Journal of Traditional Chinese Medicine ›› 2023, Vol. 43 ›› Issue (4): 650-660.DOI: 10.19852/j.cnki.jtcm.20230526.002
• Meta-analysises • Previous Articles Next Articles
Effectiveness and safety of Angong Niuhuang pill (安宫牛黄丸) in treatment of acute stroke: a systematic review and Meta-analysis
MENG Xiangran, CAO Xue, SUN Minglin, AI Yanke, HE Liyun(
), LIU Jia()
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medicine Sciences, Beijing 100700, China
-
Received:2022-05-06Accepted:2022-09-12Online:2023-08-15Published:2023-05-26 -
Contact:Prof. HE Liyun, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medicine Sciences, Beijing 100700, China. hely3699@163.com. Telephone: +86-18801368925
Prof. LIU Jia, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medicine Sciences, Beijing 100700, China. marie_liujia@sina.cn -
Supported by:Science and Technology Innovation Project of China Academy of Chinese Medical Sciences: Research on Key Technologies of Real-world Clinical Evaluation and Data Governance Analysis Based on Disease Research(CI2021A00702-2);Project of National Key Research and Development Program: Development of International Clinical Research Service Standard for Acupuncture and Moxibustion(2019YFC1712205)
Cite this article
MENG Xiangran, CAO Xue, SUN Minglin, AI Yanke, HE Liyun, LIU Jia. Effectiveness and safety of Angong Niuhuang pill (安宫牛黄丸) in treatment of acute stroke: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2023, 43(4): 650-660.
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Figure 1 Flowchart of literature selection ANP: Angong Niuhuang pill; RCTs: randomized controlled trials.
Figure 1 Flowchart of literature selection ANP: Angong Niuhuang pill; RCTs: randomized controlled trials.
Table 1 Basic characteristics of the included literature
| Study | Type of stroke | Sample size (E/C) | Sex (M/F) | Mean age (years) | Intervention (E) | Duration (d) | Outcome | Score | ||
|---|---|---|---|---|---|---|---|---|---|---|
| E | C | E | C | |||||||
| Xiang L 2015 | ACI | 86 (43/43) | 27/16 | 24/19 | 62.1±10.3 | 62.7±9.5 | ANP 3 g, qd+CT | 10 | ①②③ | 3 |
| Hu RK | AIH | 53 (28/25) | 19/9 | 17/8 | 55.8±10.7 | 53.6±11.3 | ANP 3 g, qd (nasal feeding) | 5 | ①②③⑧ | 3 |
| et al 2014 | +CT | |||||||||
| Zhang YJ et al 2019 | AIH | 98 (49/49) | 29/20 | 27/22 | 64±5 | 63±5 | ANP 3 g, qd (oral or nasal feeding)+CT | 14 | ①②③ | 4 |
| Liao XS | AIH | 87 (45/42) | 27/18 | 24/18 | 60.53±10.71 | 59.31±8.67 | ANP 3 g, bid (nasal feeding)+CT | 7 | ③⑥⑧ | 3 |
| et al 2020 | ||||||||||
| Xiong HY et al 2015 | AIH | 32 (16/16) | 7/9 | 6/11 | 62.70±3.32 | 40.19±4.35 | ANP 3 g, qd (oral or nasal feeding)+CT | 10 | ③ | 3 |
