Abstract: Background　Non-alcoholic fatty liver disease （NAFLD） is the main cause of chronic liver disease in many regions of the world，and some cases gradually develop into liver cirrhosis and liver cancer.However，there are currently no consensus guidelines for drug therapy for NAFLD. In recent years，the drugs angiotensin-converting enzyme inhibitor （ACEI） and angiotensinⅡ receptor blocker （ARB） have been focused on for prevention and treatment of NAFLD.Objective　A meta-analysis was conducted to analyze the efficacy and safety of ACEI or ARB drugs in the treatment of NAFLD.Methods　We searched multiple databases including the Cochrane Clinical Controlled Trial Registration Database，EMBase，Medline，the China Biomedical Literature Database，CNKI，the Weipu Network and the Wanfang Database to retrieve literature in which RCT of ACEI/ARB in the treatment of NAFLD. The studies were published between 1978 and 2017. RevMan 5.3 was used for statistical analyses.The investigated indicators included liver pathology and laboratory tests〔alanine aminotransferase（ALT），aspartate aminotransferase （AST），serum total cholesterol （TC），triglyceride （TG） and low-density lipoprotein （LDL）〕．Results　A total of 8 articles that met the criteria and a total of 646 patients were included. Meta-analysis showed that the rate of improvement in liver histology between the experimental group and the control group was statistically significant〔OR=5.52，95%CI（1.78，17.06），P=0.003〕.The  difference was not statistically significant in the levels of ALT and AST between the two groups 〔WMD= -6.90，95%CI （-15.68，1.88），P = 0.12；WMD = -3.96，95%CI（-8.64，0.72），P=0.10〕.There were no significant differences in the levels of TC，TG and LDL between the two groups〔WMD=-8.10，95%CI（-21.00，4.80），P=0.22；WMD=-15.36，95%CI（-46.38，15.66），P=0.33；WMD=-2.54，95%CI（-12.58，7.49），P=0.62〕.Conclusion　ACEI/ARB can improve liver histology and liver function in patients with NAFLD.However，there are few large-sample，high-quality RCTs investigating the treatment of NAFLD with ACEI or ARB. More high-quality RCTs are still needed for supplementation and evaluation of the efficacy of these drugs for NAFLD treatment.

Key words: Fatty liver, Angiotension converting enzyme inhibiter, Angiotensin Ⅱ type receptor blockers, Effectiveness, Meta-analysis

摘要： 背景　非酒精性脂肪性肝病（NAFLD）在全球许多地区成为慢性肝病的主要原因，且部分患者会逐步发展为肝硬化、肝癌等，但是，目前在临床或指南上无明确推荐的药物用于治疗NAFLD。血管紧张素转化酶抑制剂（ACEI）或血管紧张素Ⅱ受体阻滞剂（ARB）类药物成为近期预防和治疗NAFLD的热点。目的　分析ACEI或ARB类药物治疗NAFLD的效果。方法　计算机检索Cochrane临床对照试验中心注册数据库、EMBase、Medline、中国生物医学文献数据库、中国知网、维普网和万方数据知识服务平台，检索时间为1978—2017年，收集ACEI/ARB类药物治疗NAFLD的随机对照试验（RCT）。采用RevMan 5.3版本软件进行统计分析试验组和对照组肝组织学、实验室检查〔丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）、血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）〕。结果　共纳入8篇文献，包括646例患者。Meta分析结果显示：试验组与对照组肝脏组织学改善率比较，差异有统计学意义〔比值比（OR）=5.52，95%CI（1.78，17.06），P=0.003〕；试验组ALT、AST水平与对照组比较，差异均无统计学意义〔加权均数差（WMD）=-6.90，95%CI（-15.68，1.88），P=0.12；WMD=-3.96，95%CI（-8.64，0.72），P=0.10〕。两组TC、TG、LDL水平比较，差异均无统计学意义〔WMD=-8.10，95%CI（-21.00，4.80），P=0.22；WMD=-15.36，95%CI（-46.38，15.66），P=0.33；WMD=-2.54，95%CI（-12.58，7.49），P=0.62〕。结论　ACEI/ARB类药物可改善NAFLD患者肝脏组织学和肝功能，临床疗效较为确切。但目前关于ACEI/ARB类药物治疗NAFLD的大样本、高质量的RCT较少，仍需更多高质量RCT进行补充和评价。

关键词: 脂肪肝, 血管紧张素转化酶抑制剂, 血管紧张素Ⅱ型受体拮抗剂, 疗效, Meta分析