Ye Yang, Zhu Yu-Tian, Xin Xi-Yan, Zhang Jia-Cheng, Zhang Hao-Lin, Li Dong
Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China.
Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China.
Phytomedicine. 2022 Jun;100:154072. doi: 10.1016/j.phymed.2022.154072. Epub 2022 Mar 23.
Tissue-type plasminogen activator (tPA) remains the sole FDA approved thrombolytic drug for ischemic stroke. But delayed thrombolytic therapy with tPA may increase the risk of hemorrhagic transformation. Many Chinese herbal medicines have been used as tPA helpers to enhance the capacity of tPA and minimize the risk of hemorrhagic transformation. The efficacy of Chinese herbal medicines on tPA thrombolysis is not systematically analyzed.
We searched the following three databases up to January 2022: Web of Science, PubMed, and Scopus. Studies that reported the efficacy and safety of Chinese herbal medicines on tPA thrombolysis in experimental stroke were included. The efficacy outcomes were neurological score and infarct volume, the safety outcomes were cerebral hemorrhage and blood brain barrier (BBB) damage. We used the checklist of CAMARADES to assess the quality of included studies. Standardized mean difference (SMD) with 95% confidence intervals were used to assess all the outcomes. Subgroup analyses were performed to explore the sources of heterogeneity. Trim and fill method and Egger's test were used to assess the potential publication bias. Sensitivity analyses were used to identify the stability of the results.
A total of nine studies including 11 Chinese herbal medicines fulfilled the inclusion criteria and were subsequently analyzed. The pooled data demonstrated that Chinese herbal medicines improved neurological score (2.23 SMD, 1.42-3.04), infarct volume (1.08 SMD, 0.62-1.54), attenuated cerebral hemorrhage (1.87 SMD, 1.34-2.4), and BBB dysfunction (1.9 SMD, 1.35-2.45) following tPA thrombolysis in experimental stroke. Subgroup analysis indicated that the route of drug delivery, dosage of tPA, and stroke model used may be factors inducing heterogeneity and influencing the efficacy.
Treatment with Chinese herbal medicines significantly improved neurological score and infarct volume, reduced cerebral hemorrhage and BBB damage after tPA thrombolysis. This study supports Chinese herbal medicine as an adjuvant therapy in reducing the side effects of tPA thrombolysis after acute ischemic stroke. The results should be interpreted with more caution since this article was based on animal studies.
组织型纤溶酶原激活剂（tPA）仍然是美国食品药品监督管理局（FDA）批准的唯一用于缺血性中风的溶栓药物。但是tPA延迟溶栓治疗可能会增加出血转化的风险。许多中药已被用作tPA辅助药物，以增强tPA的能力并将出血转化的风险降至最低。中药对tPA溶栓的疗效尚未得到系统分析。
截至2022年1月，我们检索了以下三个数据库：科学网、PubMed和Scopus。纳入报告中药对实验性中风tPA溶栓疗效和安全性的研究。疗效指标为神经功能评分和梗死体积，安全性指标为脑出血和血脑屏障（BBB）损伤。我们使用CAMARADES清单评估纳入研究的质量。采用95%置信区间的标准化均值差（SMD）评估所有结果。进行亚组分析以探索异质性来源。采用Trim和Fill方法以及Egger检验评估潜在的发表偏倚。采用敏感性分析确定结果的稳定性。
共有9项研究（包括11种中药）符合纳入标准，随后进行了分析。汇总数据表明，在实验性中风中，tPA溶栓后中药改善了神经功能评分（SMD 2.23，1.42 - 3.04）、梗死体积（SMD 1.08，0.62 - 1.54），减轻了脑出血（SMD 1.87，1.34 - 2.4）和BBB功能障碍（SMD 1.9，1.35 - 2.45）。亚组分析表明，给药途径、tPA剂量和所用中风模型可能是导致异质性和影响疗效的因素。
中药治疗显著改善了神经功能评分和梗死体积，减少了tPA溶栓后的脑出血和BBB损伤。本研究支持中药作为急性缺血性中风后减少tPA溶栓副作用的辅助治疗方法。由于本文基于动物研究，对结果的解释应更加谨慎。
