Supplementary Material for: The Effect of Astragalus on Humoral and Cellular Immune Response: A Systematic Review and Meta-Analysis of Human Studies

Objective: Astragalus is used in traditional Chinese medicine for immune system disorders. Its effect on immune system function is evaluated in multiple studies. The objective of this systematic review and meta-analysis was to evaluate the effect of Astragalus on humoral and cellular immune response in human studies. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published up to April 2023. Studies that assessed the impact of Astragalus on humoral and cellular immune markers were included. The data were extracted, and a random-effects meta-analysis was performed to determine the overall effect size. Subgroup analyses were conducted based on outcome measures. Results: A total of 19 studies,including 1094 human participants, were included in the meta-analysis. The analysis of humoral immune markers revealed a significant reduction in proinflammatory cytokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-ɣ, following Astragalus intervention (SMD -2.8765, 95% CI: -3.2385 to -2.5145, p < 0.0001). In the cellular immunity domain, Astragalus was found to significantly increase CD3 levels and the CD4/CD8 ratio (SMD 2.4629, 95% CI: 1.9598; 2.9661). Subgroup analyses based on outcome measures supported these findings. However, substantial heterogeneity was observed among the included studies. Conclusion: This systematic review and meta-analysis provide evidence supporting the immunomodulatory effects of Astragalus on humoral and cellular response. Astragalus demonstrated a significant reduction in proinflammatory cytokines and an enhancement of cellular immune markers, suggesting its potential as a therapeutic agent for immune-related disorders.

研究目的：黄芪（Astragalus）在传统中医学中常用于治疗免疫系统紊乱类疾病，多项研究已对其调节免疫系统功能的效应进行了评估。本项系统评价与荟萃分析旨在探究黄芪在人体研究中对体液免疫与细胞免疫应答的影响。
研究方法：研究人员全面检索了截至2023年4月发表的电子数据库文献，筛选出评估黄芪对体液免疫及细胞免疫标志物影响的相关研究。提取研究数据后，采用随机效应模型开展荟萃分析以计算总体效应量，并根据结局指标进行亚组分析。
研究结果：本荟萃分析共纳入19项研究，涉及1094名人类受试者。针对体液免疫标志物的分析显示，黄芪干预后，包括白细胞介素-2（IL-2）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）以及干扰素-γ（IFN-ɣ）在内的促炎细胞因子水平显著降低（标准化均数差SMD=-2.8765，95%置信区间CI：-3.2385~-2.5145，p<0.0001）。在细胞免疫维度，黄芪可显著提升CD3水平及CD4/CD8比值（SMD=2.4629，95%CI：1.9598~2.9661）。基于结局指标的亚组分析验证了上述结论，但纳入的各项研究间存在显著异质性。
研究结论：本项系统评价与荟萃分析提供了证据，证实黄芪对体液免疫与细胞免疫应答具有免疫调节效应。黄芪可显著降低促炎细胞因子水平并增强细胞免疫标志物表达，提示其有望成为免疫相关疾病的潜在治疗药物。