什么是水飞蓟素（奶蓟），它是否有助于管理我的乙型肝炎

StephenW

What is silymarin (milk thistle), and is it helpful for managing my hepatitis B and D?
January 23, 2019 hepbtalk       



Silymarin, an herb and extract of milk thistle seeds, is a supplement commonly taken by hepatitis patients across the world, yet its proven benefits remain controversial. It is not a treatment for hepatitis B or D, nor has it been shown to have any effect against fighting the viruses. This herb is believed to have possible benefits on liver health due to its antioxidant and free radical fighting properties, although no studies have found a consistent positive effect on viral load or fibrosis scores 1 .

Silymarin is often taken by patients or suggested by their health care provider during or after interferon treatment ends, presumably with the hope of a protective or anti-inflammatory effect on the liver. But a 2013 study on hepatitis C patients unsuccessfully treated with interferon (the standard treatment for hepatitis B and D coinfection) found no significant difference in silymarin’s ability to lower ALT scores over placebo, a pill with no active drug ingredients 2 . Another 2013 metanalysis reviewed 8 studies which tested silymarin against a placebo and looked for measurable levels of improvement in ALT scores, of which the results were mixed and inconsistent1.

Interestingly, several studies have found improvements in patients’ self-reported patient quality of life after taking silymarin 1 – perhaps due to decreased stress or self-perceived control over their health. However, a 2012 study which randomly assigned patients either silymarin or placebo to measure possible declines in ALT or virus levels, in addition to self-reported quality of life, found little to no improvement in any of these outcomes3 regardless of whether they took milk thistle or a placebo.

As mentioned in our previous blog post, the U.S. National Institutes for Health (NIH) has published a directory of what scientific research has discovered about common herbal supplements. Probably the most popular herbal supplement pitched as a liver remedy is milk thistle, and its extract silymarin. The NIH milk thistle report found, “Previous laboratory studies suggested that milk thistle may benefit the liver by protecting and promoting the growth of liver cells, fighting oxidation (a chemical process that can damage cells), and inhibiting inflammation. However, results from small clinical trials of milk thistle for liver diseases have been mixed, and two rigorously designed studies found no benefit.”

The verdict on silymarin? Due to mixed literature and lack of proven improvements, patients should not rely on silymarin as a treatment for hepatitis B or D, and should discuss any new prescription recommendations with their doctor. Silymarin will not counterbalance damage done by hepatitis B or D viruses. While some studies have found silymarin to be well tolerated with low side-effects6, individual reactions can vary. In the U.S., supplements including silymarin are not regulated by the Food and Drug Administration (FDA), making the true contents of supplements unknown. For these reasons, patients should be cautious about supplements and consider additional ways to improve their overall health. Lifestyle changes including eating a nutritious, balanced diet, avoiding alcohol and cigarettes, and getting regular exercise have been repeatedly proven to have the ability to lower ALT and AST numbers4,5. It is understandable why many patients may turn to herbal supplements for possible health benefits, but without more consistent regulation, and proven clinical benefit, investing in overall healthy lifestyle changes may prove most beneficial.

It is very important for hepatitis B and D patients to be managed by a doctor, preferably a liver specialist, who is familiar with managing coinfected patients. For assistance in locating a specialist near you, please visit our Physician Directory page. For additional questions, please visit www.hepdconnect.org or email [email protected].

Disclaimer: Herbal products are not U.S.FDA approved, and the Hepatitis B Foundation cannot endorse the usage of such products that lack regulation and scientific evidence to deem them both effective and safe.

References

1. Polyak, S. J., Ferenci, P., & Pawlotsky, J. M. (2013). Hepatoprotective and antiviral functions of silymarin components in hepatitis C virus infection. Hepatology (Baltimore, Md.), 57(3), 1262-71.

2. Fried, M. W., Navarro, V. J., Afdhal, N., Belle, S. H., Wahed, A. S., Hawke, R. L., Doo, E., Meyers, C. M., Reddy, K. R., Silymarin in NASH and C Hepatitis (SyNCH) Study Group (2012). Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA, 308(3), 274-82.

