Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (11): 1215-1220.doi: 10.3736/jcim20111109

• Original Clinical Research • Previous Articles     Next Articles

Flavonoids of puerarin versus tanshinone ⅡA for ischemic stroke: A randomized controlled trial

Lei Chen, Xiao-ying Bi, Li-xun Zhu, Yi-qing Qiu, Su-ju Ding, Ben-qiang Deng()   

  1. Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
  • Received:2011-07-26 Accepted:2011-09-01 Online:2011-11-20 Published:2011-11-15

Background:Flavonoids are widely used today in the treatment of ischemic stroke. The therapeutic effects and functions of flavonoids are, therefore, generating more and more interest.
Objective: To investigate the therapeutic effects and functions of flavonoids of puerarin in treating patients with ischemic stroke. Design, setting, participants and interventions: A total of 67 inpatients suffering from ischemic stroke from the Department of Neurology, Changhai Hospital in China were divided into two groups randomly, the treatment group, which was treated with flavonoids of puerarin, and the control group, administered with tanshinone ⅡA sulfate instead.
Main outcome measures: Defects in neurological function were evaluated according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of onset. Lactate dehydrogenase (LDH), serum interleukin-6 (IL-6) and brain-derived neurotrophic factor (BDNF) levels were determined by radioimmunoassay on the second trial day. After a 14-day treatment, LDH, serum IL-6 and BDNF levels and NIHSS score were also detected, and CT perfusion imaging was used to measure and analyze the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and mean transit time (MTT).
Results: On the first day, NIHSS scores of the two groups were similar. On the second day there was no significant difference in LDH and IL-6 levels between the treatment group and the control group. After a 14-day treatment, LDH and IL-6 levels and the NIHSS score in the treatment group were lower than those in the control group (P<0.05). There was no significant difference in BDNF levels in the two groups. After 14 d, the CT perfusion imaging demonstrated that the treatment group showed more effective blood perfusion than the control group.
Conclusion: Flavonoids of puerarin can restrain the increase of IL-6 after acute ischemic stroke, and depress the LDH raised by reperfusion after cerebral ischemia. It can also enhance blood perfusion of the ischemic region.

Key words: puerarin, flavone, tanshinone, brain ischemia, stroke, lactate dehydrogenases, interleukin-6, brain-derived neurotrophic factor

Figure 1

Flow diagram of this randomized trial"

Table 1

Serum levels of LDH, IL-6 and BDNF and NIHSS score of the two group before and after treatment (x±s)"


Group

n

LDH (U/L)

IL-6 (ng/L)

BDNF (ng/L)

Score of NIHSS

Flavonoids of puerarin

Before treatment

34

313.4±93.3

75.0±17.6

465.5±94.6

7.1±1.8

After treatment

34

158.3±56.4*

8.5±2.9*

899.7±211.1

3.2±1.6*

Tanshinone ⅡA sulfate

Before treatment

33

295.8±103.9

65.9±37.3

363.4±158.3

7.0±1.7

After treatment

33

228.2±95.6

28.3±10.8

702.1±123.4

4.3±1.9

Table 2

CT perfusion imaging analysis of the two group (n, %)"


Group

n

Normal perfusion

Delayed perfusion

Insufficient perfusion

Flavonoids of puerarin

34

8 (23.5%)

12 (35.3%)

14 (41.2%)

Tanshinone ⅡA sulfate

33

5 (15.2%)

8 (24.2%)

