| Acute ischemic stroke has 3 characteristics:high incidence,high morbidity and high mortality.Besides thrombolysis,there is no efficient treatment to acute ischemic stroke In Western Medicine.At present,it's a hotspot to study Brain function and structural remodeling after ischemia,but there is few approved drugs at this stage.Chinese medicine believes that xueyu goes throughout the whole process of stroke,so promoting blood circulation for removing blood stasis is the fundamental method to treatment of stroke.Pseudo-ginseng is a traditional Chinese medicine with blood circulation function.Panax Notoginseng Saponins(PNS)is the main active ingredient extracted from pseudo-ginseng.PNS has certain effects,such as antiplatelet aggregation,anti-atherosclerosis,anti-inflammatory,scavenging free radicals,inhibiting calcium ion release,promoting nerve structure remodeling and function recovery.There are many studies on the efficacy of traditional Chinese medicine in the treatment of stroke,while most of them analyses by using neurological scales and TCM syndrome scales.In addition to using the usual scale,functional magnetic resonance imaging(DTI combined BOLD-fMRI)under resting state is used in this study to reveal the effects of PNS injection on brain function and structure remodeling of patients with acute ischemic stroke,and provide a visualized reference for Chinese medicine treatment of stroke.Section 1:A clinical study on the treatment of acute ischemic stroke with PNS injectionObjective:To investigate and compare the differences of scores of NIHSS,ADL,Stroke syndrome diagnosis standard before and after western medicine and western medicine combined with PNS injection treatments.To analyze the correlation between Chinese medical scales and Western medical scales.Methods:Eighty patients with acute stroke were randomly divided into two groups by the draw method,which names control group and PNS group,and 40 patients are in each group.The patients in the control group were given routine treatment by Western medicine.In addition to treatment of Western medicine,patients in PNS group were given PNS injection treatment.Scores of NIHSS,ADL and Stroke Syndrome Diagnosis Standard(SSDS)were collected on day 1,day 7,day 14 and day 30,SPSS 19.0 software was used to analyze the collected data.Results:1.NIHSS:The scores of PNS group decreased significantly from day 1 to day 7,day 7 to day 14 and day 14 to day 30,while The scores of the control group decreased significantly from day 7 to day 14 and day 14 to day 30,statistically significant(P<0.01).The scores of the PNS group on the 7th day,the 14th day and the 30th day were lower than those of the control group,the difference was statistically significant(P<0.01).2.ADL:The scores of PNS group increased significantly from day 1 to day 7,day 7 to day 14 and day 14 to day 30,while the scores of the control group increased significantly from day 7 to day 14 and day 14 to day 30,statistically significant(P<0.01).The scores of PNS group on the 7th,14th and 30th day were higher than those of the control group,the difference was statistically significant(P<0.05).3.Stroke Syndrome Diagnosis Standard(SSDS)?TCM syndrome cases:In PNS group,the number of wind cases was significantly reduced from day 1.The number of hot cases was significantly reduced from day 7 to day 14 and day 14 to day 30.The number of phlegm cases was significantly reduced from day 1 to day 7 and day 7 to day 14.The number of xueyu cases was significantly reduced from day 1 to day 7 and day 7 to day 14,and the number of yinxu cases was significantly reduced on the 14th day.The changes above were statistically significant(P<0.05).The changes of number of qixu cases was not statistically significant(P>0.05).In the control group,The number of wind cases was significantly reduced from day 1.The number of hot cases was significantly reduced from day 7 to day 14 and day 14 to day 30.The number of phlegm cases was significantly reduced from day 7 to day 14,and the number of xueyu cases was significantly reduced from day 7 to day 14.The above changes were statistically significant(P<0.05).The changes of numbers of cases of qixu and yinxu was not statistically significant(P>0.05).On the 14th day,the number of xueyu cases in the PNS group was significantly lower than that in the control group.On the 30th day,the numbers of phlegm and xueyu in the PNS group were significantly lower than that in the control group(P<0.01).The changes above were statistically significant(P<0.05).?Scores of TCM factors:In PNS group,scores of wind decreased significantly from day 1 to day 7.The scores of hot decreased from day 1 to day 7,from day 7 to day 14 and day 14 to day 30.Scores of phlegm decreased from day 1 to day 7,day 7 to day 14 and day 14 to day 30.scores of xueyu decreased significantly from day 1 to day 7,day 7 to day 14,and day 14 to day 30.The changes above were statistically significant(P<0.05).The changes of Score of qixu were not statistically significant(P>0.05).The scores of yinxu were significantly decreased from 1st day to 7th day and 7th to 14th day,with statistical significance(P<0.05).In the control group,the scores of wind decreased significantly from day 1 to day 7 and day 7 to day 14.The scores of Hot decreased significantly from day 7 to day 14 and from day 14 to day 