3. Fried MW, Navarro VJ, Afdhal N, et al. Effect of Silymarin (Milk Thistle) on Liver Disease in Patients with Chronic Hepatitis C Unsuccessfully Treated with Interferon Therapy: A Randomized Controlled Trial. JAMA.2012;308(3):274–282. doi:10.1001/jama.2012.8265

4. Rusu, E., Jinga, M., Enache, G., Rusu, F., Dragomir, A. D., Ancuta, I., Draguţ, R., Parpala, C., Nan, R., Sima, I., Ateia, S., Stoica, V., Cheţa, D. M., Radulian, G. (2013). Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C–a randomized trial. Nutrition journal, 12, 119.

5. St George A, Bauman A, Johnston A, Farrell G, Chey T, George J Gastroenterol Hepatol. 2009 Mar; 24(3):399-407.

6. Rambaldi, Andrea & P Jacobs, Bradly & Gluud, Christian. (2007). Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane database of systematic reviews (Online).

StephenW

什么是水飞蓟素（奶蓟），它是否有助于管理我的乙型肝炎和丁型肝炎？
2019年1月23日hepbtalk



水飞蓟素是一种草药和奶蓟种子的提取物，是世界各地肝炎患者常用的补充剂，但其经证实的益处仍存在争议。它不是乙型肝炎或乙型肝炎的治疗方法，也没有显示对抗病毒有任何作用。尽管没有研究发现对病毒载量或纤维化评分有一致的积极影响，但据信这种草药因其抗氧化和抗自由基作用而对肝脏健康有益。

在干扰素治疗结束期间或之后，水飞蓟素经常由患者服用或由其医疗保健提供者建议，可能希望对肝脏具有保护性或抗炎作用。但2013年对干扰素治疗失败的丙型肝炎患者（乙型和丁型合并感染的标准治疗）的研究发现，与不含活性药物成分的安慰剂相比，水飞蓟素降低ALT评分的能力没有显着差异2。另一项2013年的元分析回顾了8项研究，这些研究测试了水飞蓟素对安慰剂的影响，并寻找可测量的ALT评分改善水平，其结果混合且不一致1。

有趣的是，一些研究发现服用水飞蓟素1后患者自我报告的患者生活质量有所改善 - 可能是由于压力减轻或自我控制对健康的控制。然而，2012年的一项研究随机分配了水飞蓟素或安慰剂患者以测量ALT或病毒水平的可能下降，除了自我报告的生活质量外，发现任何这些结果几乎没有改善3，无论他们是否服用了牛奶蓟或安慰剂。

正如我们之前的博客文章所述，美国国立卫生研究院（NIH）已经发布了一份关于普通草药补充剂的科学研究发现的目录。可能最流行的草药补充剂作为肝脏补救剂是牛奶蓟，其提取物水飞蓟素。 NIH奶蓟报告发现，“以前的实验室研究表明，奶蓟可能通过保护和促进肝细胞的生长，抗氧化（一种可以破坏细胞的化学过程）和抑制炎症而使肝脏受益。然而，奶蓟对肝脏疾病的小型临床试验的结果参差不齐，两项严格设计的研究发现没有任何益处。

对水飞蓟素的判决？由于混合文献和缺乏经证实的改善，患者不应该依赖水飞蓟素作为乙型肝炎或乙型肝炎的治疗，并应与医生讨论任何新的处方建议。水飞蓟素不会抵消乙肝或丁型肝炎病毒造成的损害。虽然一些研究发现水飞蓟素具有良好的耐受性且副作用小6，但个体反应可能不同。在美国，包括水飞蓟素在内的补充剂不受食品和药物管理局（FDA）的管制，使得补充剂的真实含量未知。由于这些原因，患者应该对补充剂保持谨慎，并考虑其他方法来改善他们的整体健康状况。生活方式的改变，包括吃营养均衡的饮食，避免酒精和香烟，以及定期运动，已被反复证明有能力降低ALT和AST数量4,5。可以理解的是，为什么许多患者可能转向草药补充剂以获得可能的健康益处，但如果没有更一致的监管和已证实的临床益处，投资整体健康的生活方式改变可能证明是最有益的。

对于乙肝和D患者来说，由熟悉管理共感染患者的医生（最好是肝脏专科医生）进行管理是非常重要的。如需帮助找到您附近的专家，请访问我们的医师目录页面。如有其他问题，请访问www.hepdconnect.org或发送电子邮件至[email protected]。

免责声明：草药产品未经美国食品药品监督管理局批准，乙肝基金会不能认可使用缺乏法规和科学证据的产品，认为这些产品既有效又安全。