicine alone was not superior to Western medicine treatments in achieving HBV DNA, HBeAg, and ALT reduction.

키워드

과제정보

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2018R1A5A2025272).

참고문헌

  1. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 19th edition. Seoul: McGraw-Hill Professional Publishing; 2017, p. 2877-96.
  2. Decker A, Neumann-Haefelin C, Thimme R. Viral hepatitis A-E. Internist (Berl) 2021;62(2):163-74. https://doi.org/10.1007/s00108-020-00923-9
  3. World Health Organization, 2017. Global Hepatitis Report, 2017. ISBN: 978-92-4-156545-5. Available at: http://apps.who.int/iris/bitstream/handle/10665/255017/WHO-HIV-2017.06-eng.pdf.?sequence=1. Accessed 14 Nov 2018.
  4. Almeida PH, Matielo CEL, Curvelo LA, Rocco RA, Felga G, Della Guardia B, et al. Update on the management and treatment of viral hepatitis. World J Gastroenterol 2021;27(23):3249-61. https://doi.org/10.3748/wjg.v27.i23.3249
  5. Jeong SH. Epidemiology of Hepatitis C Virus Infection in Korea. The Korean Journal of Medicine 2015;88(6):630-4. https://doi.org/10.3904/kjm.2015.88.6.630
  6. Richmond JA, Bailey DE, Patel K, Jezsik JA, Muir A, Lin JR, et al. The use of complementary and alternative medicine by patients with chronic hepatitis C. Complement Ther Clin Pract 2010; 16(3):124-31. https://doi.org/10.1016/j.ctcp.2009.10.004
  7. Jeongughanuigwadaehag gangyenaegwahaggyosil. Gangyenaegwahag. Seoul: Nado; 2013 p. 292-8.
  8. Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AIMU Annu Symp Proc 2006;2006: 359-63.
  9. Kim SY, Park JE, Seo HJ, Seo HS, Son HJ, Sin CM, et al. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul: National Evidence-based Healthcare Collaborating Agency; 2011, p. 141-2.
  10. Batey RG, Bensoussan A, Fan YY, Bollipo S, Hossain MA. Preliminary report of a randomized, double-blind placebo-controlled trial of a Chinese herbal medicine preparation CH-100 in the treatment of chronic hepatitis C. J Gastroenterol Hepatol 1998;13(3):244-7. https://doi.org/10.1111/j.1440-1746.1998.01550.x
  11. Chen C, Guo SM, Liu B. A randomized controlled trial of kurorinone versus interferon-α2a treatment in patients with chronic hepatitis B. J Viral Hepat 2000;7(3):225-9. https://doi.org/10.1046/j.1365-2893.2000.00216.x
  12. Chen ZX, Zhang SJ, Lao SX, Hu HT, Zhang, CY, Guan SH, et al. He Jie Tang in the treatment of chronic hepatitis B patients. World J Gastroenterol 2005;11(42):6638-43. https://doi.org/10.3748/wjg.v11.i42.6638
  13. Chen FP, Chang CM, Wu TP, Yang JL, Kung YY, Huang YH, et al. Clinical efficacy of Rong-Yang-Jyh-Gan-Tang on patients with chronic hepatitis C: A double-blinded randomized placebo-controlled crossover study. J Ethnopharmacol 2007;196:1-8. https://doi.org/10.1016/j.jep.2016.12.013
  14. He J, Zhou D, Tong G, Xing Y, Chen Y, Zhang X, et al. Efficacy and safety of a Chinese herbal formula (invigorating kidney and strengthening spleen) in chronic hepatitis B virus carrier: Results from a multicenter, randomized, double-blind, and placebo-controlled trial. Evid Based Complement Alternat Med 2013;2013:961926.
  15. Lee CJ, Cheng CH, Li YH, Liu CY, Hsu CH. A Chinese medicine, Kuan-Sin-Yin decoction, improves liver function in hepatitis B virus carriers: A randomized, controlled study. J Altern Complement Med 2013;19(12):964-73. https://doi.org/10.1089/acm.2013.0136
  16. Liu CY, Ko PH, Yen HR, Cheng CH, Li YH, Liao ZH, et al. The Chinese medicine Kuan-Sin-Yin improves liver function in patients with chronic hepatitis C: A randomised and placebo-controlled trial. Complement Ther Med 2016;27:114-22. https://doi.org/10.1016/j.ctim.2016.06.004
