ABSTRACT
Erigeron breviscapus injection(DZXI) and Breviscapus injection(DZSI) are two popular injections in treatment of acute ischemic stroke in China. Both of them are manufactured from a same herbal medicine, E. breviscapus, but DZXI is an herbal extract(mixture) preparation and DZSI is a pure compound injection. This article was aimed to systemically evaluate and compare their efficacy and safety in treatment of acute ischemic stroke. The randomized controlled trials(RCTs) were collected for comparing DZXI and DZSI with Salvia miltiorrhiza injection(FDI) as the medium, and they were compared with indirect Meta-analysis(ITC). Thirty-nine RCTs with 4 180 patients were included. Meta-analysis results showed that both DZXI and DZSI had better efficacy than FDI in acute ischemic stroke. In the indirect comparison, DZSI had a higher total efficacy than DZXI, with significantly statistical differences[OR=0.634, 95%CI = (0.432,0.928), P<0.000 01], but there was no significant difference in improvement of neurological deficit [MD=-1.19, 95%CI=(－3.57,1.19), P=0.953]. On the safety aspect, adverse reaction rate of DZXI was 1.14%, mainly including head swelling, fever and chills while DZSI had no significant adverse reactions. The limited evidences in this study showed that Breviscapine injection had higher total efficiency and safety than E. breviscapine injection, but due to the low quality of the included RCTs, these two medicines should be comprehensively compared in further high-quality clinical trials.
ABSTRACT
This paper summarized the chemical structures and amounts of caffeoylquinic acids in Erigeron breviscapus, as well as its prevention and cure effects on ischemic stroke in clinical and possible pharmacological mechanism. The results showed 22 caffeoylquinic acids reported from E. breviscapus, accounting for 29% of all compounds from this herb; The average content of total polyphenols was 36.93%, and more than 95% of components in Erigeron Breviscapus Injection are caffeoylquinic acids, higher than that of scutellarin. Several high quality clinical studies confirmed that Erigeron Breviscapus Injection enhanced treatment performance and improve the neurological score in the treatment after ischemic stroke and had good safety. In pharmacological research, caffeoylquinic acid compounds display anti-oxidant, anti-free radical, anticoagulation, and anti-fibrosis effects, which can protect neuro, vascular endothelial cells, glial cells, and astrocytes. They are also able to inhibit inflammatory, suppress cytokines IL-1, TNF-α, and enhance SOD & GSH-Px, which play a role in different treatment stages of ischemic stroke. So, caffeoylquinic acid is a kind of important chemical in E. breviscapus.