Objective To systematically review the efficacy and safety of nicergoline on chronic cerebrovascular insufficiency (CCVI).Methods Databases including the Cochrane Library,PubMed,CNKI,VIP and WanFang Date were electronically searched for relevant randomized controlled trails (RCTs) which studied the effectiveness and safety of Nicergoline on chronic cerebrovascular insufficiency.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality.Metaanalysis was performed by using RevMan 5.2 software.Results Totally 9 studies involving 1 030 patients were included.The meta-analysis results showed that,compared with conventional treatment alone,the Nicergoline group was superior in improving the velocity of middle cerebral artery(MCA) in both systolic(MD=16.43,95％CI:10.39-22.46) and the late diastolic (MD=11.48,95％CI:5.34-17.63).Besides,Nicergoline significantly improved the pulse index (PI) of MCA (MD=-0.37,95％CI:-0.48--0.26).Likewise,it obviously improved the velocity in both systolic (MD=11.23,95％CI:6.10-16.35),the late diastolic (MD=8.80,95％CI:5.20-12.40) and the PI of vertebral artery (VA) (MD=-0.38,95％CI:-0.47--0.28).The remission rate of the nicergolinegroup was higher than that of the control group (OR=3.93,95％ CI:2.66-5.81).Drug-related adverse reactions were not reported in included studies.Conclusions Nicergoline shows a certain efficacy on CCVI without obvious adverse reactions.

Hyponatremia is common in the attack of acute intermittent porphyria(AIP), which can cause epilepsy, coma and other adverse events and endanger the life of patients. Carbohydrate loading therapy is applied to control the attack of AIP in the clinic. But the application of glucose can exacerbate hyponatremia. It is difficult for clinicians to effectively correct hyponatremia while treating AIP with glucose. We reported a case of AIP whose refractory hyponatremia was corrected with short-term low-dose tolvaptan to improve knowledge in management.