Effect Of The Combination Of Jiawei Buyang Huanwu Decoction And Rehabilitation Training On The Serum Proinflammatory Cytokines In Patients With Post Stroke Fatigue

BackgroundA significant proportion of stroke survivors suffer from persistent and significant fatigue which is linked to reduced independence and case fatality. Despite its high prevalence and detrimental effects, studies of post-stroke fatigue (PSF) interventions are scarce. Only one randomised controlled trial of post-stroke fatigue treatment (i.e. fluoxetine) was identified, The main mechanisms has been suggested, including the effect of proinflammatory cytokines (TNF-alpha, IL-lbeta and IL-6), Jiawei buyang huanwu decoction has been identified as an important rehabilitation intervention for the management of stroke-related fatigue. Factors contributing to the lack of evidence for PSF management are identified and it is concluded that there is a need to better differentiate those most likely to suffer PSF, to validate existing assessments of fatigue, and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.ObjectiveThis study is to investigate the effect of combination of Jiawei Buyang huanwu decoction and rehabilitation training on the serum proinflammatory cytokines (IL-1β, IL-6, TNF-α) in patients with post stroke fatigue and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.Methods1. General MaterialA total of 70 PoSF patients were in the recovery period from January 2010 to January 2010 in Rehabilitation department of Guangdong Provincial TCM Hospital, these patients were randomly divided into two groups, the treatment group (rehabilitation training combined with Chinese Herbal medicine) and the control group(simple rehabilitation training). There are 35 cases in each group, who are all age range 51-92 admitted to the unit 1-6 months post stroke.2. Research MethodsThe subjects of treatment group were orally took modified Buyang huanwu decoction and gave rehabilitation training; The subjects of control group were given rehabilitation training. VAS and FSS for fatigue and MBI for ADL were scored separately the 1st and 30th day of treatment. The concentration of IL-1β, IL-6, TNF-αin serum were tested in the 1st and 30th day of treatment. The hepatic & renal function and routine test of patients also were observed to avoid the adverse reaction.ResultsA total of 70 patients involved had accomplished in the trials without death or droping off. There were significant differences between the treatment group and control in the scores of VAS, FSS and MBI (P<0.05), after 30 days' treatment. There were significant differences between the treatment group and control in the concentration of IL-1β, IL-6, TNF-αin serum (P<0.05). The changing of the serum proinflammatory cytokines correlated positively to FSS and VAS, negatively to MBI。ConclusionsAfter 30 days of treatment, treatment and control groups both could improve the MBI scores and lower FSS and VAS scores in patients with PoSF. The concentration of IL-1β, IL-6, TNF-αin serum are also decreased. It indicated that the treatment could improve the patients'activities of daily living, and relieve fatigue. Treatment group was significantly better than the control group. This showed that to improve the activities of daily living and relieve fatigue of patients with PoSF, the Jiawei Buyang huanwu decoction combined with rehabilitation training is better than simple rehabilitation training, and the concentration of inflammatory cytokines are harmful to rehabilitation of patients' ADL.