30.Phlegm scores decreased significantly from day 7 to day 14 and day 14 to day 30.scores of xueyu decreased significantly from day 7 to day 14 and day 14 to day 30.The scores of qixu decreased first and then increased,and the scores increased significantly from day 14 to day 30.The changes above were statistically significant(P<0.01).The scores of yinxu were significantly decreased from 7th to 14th day,with statistical significance(P<0.05).On the 7th day,the scores of wind,hot,xueyu and yinxu in the PNS group were significantly lower than those in the control group.On the 14th day,the scores of hot,phlegm,xueyu and yinxu in the PNS group were significantly lower than those in the control group,while the scores of qixu were significantly higher than those in the cont:rol group.On 30th day,the scores of hot,phlegm,xueyu and yinxu in the PNS group were significantly lower than those in the control group.The differences above were statistically significant(P<0.05).4.Correlation analysis of Chinese and Western Medicine scales:There was no significant correlation between scores of NIHSS and scores of wind and qi in SSDS(P>0.05),while there were significant positive correlation between scores of NIHSS and scores of hot,phlegm,xueyu and yinxu.(P<0.01).There was no significant correlation between scores of ADL and scores of wind and qi in SSDS(P>0.05),while there were significant negtive correlation between scores of ADL and scores of hot,phlegm,xueyu and yinxu.(P<0.01).Section 2:A study on evaluation of nerve remodeling of patients with acute ischemic stroke with PNS injection by fMRIObjective:In this study,the effects of treatments of western medicine combined with PNS injection on neurological function and structure remodeling will be observed in micro-level.The study will compare macroscopic scores of Chinese and Western medicine scale to microscopic data of DTI combined BOLD-fMRI,and analyze the correlation between them.Methods:A total of 10 patients were randomly selected from the PNS group by the draw method for head magnetic resonance and functional magnetic resonance imaging(DTI,fMRI-BOLD)exam on day 1,day 14 and day 30.And then,compare the conclusion of examinations above to the conclusion of same examinations of 10 healthy people in similar age.We read the DTI data through the FSL software,divide the white matter into 48 partitions,measure the mean of the fractional anisotropy(FA)and the mean diffusivity(MD)of each white matter partition.SPSS 19.0 software was used to analyze the selected ROIs and reconstruct the diffusion tensor traces(DTT)of healthy people and patients on the basis of DTI.The fMRI-BOLD data was preprocessed by using the DPARSF software.The regional homogeneity(ReHo)method was used to assess the state of brain activity in the whole brain.Results:1.Healthy people:?DTI:The FA value of the right side of posterior corona radiate was significantly higher than that of the left side.In all regions,the FA value of genu of corpus callosum was the largest,and the FA value of fornix was the smallest.The MD values of the left side of anterior and posterior limb of internal capsule,anterior and superior corona radiate,sagittal stratum and external capsule were significantly higher than those of the right side.In all regions,the MD value of fornix was the largest,and the MD value of pontine crossing tract was the smallest,?DTT:DTI was able to visually depict the morphology of white matter fiber tracts.2.Acute cerebral infarction patients:?DWI:At day 1 and day 14,DWI showed a high signal in all the 10 patients.At Day 30,DWI signal slightly lower than before,but still showed a higher signal.? DTI:(1)FA value:At day 1,FA values of following parts of patients were significantly lower than that of healthy people:the pontine crossing tract,genu of corpus callosum;anterior and posterior limb of internal capsule of diseased side,anterior,superior and posterior corona radiate of diseased side,sagittal stratum,superior longitudinal fasciculus,external capsule,cingulum of diseased side;anterior limb of internal capsule of healthy side,anterior and posterior corona radiate of healthy side,sagittal stratum,external capsule and parahippocampal gyrus of healthy side.At day 14,FA values of following parts of patients were significantly lower than that of healthy people:the genu of corpus callosum,cerebral peduncle of diseased side,anterior and posterior limb of internal capsule of diseased side,posterior,superior limb of internal capsule of diseased side,sagittal stratum,superior longitudinal fasciculus,external capsule,cingulum of diseased side;anterior and posterior corona radiate of healthy side,sagittal stratum,superior longitudinal fasciculus,external capsule and parahippocampal gyrus of healthy side.On day 30,FA values of following parts of patients were lower than those of healthy people:the posterior limb of internal capsule of diseased side,anterior corona and posterior radiate of diseased side,superior longitudinal fasciculus of diseased side,external capsule and cingulum of diseased side;Anterior and posterior corona radiate of diseased side,sagittal stratum of diseased side.All the differences above were statistically significant(P<0.05).From day 14 to day 30.FA values of pontine crossing tract,genu,body and splenium of corpus callosum and fornix increased