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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
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