20 (60.1%)
[1] Kang YY, Kuang HY, Ma LL, Duan P . The effect of different total flavonoids of Astragalus on the apoptosis of cultured bovine retinal capillary pericytes under high glucose. Harbin Yi Ke Da Xue Xue Bao. 2008; 42(2): 135-137. Chinese with abstract in English.
doi: 10.3969/j.issn.1000-1905.2008.02.011
康英英, 匡洪宇, 马丽丽, 段鹏 . 不同浓度的黄芪总黄酮对髙糖培养下牛视网膜血管周细胞凋亡的影响.哈尔滨医科大学学报. 2008; 42(2):135-137.
doi: 10.3969/j.issn.1000-1905.2008.02.011
[2] Su MM, Yu XF, Qu SC, Xu HL, Sui DY . Effects of TFAD on the blood-liquid metabolism in experimental hyperlipoproteinemia rats. Zhongguo Yao Li Xue Tong Bao. 2007; 23(12): 1593-1597. Chinese with abstract in English.
苏曼曼, 于晓风, 曲绍春, 徐华丽, 睢大赏 . 分蘖葱头总黄酮对实验性髙脂血症大鼠血脂代谢的影响.中国药理学通报. 2007; 23(12):1593-1597.
[3] Wei ZW, Gao XW, Zheng WF . Anti-tumor activities of total flavonoids from the roots of Daphne genkwa. Jie Fang Jun Yao Xue Xue Bao. 2008; 24(2): 116-120. Chinese with abstract in English.
魏志文, 髙晓雯, 郑维发 . 芫花根总黄酮抗肿瘤活性研究.解放军药学学报. 2008; 24(2):116-120.
[4] Tang Y, Luo ZY, Yan FW, Wu MC . Study on the anti-oxidative effect of total flavonoids from Ampelopsis grossedentata ( AGTF) in vivo and in vitro. Zhongguo Yi Yuan Yao Xue Za Zhi. 2006; 26(12): 1449-1452. Chinese with abstract in English.
doi: 10.3321/j.issn:1001-5213.2006.12.001
唐瑛, 罗祖友, 严奉伟, 吴谋成 . 藤茶总黄酮对小鼠的体内外抗氧化作用研究.中国医院药学杂志. 2006; 26(12) : 1449-1452.
doi: 10.3321/j.issn:1001-5213.2006.12.001
[5] Liu LM, Zhu JB, Dai YN, Feng SL . Anti-inflammatory effect of total flavones from Lagotis brevituba Maxim. Zhongguo Yao Shi. 2010 ; 13 (4): 503-505. Chinese with abstract in English.
doi: 10.3969/j.issn.1008-049X.2010.04.020
刘利敏, 朱俊博, 戴亚妮, 封士兰 . 藏药短管兔耳草总黄酮抗炎作用研究.中国药师. 2010; 13(4):503-505.
doi: 10.3969/j.issn.1008-049X.2010.04.020
[6] Fischer U, Arnold M, Nedeltchev K, Brekenfeld C, Ballinari P, Remonda L, Schroth G, Mattie HP . NIHSS score and arteriographic findings in acute ischemic stroke. Stroke. 2005; 36(10):2121-2125.
doi: 10.1161/01.STR.0000182099.04994.fc pmid: 16151026
[7] Rong QW, Wang S, Shi L, Wang YF . The study of 64 multislice-spiral CT cerebral perfusion imaging and CT angiography in acute cerebral infarction. Yi Xue Ying Xiang Xue Za Zhi. 2011 ; 21 (3) : 313-316. Chinese with abstract in English.
doi: 10.3969/j.issn.1006-9011.2011.03.002
戎倩雯, 王嵩, 石璐, 王一凡 . CT脑灌注与血管造影在急性脑梗死中的临床应用.医学影像学杂志. 2011; 21(3):313-316.
doi: 10.3969/j.issn.1006-9011.2011.03.002
[8] Yoshida M, Tomitori H, Machi Y, Katagiri D, Ueda S, Horiguchi K, Kobayashi E, Saeki N, Nishimura K, Ishii I, Kashiwagi K, Igarashi K . Acrolein, IL-6 and CRP as markers of silent brain infarction. Atherosclerosis. 2009; 203(2) : 557-562.
doi: 10.1016/j.atherosclerosis.2008.07.022 pmid: 18757054
[9] Yoshida M, Higashi K, Kobayashi E, Saeki N, Wakui K, Kusaka T, Takizawa H, Kashiwado K, Suzuki N, Fukuda K, Nakamura T, Watanabe S, Tada K, Machi Y, Mizoi M, Toida T, Kanzaki T, Tomitori H, Kashiwagi K, Igarashi K . Correlation between images of silent brain infarction, carotid atherosclerosis and white matter hyperintensity, and plasma levels of acrolein, IL-6 and CRP. Atherosclerosis. 2010; 211(2):475-479.
doi: 10.1016/j.atherosclerosis.2010.03.031
[10] Izumi Y, Izumi M, Benz AM, Zorumski CF . Lactate dehydrogenase release is facilitated by brief sonication of rat hippocampal slices and isolated retinas following acute neuronal damage.[J] Neurosci Methods. 2001 ; 108(1):49-55.
doi: 10.1016/S0165-0270(01)00369-7
[11] van Zanten AP, Twijnstra A, Hart AA, Ongerboer de Visser BW . Cerebrospinal fluid lactate dehydrogenase activities in patients with central nervous system metastases. Clin Chim Acta. 1986; 161(3):259-268.
