银杏内酯葡甲胺注射液联合依达拉奉显著提高急性缺血性脑卒中的疗效：一项荟萃分析。

Ginkgolide injections in meglumine, combined with edaravone, significantly increases the efficacy in acute ischemic stroke: A meta-analysis.

作者信息

Yan Mingyuan, Wu Jing, Wang Le, Wang Kaiyue, Li Lili, Sun Tianye, Zhang Han, Zhang Mi, Zou Lin, Yang Songyi, Liu Jinmin

机构信息

Beijing University of Chinese Medicine, Beijing, China.

Dongzhimen Hospital, University of Chinese Medicine, Beijing, China.

出版信息

Front Pharmacol. 2024 Apr 25;14:1236684. doi: 10.3389/fphar.2023.1236684. eCollection 2023.

OBJECTIVE

This study aimed to evaluate the efficacy of combining diterpene ginkgolide meglumine injection (DGMI) with edaravone for the treatment of acute ischemic stroke. This is particularly relevant because Western drugs, excluding intravenous thrombolysis, have shown limited success.

METHODS

A comprehensive search was conducted using multiple databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure WanFang, VIP, and Chinese Biomedical Database (CBM) until June 2023. The data were analyzed using fixed-effects and random-effects models in Review Manager. The mean difference with 95% confidence interval was calculated for each outcome.

RESULTS

Eighteen studies involving 1,636 participants were included in the analysis. The DGMI group showed significant reductions in the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and C-reactive protein (CRP) level, compared to the control group. Furthermore, the DGMI group showed a significant improvement in superoxide dismutase (SOD) levels and a reduction in malondialdehyde (MDA) levels. The combination of DGMI and edaravone was more effective in reducing neuron-specific enolase (NSE) levels following brain tissue injury than edaravone alone. Additionally, DGMI complemented edaravone in reducing rheological parameters associated with ischemic stroke, including hematocrit, plasma viscosity, platelet adhesion rate, and erythrocyte deformation index.

CONCLUSION

The combination of DGMI and edaravone significantly improved the therapeutic efficacy in patients with acute ischemic stroke. However, more extensive and high-quality clinical trials are required to validate these underlying mechanisms.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=260215, identifier: PROSPERO (CRD42021260215).

目的

本研究旨在评估二萜类银杏内酯葡甲胺注射液（DGMI）联合依达拉奉治疗急性缺血性脑卒中的疗效。这一点尤为重要，因为除静脉溶栓外，西药治疗急性缺血性脑卒中的效果有限。

方法

截至2023年6月，使用多个数据库进行全面检索，包括PubMed、Cochrane图书馆、科学网、中国知网、万方、维普和中国生物医学文献数据库（CBM）。在Review Manager中使用固定效应模型和随机效应模型对数据进行分析。计算每个结局的95%置信区间的平均差。

结果

纳入分析的18项研究共1636名参与者。与对照组相比，DGMI组的美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分和C反应蛋白（CRP）水平显著降低。此外，DGMI组超氧化物歧化酶（SOD）水平显著提高，丙二醛（MDA）水平降低。DGMI与依达拉奉联合使用在减轻脑组织损伤后神经元特异性烯醇化酶（NSE）水平方面比单独使用依达拉奉更有效。此外，DGMI在降低与缺血性脑卒中相关的血液流变学参数方面补充了依达拉奉的作用，这些参数包括血细胞比容、血浆黏度、血小板黏附率和红细胞变形指数。