| Cui YK | ACI | 103 (51/52) | NA | NA | NA | NA | ANP 3 g, qd (oral or nasal feeding)+CT | 7 | ①②③⑧ | 4 |
| et al 2021 | ||||||||||
| Zheng JW 2022 | ACI | 86 (43/43) | 25/18 | 23/20 | 65.89±4.32 | 65.82±4.36 | ANP 3 g, qd (oral)+CT | 14 | ①②③ | 3 |
| Lai ZZ | ACI | 70 (35/35) | 24/11 | 26/9 | 69.6±13.0 | 66.3±11.3 | ANP 3 g, qd+CT | 14 | ①② | 3 |
| et al 2019 | ||||||||||
| Geng F | AIH | 120 (60/60) | 37/23 | 35/25 | 54.9±11.8 | 55.6±11.3 | ANP 3 g, qd (oral)+CT | 14 | ①②⑤⑧ | 3 |
| et al 2018 | ||||||||||
| Lü BY 2021 | AIH | 200 (100/100) | 54/46 | 57/43 | 63.5±10.7 | 62.9±11.2 | ANP 3 g, qd (oral or nasal feeding)+CT | 14 | ①②⑥ | 3 |
| Chen R 2021 | AIH | 90 (45/45) | 32/13 | 30/15 | 58.74±10.96 | 57.86±5.72 | ANP 3 g, qd+CT | 14 | ①②④⑦ | 3 |
| Li XH 2018 | AIH | 100 (50/50) | 25/25 | 27/23 | 45.01±2.15 | 45.21±2.06 | ANP 3 g, qd+CT | 7 | ②⑤⑧ | 4 |
| Wang L | AIH | 124 (62/62) | 32/30 | 33/29 | 51.33±10.41 | 51.29±10.52 | ANP 3 g, qd+CT | 7 | ①⑤⑧ | 3 |
| et al 2020 | ||||||||||
| Li PY | AIH | 110 (55/55) | 31/24 | 29/26 | 12.7±3.4 | 12.3±3.0 | ANP 3 g, qd (oral or nasal feeding) +CT | 14 | ①②⑦ | 3 |
| et al 2019 | ||||||||||
| Feng YM | ACI | 80 (40/40) | 24/16 | 22/18 | 62.3±10.9 | 61.4±10.2 | ANP 3 g, qd+CT | 7 | ①②③ | 3 |
| et al 2015 | ||||||||||
| Zhang YM et al 2020 | ACI | 90 (45/45) | 26/19 | 25/20 | 67.3±2.4 | 65.7±2.3 | ANP 6-9g, bid (oral or nasal feeding) +CT | 21 | ①② | 3 |
| Feng HY 2020 | AIH | 40 (20/20) | 13/7 | 13/7 | 60.35±8.60 | 62.00±10.46 | ANP 3 g, qd+CT | 10 | ①②③⑧ | 4 |
| Yang RG 2019 | AIH | 120 (60/60) | 37/23 | 36/24 | 73.61±5.89 | 71.26±5.85 | ANP 3 g, qd (nasal feeding) +CT | 28 | ②④ | 3 |
| Xu XY | ACI | 94 (47/47) | 24/23 | 27/20 | 71.76±8.13 | 70.38±8.09 | ANP 3 g, qd+CT | 14 | ①②④⑧ | 3 |
| et al 2020 | ||||||||||
| Zhang SX et al 2016 | ACI | 122 (61/61) | 35/26 | 37/24 | 63.5±9.9 | 64.7±10.2 | ANP 3 g, qd+CT | 14 | ①②③⑧ | 2 |
| Liu ZX | ACI | 80 (40/40) | 24/16 | 29/11 | 71.43±6.12 | 70.51±6.09 | ANP 3 g, qd (oral) +CT | 7 | ①②④⑧ | 2 |
| et al 2020 | ||||||||||
| Liu QY | ACI | 120 (60/60) | 32/28 | 33/27 | 53.32±6.97 | 53.20±6.91 | ANP 3 g, qd+CT | 28 | ①②⑥⑧ | 2 |
| et al 2020 | ||||||||||
| Zhang T 2017 | AIH | 92(46/46) | 28/18 | 27/19 | 52.6±9.7 | 53.7±9.4 | ANP 3 g, qd (oral)+CT | 14 | ① | 2 |
| Liu SX 2012 | ACI | 160 (80/80) | NA | NA | NA | NA | ANP 3 g, qd (oral)+CT | 5 | ①②⑧ | 2 |
| He J | AIH | 100(50/50) | NA | NA | 46.12±6.24 | 48.44±5.53 | ANP 3 g, bid+CT | 15 | ③ | 2 |
| et al 2019 | ||||||||||
| Qiao WJ | AIH | 88 | NA | NA | NA | NA | ANP 3 g, qd+CT | 10 | ③⑥ | 2 |
| et al 2016 | (44/44) | |||||||||
| Liu PC | AIH | 120 | 28/32 | 27/33 | 62.18±10.18 | 58.47±11.21 | ANP 3 g, qd+CT | >3 | ①②⑧ | 2 |
| et al 2020 | (60/60) | |||||||||
