Effectiveness and safety of ShenXiong glucose injection for acute ischemic stroke: a systematic review and GRADE approach

Abstract

Background: To appraise critically whether published trials of ShenXiong glucose injection for patients with acute ischemic stroke (AIS) are of sufficient quality, and in addition to rate the quality of evidence by using the GRADE approach (grading of recommendations, assessment, development, and evaluation, GRADE).

Methods: A literature search was performed in the Cochrane Library, MEDLINE, EMBASE, CBM, Chinese TCM (traditional Chinese medicine) Database, CNKI, VIP, WanFang Databases until January 2015. The limits were patients with AIS and randomized controlled trials (RCTs) or quasi-RCTs. Studies by which patients suffering intracerebral haemorrhage were excluded.

Results: Twelve studies fulfilled the inclusion criteria. We found significant benefits of ShenXiong glucose injection compared with conventional treatment in improving activities of daily living function at 4 weeks (MD = 34.12, 95 % CI: 29.07, 39.17), neurological function deficit at 2 weeks (MD = -5.39, 95% CI: -6.90, -3.87), 4 weeks (MD = -5.16, 95 % CI: -6.49, -3.83), and clinical effects at 4 weeks (RR = 1.17, 95% CI: 1.10, 1.24). No trials reported the effects of ShenXiong glucose injection on the risk of early, deterioration, or quality of life. No adverse events were reported within the whole follow-up period.

Conclusions: The use of ShenXiong glucose injection may improve rehabilitation for patients with acute ischemic stroke, however, as the GRADE approach indicated low to moderate quality of available evidence as well as insufficient information about harm and patients preference, the recommendations were not provided for ShenXiong glucose injection taking as a therapeutic intervention to patients with acute ischemic stroke.

Fig. 1

Flow chart of study selection. Abbreviations: CBM, Chinese Biomedical Literature Database; CNKI: China National Knowledge Infrastructure; VIP: Chinese Scientific Journals Database; WJITWM: World Journal of Integrated Traditional and Western Medicine; CJIM: Chinese Journal of Integrative Medicine; JCIM: Journal of Chinese Integrative Medicine; JTCM: Journal of Traditional Chinese Medicine; JBUTCM: Journal of Beijing University of Traditional Chinese Medicine

Fig. 2

A random effects Meta-analysis on improvement of activities of daily living function of ShenXiong glucose injection

Fig. 3

Subgroup analysis. ShenXiong glucose injection vs DanShen ligustrazine injection; Outcome: Improvement of activities of daily living function at 4 weeks follow-up

Fig. 4

A random effects Meta-analysis on neurological function deficit score of ShenXiong glucose injection

Fig. 5

Subgroup analysis. ShenXiong glucose injection vs. DanShen ligustrazine injection; Outcome: Improvement of neurological deficit at 2 weeks follow up

Fig. 6

A random effects Meta-analysis on response rate of ShenXiong glucose injection

Fig. 7

Funnel plot analysis. Funnel plot analysis on response rate of the 11 trials comparing ShenXiong glucose injection with conventional treatment