| Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system, may be a process that individual genetic susceptibility and environmental factors interact. The incidence of MS increases with latitude, experts tend to MS is not uncommon in China, but a low incidence area. Because of higher incidence, chronic process and tendency to the young patients, MS is one of the most important neurological diseases. MS demyelinating lesions involve the cerebral hemispheres, optic nerve, spinal cord, brainstem and cerebellum, mainly invove white matter, pathological performance is featured by lesions located in the periventricular. Multiple space(multiple lesions in the central nervous system) and time (remission and recurrence of duration)constitute the main features of MS clinical course and its signs and symptoms. Some residual symptoms and signs are produced after each recurrence, the gradual accumulation lead to disease more serious. MS is slow stepwise progress at late phase, not s ignif icant rel ief but gradual ly increased. A growing number of studies suggest that the clinical emergence of progressive irreversible neurological dysfunction may be associated with axonal injury, axonal injury may already appeared early in the disease, how to reduce axonal injury early in the disease is the core of MS treatment. Magnetic resonance spectroscopy (MRS) is a new technology for the study of brain metabol ism in recent years, due to the abnormal metabolism usually appear earlier than changes in the structure, so MRS can detect the abnormality that magnetic resonance imaging (MRI)can not display. Brain N-acetyl aspartate level (markers of axons and neurons) can be quantitatively detected by MRS, so MRS is an important means of clinical research on MS.1PurposeOn the basis of quantitative evaluation of axonal injury in MS in the use of imaging techniques (magnetic resonance spectroscopy), to investigate the relationship between the axonal injury and progress, recurrence of the disease and explore that mitigating axonal injury may be one of the mechanisms of Erhuangfang.2MethodsFrom January2006to December2010,67inpatients and outpatients were diagnosed as multiple sclerosis in department of Neurology and Traditional Chinese Medicine of Beijing Tiantan Hospital affiliated to Capital Medical University, whose syndrome types comply with Yin-deficiency of liver and kidney. Enrolled patients were randomly divided into control group (n=24) and Erhuangfang group (n=43). The control group underwent western medicine treatment in acute relapse and remission, while Erhuangfang group took Erhuangfang on the basis of western medicine treatment, they were all followed up for2years. Erhuangfang group patients underwent magnetic resonance spectroscopy to detect the level of NAA, CHO, CR of ipsilateral and contralateral lesion before they were treated and treated for1year. Followed up for at least two years, relapse frequency, annual relapse rate, EDSS, NAA/CR, CHO/CR level were compared between the two groups before and after treatment, to evaluate the therapeutic effect of Erhuangfang.3Results3.1General cl inical data:female47cases, male20cases, female/male rat io of2.4:1. Minimum age of onset is15-year-old, maximum age is60-year-old, average32.85±10.76-year-old,20to50-year-old (79.1%) is the peak incidence of period. The least recurrence is1time, the most is6times, an average of2.21±1.37times. The course of the disease is from1year to7years, average2.77±1.90years;3.2The first onset nervous system symptoms:visual impairment,26.0%, sensory impairments31.7%, movement disorders (23.1%), other symptoms (19.2%);3.3Main neurological symptoms:visual disturbances (22.0%), sensory disturbances (29.6%), movement disorders (25.2%), other symptoms (23.2%);3.4In control group, referring to relapse frequency and annual relapse rate, the difference between posttreatment (1.42±0.97and0.75±0.55) and pretreatment (2.04±0.96and0.91±0.46) was not statistically significant (P>0.05);3.5In Erhuangfang group, posttreatment relapse frequency and annual relapse rate (0.63±0.58and0.31±0.29) were evidently decreased than pretreatment (2.30±1.55and1.01±0.52), the difference was statistically significant (P=0.000); compared with the control group, the difference was also statistically significant (P=0.006);3.6Between the control group and Erhuangfang group, the EDSS had no significant change before and after treatment, the difference was not statistically significant (P>0.05); 3.7The MRI lesion sites:brain lesions (36.4%), brainstem lesions (38.6%), cerebellar lesions (5.0%), spinal cord lesions (20.0%);3.8In Erhuangfang group, touched on pretreatment level of NAA/CR and CHO/CR, the difference between ipsilateral lesion (1.81±0.68and1.20±0.69) and contralateral lesion(1.96±0.53and0.94±0.24) was not statistically significant (P>0.05);3.9In Erhuangfang group, related to the level of NAA/CR and CHO/CR, both ipsilateral lesion and contralateral lesion, the difference between posttreatment (1.77±0.47and1.05±0.21) and pretreatment (1.88±0.50and1.00±0.27) was not statistically significant (P>0.05);3.10NAA/CR level was not related to age of onset, EDSS, relapse frequency, annual recurrence rate, and was significantly associated with the duration, correlation coefficient was0.429, P=0.006.4ConclusionThe duration of multiple sclerosis is more longer, axonal injury is more serious, long-term use (>1years) of Erhuangfang can effectively reduce relapse and slow disease progression. Reducing axonal injury may be one of the mechanisms that play a therapeutic role. |
PDF Full Text Request