  17. Min L, Chen X, Ye Y, Zhang Q, Ru S, Li X. Modeling and simulating dynamics of complete-and poor-response chronic hepatitis B Chinese patients for adefovir and traditional Chinese medicine plus adefovir therapy. Evid Based Complement Alternat Med 2013;2013:767290.
  18. Ye YA, Tian DL, Jiang J, Li J, Chen JJ, Li ZH, et al. Effect of Shuanghu Qinggang ranule and Yigan Yiqi Jieyu granule plus lamivudine on chronic hepatitis B patients: A randomized double-blind placebo-controlled trial. Chin J Integr Med 2016;1-7. https://doi.org/10.1007/BF02857421
  19. YongCai X, GuoXin H, YanZhong P, Jie Z, YingPing L. Clinical effect of Dahyang Zhe Chong capsules combined with entecavir in treatment of chronic hepatitis B patients with liver fibrosis. J Clin Hepatol 2016;32:1502-7.
  20. Zhang CP, Tian ZB, Liu XS, Zhao QX, Wu J, Liang YX. Effects of Zhaoyangwanon chronic hepatitis B and posthepatic cirrhosis. World J Gastroenterol 2004;10(2):295-8. https://doi.org/10.3748/wjg.v10.i2.295
  21. Zhang SJ, Chen ZX, Lao SX, Huang BJ. Effect of Hejie decoction on T cell immune state of chronic hepatitis B patients. World J Gastroenterol 2004;10(10):1436-9. https://doi.org/10.3748/wjg.v10.i10.1436
  22. Ye ZR, Du WX, Wu L. Clinical analysis of modified Chaiping decoction in treating HBeAg-negative chronic hepatitis B. Zhongguo Zhong Yao Za Zhi 2006;41(20):3875-80.
  23. Zhou W. Huju Yigan capsules combined with entecavir for treatment of patients with chronic hepatitis B: Clinical efficacy and influence on serum inflammatory factors. Shi Jie Hua Ren Xiao Hua Za Zhi 2017;25(20): 1882-8.
  24. Zhu XJ, Sun XH, Zhou ZH, Liu SQ, Lv H, Li M, et al. Lingmao formula combined with entecavir for HBeAg-positive chronic hepatitis B patients with mildly elevated alanine aminotransferase: A multicenter, randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med 2013;2013:620230.
  25. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of Two Methods to Detect Publication Bias in Meta-analysis. JAMA 2006;295(6):676-80. https://doi.org/10.1001/jama.295.6.676
  26. Wang J, Xin S, JinX, Yongqian Cheng, Tao Yan, Song Qing, et al. Meta-analysis of combination therapy of Chinese herbs plus interferon and ribavirin in patients with chronic hepatitis C. Med Sci Monit 2016;22:1817-26. https://doi.org/10.12659/msm.895647
  27. Zhao S, Liu E, Wei K, Lu S, Chu Y, Li Y, et al. Interferon plus Chinese herbs are associated with higher sustained virological response than interferon alone in chronic Hepatitis C: A meta-analysis of randomised trials. Antiviral Res 2011;89(2):156-64. https://doi.org/10.1016/j.antiviral.2010.12.003
  28. Wang T, Zhou X, Liu H, Wang J, Zhang P, Zhu Y, et al. Fuzheng Huayu capsule as an adjuvant treatment for HBV-related cirrhosis: A systematic review and meta-analysis. Phytother Res 2018;32(5):757-68. https://doi.org/10.1002/ptr.6009
  29. Wei F, Lang Y, Gong D, Fan Y. Effect of Dahuang zhechong formula on liver fibrosis in patients with chronic hepatitis B: A meta-analysis. Complement Ther Med 2015;23(1): 129-38. https://doi.org/10.1016/j.ctim.2014.12.011
  30. Yang Y, Jiang HY, Shi Y, He JL, Su S, Chen Z. Chinese herbal medicine for carriers of the hepatitis B virus: An updated systematic review and meta-analysis. Pharmazie 2014;69(10): 723-53.
  31. Jeongughanuigwadaehag bonchohag gongdonggyojae-pyeonchanwiwonhoe. Bonchohag, Seoul: Jeongseonsa; 2011, p. 584-6, 577-81.
  32. The Korean Association for the Study of the Liver. Chronic hepatitis B clinical practice guideline. Seoul: Jin Publishing; 2015, p. 6, 28.