Abstract
Objective: Xingnaojing injection (XNJ) is derived from An-Gong-Niu-Huang pill, a well-known traditional Chinese patent medicine, which is widely used for stroke. To evaluate the therapeutic effect of XNJ on cerebral infarction, an extensive meta-analysis was used.Methods: Six major electronic databases including the Chinese Biomedical Database (CBM), Wanfang, the VIP medicine information system (VMIS) and the China National Knowledge Infrastructure (CNKI), PubMed, Embase, and the Cochrane Library were examined to retrieve randomized controlled trials designed to evaluate the clinical efficacy of XNJ in treating CI before November 26, 2016.Results: There were 53 randomized controlled trials with 4915 participants in this study. The results reflected that compared with the conventional therapy (CT) alone, XNJ could significantly improve the overall response rate (OR = 3.56, 95% CI [2.94, 4.32], P < 0.00001), and clinical symptom (including increasing activities of daily living (ADL, MD = 10.23, 95% CI [9.47, 10.99], P < 0.00001), and reduce infarction size (MD = -1.83, 95% CI [-2.49, -1.16], P < 0.00001)). However, there was no significant difference between the XNJ treatment and conventional therapy in Glasgow Coma Scale (GCS, P = 0.32). Neurological deficit score demonstrated that XNJ could significantly reduce the score in two different evaluation criterions as National Institutes of Health Stroke Scale (NIHSS, MD = -3.44, 95% CI [-4.52, -2.36], P < 0.00001), and the Chinese Stroke Scale (CSS, MD = -5.72, 95% CI [-6.94, -4.50], P < 0.00001). Additionally, serum MMPs, including MMP-2 and MMP-9 were significantly reduced by XNJ treatment compared with conventional therapy (MD = -11.24, 95% CI [-20.83, -1.65], P = 0.02; MD = -25.08, 95% CI [-35.49, -14.67], P < 0.00001, respectively). Moreover, XNJ was able to improve hemorrheology in reducing whole blood viscosity, plasma viscosity, and hematocrit (MD = -1.44, 95% CI [-2.18, 0.70], P = 0.001; MD = -0.22, 95% CI [-0.37, -0.07], P = 0.003; MD = -3.63, 95% CI [-6.23, -1.03], P = 0.006, respectively). The therapeutic efficacy of XNJ was found associated with improving hemodynamics (increasing peak-flow rate, and average velocity) (MD = 12.66, 95% CI [10.50, 14.81], P < 0.00001; MD = 9.90, 95% CI [8.63, 11.17], P < 0.00001). XNJ was also related to reducing cholesterol and triglyceride (MD = -1.06, 95% CI [-1.21, -0.92], P < 0.00001; MD = -1.05, 95% CI [-1.12, -0.97], P < 0.00001).Conclusion: Despite the sample size and the poor quality of the included studies of this review, the results of the research showed that XNJ might be a beneficial therapeutic method for the treatment of cerebral infarction.
Highlights
MATERIALS AND METHODSStroke is the one of the most common diseases worldwide, with a high disability, mortality and recurrence rate, and usually leads to serious damage of central nervous system (Johnston et al, 2009)
53 eligible articles with 4915 participants (2475 cases in the experimental group, 2440 cases in the control group) were included in the meta-analysis according to the inclusion and exclusion criteria after the full-text reading (Figure 1)
The results revealed that compared with the conventional therapy (CT), Xingnaojing injection (XNJ) could remarkably increase the peak-flow rate, and average velocity (MD = 12.66, 95% confidence intervals (95% CI) [10.50, 14.81], P < 0.00001; mean difference (MD) = 9.90, 95% CI [8.63, 11.17], P < 0.00001) (Figure 7)
Summary
MATERIALS AND METHODSStroke is the one of the most common diseases worldwide, with a high disability, mortality and recurrence rate, and usually leads to serious damage of central nervous system (Johnston et al, 2009). There are three types of stroke, including ischemia stroke, cerebral hemorrhage, and cerebral thrombosis. Been known as cerebral infarction, is the most commonly seen in stroke, with the highest morbidity about 70% (Luo, 2010). The main pathology clearly defined, namely that brain tissue hypoxic ischemia is caused by atherosclerosis of cerebral arteries, alone or with superimposed thrombosis, hypertension, diabetes mellitus, and cardiovascular disease (Zhou, 2010; Hata et al, 2011), the corresponding precautionary measures are still limited in preventing the incidence rate. The conventional therapy (CT), including thrombolysis, restoring blood supply to ischemic area, controlling cerebral edema, cerebral protection agents, preventing and treating complications, controlling hypertension, reducing blood viscosity, and so on, is the main clinical therapy for cerebral infarction (Deng et al, 2011). The theory that complementary medicine can substantial improve the disease has been put forward (Sze et al, 2005)
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