| Shen N 2014 | ACI | 80 | 25/15 | 23/17 | 65.2±9.3 | 64.5±8.7 | ANP 3 g, qd+CT | 7 | ①②⑧ | 2 |
| (40/40) | ||||||||||
Table 1 Basic characteristics of the included literature
| Study | Type of stroke | Sample size (E/C) | Sex (M/F) | Mean age (years) | Intervention (E) | Duration (d) | Outcome | Score | ||
|---|---|---|---|---|---|---|---|---|---|---|
| E | C | E | C | |||||||
| Xiang L 2015 | ACI | 86 (43/43) | 27/16 | 24/19 | 62.1±10.3 | 62.7±9.5 | ANP 3 g, qd+CT | 10 | ①②③ | 3 |
| Hu RK | AIH | 53 (28/25) | 19/9 | 17/8 | 55.8±10.7 | 53.6±11.3 | ANP 3 g, qd (nasal feeding) | 5 | ①②③⑧ | 3 |
| et al 2014 | +CT | |||||||||
| Zhang YJ et al 2019 | AIH | 98 (49/49) | 29/20 | 27/22 | 64±5 | 63±5 | ANP 3 g, qd (oral or nasal feeding)+CT | 14 | ①②③ | 4 |
| Liao XS | AIH | 87 (45/42) | 27/18 | 24/18 | 60.53±10.71 | 59.31±8.67 | ANP 3 g, bid (nasal feeding)+CT | 7 | ③⑥⑧ | 3 |
| et al 2020 | ||||||||||
| Xiong HY et al 2015 | AIH | 32 (16/16) | 7/9 | 6/11 | 62.70±3.32 | 40.19±4.35 | ANP 3 g, qd (oral or nasal feeding)+CT | 10 | ③ | 3 |
| Cui YK | ACI | 103 (51/52) | NA | NA | NA | NA | ANP 3 g, qd (oral or nasal feeding)+CT | 7 | ①②③⑧ | 4 |
| et al 2021 | ||||||||||
| Zheng JW 2022 | ACI | 86 (43/43) | 25/18 | 23/20 | 65.89±4.32 | 65.82±4.36 | ANP 3 g, qd (oral)+CT | 14 | ①②③ | 3 |
| Lai ZZ | ACI | 70 (35/35) | 24/11 | 26/9 | 69.6±13.0 | 66.3±11.3 | ANP 3 g, qd+CT | 14 | ①② | 3 |
| et al 2019 | ||||||||||
| Geng F | AIH | 120 (60/60) | 37/23 | 35/25 | 54.9±11.8 | 55.6±11.3 | ANP 3 g, qd (oral)+CT | 14 | ①②⑤⑧ | 3 |
| et al 2018 | ||||||||||
| Lü BY 2021 | AIH | 200 (100/100) | 54/46 | 57/43 | 63.5±10.7 | 62.9±11.2 | ANP 3 g, qd (oral or nasal feeding)+CT | 14 | ①②⑥ | 3 |
| Chen R 2021 | AIH | 90 (45/45) | 32/13 | 30/15 | 58.74±10.96 | 57.86±5.72 | ANP 3 g, qd+CT | 14 | ①②④⑦ | 3 |
| Li XH 2018 | AIH | 100 (50/50) | 25/25 | 27/23 | 45.01±2.15 | 45.21±2.06 | ANP 3 g, qd+CT | 7 | ②⑤⑧ | 4 |
| Wang L | AIH | 124 (62/62) | 32/30 | 33/29 | 51.33±10.41 | 51.29±10.52 | ANP 3 g, qd+CT | 7 | ①⑤⑧ | 3 |
| et al 2020 | ||||||||||
| Li PY | AIH | 110 (55/55) | 31/24 | 29/26 | 12.7±3.4 | 12.3±3.0 | ANP 3 g, qd (oral or nasal feeding) +CT | 14 | ①②⑦ | 3 |
| et al 2019 | ||||||||||
| Feng YM | ACI | 80 (40/40) | 24/16 | 22/18 | 62.3±10.9 | 61.4±10.2 | ANP 3 g, qd+CT | 7 | ①②③ | 3 |
| et al 2015 | ||||||||||
| Zhang YM et al 2020 | ACI | 90 (45/45) | 26/19 | 25/20 | 67.3±2.4 | 65.7±2.3 | ANP 6-9g, bid (oral or nasal feeding) +CT | 21 | ①② | 3 |
| Feng HY 2020 | AIH | 40 (20/20) | 13/7 | 13/7 | 60.35±8.60 | 62.00±10.46 | ANP 3 g, qd+CT | 10 | ①②③⑧ | 4 |
| Yang RG 2019 | AIH | 120 (60/60) | 37/23 | 36/24 | 73.61±5.89 | 71.26±5.85 | ANP 3 g, qd (nasal feeding) +CT | 28 | ②④ | 3 |
