Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
The use of silymarin in the treatment of liver diseases
Autore:
Saller, R; Meier, R; Brignoli, R;
Indirizzi:
Univ Spital Zurich, Dept Innere Med, Abt Naturheilkunde, CH-8091 Zurich, Switzerland Univ Spital Zurich Zurich Switzerland CH-8091 H-8091 Zurich, Switzerland Univ Basel, Dept Gastroenterol, Liestal, Switzerland Univ Basel Liestal Switzerland Dept Gastroenterol, Liestal, Switzerland Tradyser GmbH, Ruschlikon, Switzerland Tradyser GmbH Ruschlikon Switzerland yser GmbH, Ruschlikon, Switzerland
Titolo Testata:
DRUGS
fascicolo: 14, volume: 61, anno: 2001,
pagine: 2035 - 2063
SICI:
0012-6667(2001)61:14<2035:TUOSIT>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
NF-KAPPA-B; SILYBIN-PHOSPHATIDYLCHOLINE COMPLEX; HEPATITIS-C VIRUS; DIABETES-MELLITUS; DOUBLE-BLIND; ALCOHOLIC CIRRHOSIS; CYTOCHROME-P450 2E1; CONTROLLED TRIAL; MILK THISTLE; SILIBININ;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
116
Recensione:
Indirizzi per estratti:
Indirizzo: Saller, R Univ Spital Zurich, Dept Innere Med, Abt Naturheilkunde, Ramistr100, CH-8091 Zurich, Switzerland Univ Spital Zurich Ramistr 100 Zurich Switzerland CH-8091 rland
Citazione:
R. Saller et al., "The use of silymarin in the treatment of liver diseases", DRUGS, 61(14), 2001, pp. 2035-2063

Abstract

The high prevalence of liver diseases such as chronic hepatitis and cirrhosis underscores the need for efficient and cost-effective treatments. The potential benefit of silymarin (extracted from the seeds of Silybum marianumor milk thistle) in the treatment of liver diseases remains a controversial issue. Therefore, the objective of this review is to assess the clinical efficacy and safety of silymarin by application of systematic approach. 525references were found in the databases, of which 84 papers were retained for closer examination and 36 were deemed suitable for detailed analysis. Silymarin has metabolic and cell-regulating effects at concentrations found in clinical conditions, namely carrier-mediated regulation of cell membrane permeability, inhibition of the 5-lipoxygenase pathway, scavenging of reactive oxygen species (ROS) of the R-OH type and action on DNA-expression, for example, via suppression of nuclear factor (NF)-kappaB. Pooled data from case record studies involving 452 patients with Amanita phalloides poisoning show a highly significant difference in mortality in favour of silibinin [the main isomer contained in silymarin] (mortality 9.8% vs 18.3% with standard treatment; p < 0.01). The available trials in patients with toxic (e.g. solvents) or iatrogenic (e.g. antipsychotic or tacrine)liver diseases, which are mostly outdated and underpowered, do not enable any valid conclusions to be drawn on the value of silymarin. The exception is an improved clinical tolerance of tacrine. In spite of some positive results in patients with acute viral hepatitis, no formally valid conclusion can be drawn regarding the value of silymarin in the treatment of these infections. Although there were no clinical end-points in the four trials considered in patients with alcoholic liver disease, histological findings were reported as improved in two out of two trials, improvement of prothrombin time wassignificant (two trials pooled) and liver transaminase levels were consistently lower in the silymarin-treated groups. Therefore, silymarin may be ofuse as an adjuvant in the therapy of alcoholic liver disease. Analysis wasperformed on five trials with a total of 602 patients with liver cirrhosis. The evidence shows that, compared with placebo, silymarin produces a nonsignificant reduction of total mortality by -4.2% [odds ratio (OR) 0.75 (0.5- 1.1)]; but that, on the other hand, the use of silymarin leads to a significant reduction in liver-related mortality of -7% [OR: 0.54 (0.3 - 0.9); p < 0.01]. An individual trial reported a reduction in the number of patients with encephalopathy of -8.7% (p = 0.06). In one study of patients with cirrhosis-related diabetes mellitus, the insulin requirement was reduced by -25% (p < 0.01). We conclude that available evidence suggests that silymarin may play a role in the therapy of (alcoholic) liver cirrhosis. Silymarin is has a good safety record and only rare case reports of gastrointestinal disturbances and allergic skin rashes have been published. This review does not aim to replace future prospective trials aiming to provide the 'final' evidence of the efficacy of silymarin.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 00:41:24