doi: 10.1016/0009-8981(86)90009-4
[12] Lamers KJ, Schoonderwaldt HC, Borkent MV, Theeuwes AG, Doesburg WH, Wevers RA . The effects of acute cerebrovascular disease on serum and cerebrospinal fluid parameters. Clin Neurol Neurosurg. 1987 ; 89(1) : 23-29.
doi: 10.1016/S0303-8467(87)80071-9 pmid: 2436846
[13] Ploughman M, Windle V, MacLellan CL, White N, Doré JJ, Corbett D . Brain-derived neurotrophic factor contributes to recovery of skilled reaching after focal ischemia in rats. Stroke. 2009; 40(4):1490-1495.
doi: 10.1161/STROKEAHA.108.531806
[14] Ploughman M, Granter-Button S, Chernenko G, Attwood Z, Tucker BA, Mearow KM, Corbett D . Exercise intensity influences the temporal profile of growth factors involved in neuronal plasticity following focal ischemia. Brain Res. 2007; 1150:207-216.
doi: 10.1016/j.brainres.2007.02.065
[15] Li F, Gong QH, Wu Q, Lu YF, Shi JS . Icariin isolated from Epimedium brevicornum Maxim attenuates learning and memory deficits induced by d-galactose in rats. Pharmacol Biochem Behav. 2010; 96(3):301-305.
doi: 10.1016/j.pbb.2010.05.021
[16] Cho JY, Kim IS, Jang YH, Kim AR, Lee SR . Protective effect of quercetin, a natural flavonoid against neuronal damage after transient global cerebral ischemia. Neurosci Lett. 2006; 404(3):330-335.
doi: 10.1016/j.neulet.2006.06.010
[17] Arab L, Liebeskind DS . Tea, flavonoids and stroke in man and mouse. Arch Biochem Biophys. 2010 ; 501(1):31-36.
doi: 10.1016/j.abb.2010.03.015 pmid: 20361928
[18] 18 Brandt T, von Kummer R, Müller-Küppers M, Hacke W . Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke. 1996; 27(5) : 875-881.
doi: 10.1161/01.STR.27.5.875
[19] Haley EC Jr, Levy DE, Brott TG, Sheppard GL, Wong MC, Kongable GL, Torner JC, Marler JR . Urgent therapy for stroke. Part H- Pilot study of tissue plasminogen activator administered 91 — 180 minutes from onset. Stroke. 1992; 23(5):641-645.
doi: 10.1161/01.STR.23.5.641
[1] Xin-yu Yue, Zhuo-qi Feng, Xi-yi Yu, Jia-min Hu, Xiao-Jing He, Shi Shu. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 167-172.
[2] Eric Wei Chiang Chan, Siu Kuin Wong, Hung Tuck Chan . Casticin from Vitex species: A short review on its anticancer and anti-inflammatory properties. Journal of Integrative Medicine, 2018, 16(3): 147-152.
[3] Xiao-ping Huang, Huang Ding, Jin-dong Lu, Ying-hong Tang, Bing-xiang Deng, Chang-qing Deng . Autophagy in cerebral ischemia and the effects of traditional Chinese medicine. Journal of Integrative Medicine, 2015, 13(5): 289-296.
[4] Sung Min Lim, Sook-Hyun Lee. Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: A systematic review and meta-analysis. Journal of Integrative Medicine, 2015, 13(4): 241-247.
[5] Lu Liu, Ying Gao. Study on the correlation between traditional Chinese medicine syndrome and short-term prognosis of ischemic stroke using logistic regression model and repeated-measures analysis of variance. Journal of Chinese Integrative Medicine, 2012, 10(9): 983-990.
[6] David Sibbritt, Pamela van der Riet, Saowapa Dedkhard, Kannapatch Srithong. Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies. Journal of Chinese Integrative Medicine, 2012, 10(7): 743-750.
[7] Qin-hui Fu, Jian Pei, Qi Jia, Yi Song, Yue-hua Gu, Xiao-xin You . Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: Study protocol of a multicenter, randomized, controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(5): 516-524.
[8] Yue-hua Wang, Xiao-li He, Xiao-xiu Li, Hai-lin Qin, Guan-hua Du . Effects of the effective component group of Chinese herbal medicine Xiaoxuming Decoction on brain mitochondria in rats with chronic cerebral ischemia. Journal of Chinese Integrative Medicine, 2012, 10(5): 569-576.
