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）是传统中医药中用于治疗免疫系统疾病的常用药材，现有多项研究已对其调节免疫系统功能的效应展开评估。本项系统综述（systematic review）与荟萃分析（meta-analysis）旨在评估黄芪在人体研究中对体液免疫与细胞免疫应答的调控效果。
研究方法：本研究对截至2023年4月发表的相关文献开展全面的电子数据库检索，纳入所有评估黄芪对体液及细胞免疫标志物影响的临床研究。随后提取研究数据，采用随机效应模型开展荟萃分析以确定整体效应量，并基于结局指标进行亚组分析。
研究结果：本次荟萃分析共纳入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结果显示，经黄芪干预后，包括白介素-2（IL-2）、白介素-4（IL-4）、白介素-6（IL-6）、白介素-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均出现显著降低（标准化均数差（Standardized Mean Difference，SMD）=-2.8765，95%置信区间（Confidence Interval，CI）：-3.2385~-2.5145，p<0.0001）。在细胞免疫维度，黄芪可显著提升CD3水平以及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研究结果，但纳入的各项研究间存在显著异质性。
研究结论：本项系统综述与荟萃分析的结果证实，黄芪对体液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。