| Xu XY | ACI | 94 (47/47) | 24/23 | 27/20 | 71.76±8.13 | 70.38±8.09 | ANP 3 g, qd+CT | 14 | ①②④⑧ | 3 |
| et al 2020 | ||||||||||
| Zhang SX et al 2016 | ACI | 122 (61/61) | 35/26 | 37/24 | 63.5±9.9 | 64.7±10.2 | ANP 3 g, qd+CT | 14 | ①②③⑧ | 2 |
| Liu ZX | ACI | 80 (40/40) | 24/16 | 29/11 | 71.43±6.12 | 70.51±6.09 | ANP 3 g, qd (oral) +CT | 7 | ①②④⑧ | 2 |
| et al 2020 | ||||||||||
| Liu QY | ACI | 120 (60/60) | 32/28 | 33/27 | 53.32±6.97 | 53.20±6.91 | ANP 3 g, qd+CT | 28 | ①②⑥⑧ | 2 |
| et al 2020 | ||||||||||
| Zhang T 2017 | AIH | 92(46/46) | 28/18 | 27/19 | 52.6±9.7 | 53.7±9.4 | ANP 3 g, qd (oral)+CT | 14 | ① | 2 |
| Liu SX 2012 | ACI | 160 (80/80) | NA | NA | NA | NA | ANP 3 g, qd (oral)+CT | 5 | ①②⑧ | 2 |
| He J | AIH | 100(50/50) | NA | NA | 46.12±6.24 | 48.44±5.53 | ANP 3 g, bid+CT | 15 | ③ | 2 |
| et al 2019 | ||||||||||
| Qiao WJ | AIH | 88 | NA | NA | NA | NA | ANP 3 g, qd+CT | 10 | ③⑥ | 2 |
| et al 2016 | (44/44) | |||||||||
| Liu PC | AIH | 120 | 28/32 | 27/33 | 62.18±10.18 | 58.47±11.21 | ANP 3 g, qd+CT | >3 | ①②⑧ | 2 |
| et al 2020 | (60/60) | |||||||||
| Shen N 2014 | ACI | 80 | 25/15 | 23/17 | 65.2±9.3 | 64.5±8.7 | ANP 3 g, qd+CT | 7 | ①②⑧ | 2 |
| (40/40) | ||||||||||
Figure 2 Risk of bias graph A: risk of bias item among included studies; B: risk of bias item in each included study.
Figure 2 Risk of bias graph A: risk of bias item among included studies; B: risk of bias item in each included study.
Figure 3 Results of the Meta-analysis A: forest plot of effective rate; B: forest plot of NIHSS; C: forest plot of GCS; D: forest plot of MMSE. NIHSS: National Institutes of Health Stroke Scale; GCS: Glasgow Coma Scale; MMSE: Mini-mental State Examination; SD: standard deviation; CI: confidence interval; Random: random-effects model; Fixed: fixed-effects model.
Figure 3 Results of the Meta-analysis A: forest plot of effective rate; B: forest plot of NIHSS; C: forest plot of GCS; D: forest plot of MMSE. NIHSS: National Institutes of Health Stroke Scale; GCS: Glasgow Coma Scale; MMSE: Mini-mental State Examination; SD: standard deviation; CI: confidence interval; Random: random-effects model; Fixed: fixed-effects model.
Figure 4 Results of publication bias A: funnel plot of effective rate; B: funnel plot of NIHSS; C: funnel plot of GCS; D: funnel plot of adverse reactions or their incidence. NIHSS: National Institutes of Health stroke scale; GCS: Glasgow Coma Scale.
Figure 4 Results of publication bias A: funnel plot of effective rate; B: funnel plot of NIHSS; C: funnel plot of GCS; D: funnel plot of adverse reactions or their incidence. NIHSS: National Institutes of Health stroke scale; GCS: Glasgow Coma Scale.
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