[9] Paula de Sousa Fragoso Ana, de Sá Ferreira Arthur. Evaluation of the immediate effects of manual acupuncture on brachial bicep muscle function in healthy individuals and poststroke patients: a study protocol of a parallel-group randomized clinical trial. Journal of Chinese Integrative Medicine, 2012, 10(3): 303-309.
[10] Qi-hong Shi , Jun Xiang, Xu-ying Zhu , Ding-fang Cai. Protective effects of Chinese herbal medicine Naoshuantong on neurovascular unit in rats with cerebral ischemia/reperfusion injury. Journal of Chinese Integrative Medicine, 2012, 10(10): 1135-1139.
[11] Hui Han , Li-min Wu , Ming-xiang Han, Wen-ming Yang , Dao-jun Xie , Zhao-hui Fang , Dan-chen Chu , Fang Fang . Effects of Chinese herbal medicine Shenxiong Yujing Granule on regeneration of neural cells in rats with diabetes-associated cerebral ischemia. Journal of Chinese Integrative Medicine, 2012, 10(10): 1140-1148.
[12] Yang Zhuo-xin, Chen Peng-dian, Yu Hai-bo, Luo Wen-shu, Wu Yong-gang, Pi Min, Peng Jun-hua, Liu Yong-feng, Zhang Shao-yun, Gou Yan-hua. Research advances in treatment of cerebral ischemic injury by acupuncture of conception and governor vessels to promote nerve regeneration. Journal of Chinese Integrative Medicine, 2012, 10(1): 19-24.
[13] Qi-ming Xue, Lu Huang, Ning Li. Effects of electroacupuncture at Tianshu (ST25) on pro- and anti-inflammatory cytokines in rats with severe acute pancreatitis. Journal of Chinese Integrative Medicine, 2011, 9(6): 658-664.
[14] Qin-hui Fu, Jian Pei, Jian-rong Hui, Yi Song . Studies on dynamic changes in traditional Chinese medicine syndrome patterns for stroke using data-driven and model-driven approaches: A review. Journal of Chinese Integrative Medicine, 2011, 9(12): 1292-1300.
[15] Rui-kai Zong, Jian Liu. Effects of Chinese herbal medicine Xinfeng Capsule on expressions of platelet-activating factor and interleukins 6 and 17 in peripheral blood of rats with adjuvant arthritis. Journal of Chinese Integrative Medicine, 2011, 9(12): 1347-1352.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Zhao-guo Li. Discussion on English translation of commonly used sentences in traditional Chinese medicine: part one. Journal of Chinese Integrative Medicine, 2008, 6(1): 107-110
[3] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. An explanation on "guiding principles of clinical research on mild cognitive impairment (protocol)". Journal of Chinese Integrative Medicine, 2008, 6(1): 15-21
[4] Jin-rong Fu. Establishment of multivariate diagnosis and treatment system of modern gynecology of traditional Chinese medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 22-24
[5] Hao Li, Ming-jiang Yao, Wen-ming Zhao, Jie Guan, Lin-lin Cai, Ling Cui. A randomized, controlled, double-blind trial of Huannao Yicong capsule in senile patients with mild cognitive impairment. Journal of Chinese Integrative Medicine, 2008, 6(1): 25-31
[6] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[7] Yi-ting He, Qing-lin Zha, Jian-ping Yu, Yong Tan, Cheng Lu, Ai-ping Lv. Principal factor analysis of symptoms of rheumatoid arthritis and their correlations with efficacy of traditional Chinese medicine and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 32-36
[8] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[9] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[10] Xue-mei Liu, Qi-fu Huang, Yun-ling Zhang, Jin-li Lou, Hong-sheng Liu, Hong Zheng. Effects of Tribulus terrestris L. saponion on apoptosis of cortical neurons induced by hypoxia-reoxygenation in rats. Journal of Chinese Integrative Medicine, 2008, 6(1): 45-50