significantly.The FA values of the cereal peduncle and Posterior limb of internal capsule were significantly reduced from day 1 to day 14,and significantly increased from day 14 to day 30.From day 14 to day 30,FA values of following diseased side of patients significantly increased:the corticospinal tract,medial lemniscus,anterior limb of internal capsule,anterior,superior and posterior corona radiate,sagittal stratum and parahippocampal gyrus.From day 14 to day 30,FA values of following healthy side of patients significantly increased:the posterior limb of internal capsule,external capsule,anterior and superior corona radiate.From day 1 to day 30.FA values of posterior corona radiate and sagittal stratum of healthy side of patients significantly increased.All the changes above were statistically significant(P<0.05).(2)MD:On day 1,the MD values of the pontine crossing tract of the patient were higher than that of healthy people,and in diseased side,the MD values of the corticospinal tract,medial lemniscus,posterior limb of internal capsule and superior corona radiate were lower than that of the healthy.On day 14,the MD values in the following areas were lower than that of healthy people:the pontine crossing tract,genu of corpus callosum,body of corpus callosum,splenium of corpus callosum and fornix,corticospinal tract of diseased side and medial lemniscus of diseased side.On day 30,the MD value of the corticospinal tract of diseased side was lower than that of healthy people.The above differences were statistically significant(P<0.05).The MD value of fornix increased significantly from day 14 to day 30.From day 1 to day 14,the MD values of corticospinal tract and medial lemniscus in the affected side were significantly decreased,and were significantly increased from day 14 to day 30.From day 14 to day 30,the MD value of the anterior limb of internal capsule in the diseased side increased significantly.From day 1 to day 30,the MD value of anterior corona radiate was significantly increased.From day 1 to day 14,the MD values of the posterior limb of internal capsule and superior corona radiate in the diseased side increased significantly.The changes above were statistically significant(P<0.05).?DTT:Before treatment,the patients' white matter tract in diseased side slightly less than the healthy side.After treatment,the patients' white matter tract in diseased side increased.?BOLD:On day 1,the Z value of the following parts of the patients were positive:the left parahippocampal gyrus,left latera occipital gyrus,left inferior frontal gyrus and left supplementary motor area.The following Z values of the patients were negative:the right angular gyrus,left cingulate gyrus,left postcentral gyrus and right cingulate gyrus.On day 14,the Z values of following areas were positive:the right parahippocampal gyrus and left shared motor area.The Z values of following areas were negative:the right lingual gyrus,right posterior cingulate gyrus,right supramarginal gyrus,right middle cingulate gyrus and right middle frontal gyrus.On day 30,the Z value of the following areas were positive:the right superior temporal gyrus,left parahippocampal gyrus,right middle frontal gyrus,left inferior frontal gyrus and left postcentral gyrus,and there was no region with a negative Z value.The changes above were statistically significant(P<0.001).?The correlation between results of fMRI and the scales:There was no significant correlation between FA value and score of TCM scales or western medicine scales(P>0.05).The MD value of posterior limb of internal capsule was negatively correlated with scores of NIHSS,hot,phlegm and xueyu.The MD value of superior corona radiate was negatively correlated with scores of NIHSS,and was positively correlated with scores of ADL.The correlations above were statistically significant(P<0.05)Conclusion:1.Western medicine combined with PNS injection treatment was proved to be able to promote the recovery of neurological function,and improve the scores of TCM SSDS.In a word,in the treatment of acute ischemic stroke,the use of Western medicine and PNS injection at the same time has more advantages than the use of western medicine alone.There was a close correlation between TCM syndrome factor scale(SSDS)scores and Western medicine scale scores.2.At the micro level,combined with PNS injection treatment could promote the structural remodeling of white matter tract in patients with acute ischemic stroke,and improve the cytotoxic edema and vasogenic edema,and restore functions of gray matter.There was no significant correlation between FA values and scores of TCM scales or western medicine scales.In important regions,there were certain correlations between MD values and the scores of TCM and western medicine scales.3.By DTI combined with BOLD-fMRI detection method,structural damage and repair of white matter tract of patients with acute ischemic stroke could be intuitively observed.The state of active or inactive of gray matter neurons could also be observed.At the micro level,this detection method could reveal the effect of combined PNS injection on the nerve function and structure remodeling.This method could provide a more objective and accurate basis for the treatment of acute ischemic stroke by traditional Chinese medicine. |
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