The Experimental And Clinical Study Of Modified Astragalus Tetrandrae Decoction Combined With High Dose Methylprednisolone In Treatment Of Acute Spinal Cord Injury

Objective:Through experiment and clinic, to observe the efficacy and safety of modified astragalus tetrandrae decoction and high dose methylprednisolone (MP) on treatment of acute spinal cord injury.Methods:Seventy two female SD rats were randomly divided into 3 groups:MP group, combined group(modified astragalus tetrandrae decoction+MP) and blank group. Every group had 24 rats. The BBB score was used respectively at the 1st,3rd,7th and 14th days after operation to evaluate the motor functional recovery of rats. TUNEL staining at the 1st,3rd,and 7th days was used to observe the cells apoptosis of spinal cord injury specimens. HE staining at the 14th day was used for the pathological changes.Forty five acute spinal cord injury patients of injury time within 8 hours were divided into 2 groups randomly from May 2013 to Sep 2014:MP group and treatment group. Methylprednisolone pulse therapy was for 22 cases of MP group. Modified astragalus tetrandrae decoction was added to 23 cases of combined group on the foundation of MP group of 6 weeks. Scores of ASIA scales of pre and post treatment were carried out to evaluate neurological function changes between two groups. Complications of two groups were also recorded.Results:BBB score results of three groups showed that the motor functional improvements of three groups maintained with the time going after operation. At the 3rd,7th and 14th days, combined group and MP group improved higer than blank group(P<0.05); At the 7th and 14th days, combined group improved much higer than MP group(P<0.05). TUNEL staining results showed that cells apoptosis of spinal cord injury could be seen in all groups. The amount of cells apoptosis reached peak at the 3r day, and decreased significantly at the 7th day postoperation. At the lst,3rd and 7th days, the amount of cells apoptosis of combined group and MP group were lesser than blank group(P<0.05); combined group were lesser than MP group at the 3rd and 7th days(P<0.05). HE staining showed that normal structure of spinal cord have been destroyed, the cell structure wasn’t intact, the glial cells increased and cavities appeared. Combined group and MP group had more complete normal structure. More normal nerve cells,less glial cells hyperplasia and cavities than blank group. Compared with MP group,the range of spinal cord injury in combined group was smaller, the normal structure was more clearer, more normal nerve cells survived and less cavities and glial cells increased.The neurological function of patients improved significantly in both groups at 6 weeks after treatment. The neurological sensorimotor function and ASIA grade were greatly enhanced in combined group compared with MP group.Conclusion:1.The treatment combined modified astragalus tetrandrae decoction and high dose MP have lesser cell apoptosis of spinal cord injury, pathological changes and more motor functional recovery of rats; 2. The combination of the treatment could improve the recovery of spinal cord function in patients with clinically, and also could reduce the occurrence of infection and electrolyte disorder.