DTI Detects White Matter Reorganization After Jiawei Tongnao Decoction Intervention Of Ischemic Stroke

Objective:This experiment mainly utilizes the method of filling essence and filling marrow,dissipating phlegm and eliminating blood stasis(Jiawei Tongnao Decoction)to treat patients with ischemic stroke.Through diffusion tensor imaging(DTI)technology and comprehensive neurological recovery scores,we evaluate the effects of Jiawei Tongnao Decoction on remodeling of cortical spinal cord and neurological function.Method:From March to October 2019,unilateral acute ischemic stroke outpatients and inpatients(14-30 days after onset)from the Department of Neurology,Jiangsu Province Hospital of Traditional Chinese Medicine were recruited.The inclusive 54 patients were assigned into control group(n=27)and treatment group(n=27).Besides conventional Western medicine therapy,the treatment group also received Jiawei Tongnao Decoction orally in 200ml,twice a day for 30 days.The treatment group and control group received DTI image examination and rehabilitation assessments before and 90 days after intervention,including the National Institutes of Health Stroke Scale(NIHSS),Modified Rankin Scale(mRS),Simple Fugl-Meyer Assessment(FMA)and TCM symptom integral.We compare and measure the changes and differences in Fractional Anisotropy(FA)of the corticospinal tract(CST)in treatment group and control group after stroke,and correlation of FA with FMA and NIHSS.Results:There were no significant differences in basic information,scores and FA between treatment group and control group before treatment.1.At 90 days after treatment,NIHSS,mRS,FMA and TCM symptom integral of the two group had improved(P<0.05),but treatment group remained significantly better than controls(P<0.05).2.At 90 days after treatment,the overall clinical efficacy of treatment group was significantly better than control group(P<0.05).3.At 90 days after treatment,mean FA with the affected corticospinal tract in the two groups was significantly higher than that before treatment(P<0.05).4.At 90 days after treatment,Although the mean FA of the entire CST in treatment group and control group was not significantly difference(P>0.05),the FA of every 100 nodes with the affected corticospinal tract in treatment group and control group were further compared after treatment,it was found that three segments along the tract profiles had significant differences(P<0.05,FDR corrected)between two groups,which mainly distributed in the top segment(88-100th point),the middle segment(50-60th point)and the bottom segment(10-20th point),that is,the primary motor cortex,the posterior limb of the internal capsule(PLIC)and cerebral peduncle.5.The mean value of FA at the early stage of chronic phase after stroke was significantly positively correlated with FMA(P<0.05)and negatively correlated with NIHSS(P<0.05).Conclusion:1.The combination of Jiawei Tongnao Decoction is more beneficial to promote the early recovery of cerebral white matter fiber remodeling and motor recovery for ischemic stroke patients with motor dysfunction.2.The DTI parameter FA has a negative correlation with the NIHSS score and a positive correlation with the FMA score.In the early stage of recovery from ischemic stroke,FA as a parameter showing white matter microstructure can reflect the human nerve function and motor function.3.Jiawei Tongnao Decoction may achieve motor recovery after ischemic stroke by regulating the connection and reorganization of white matter fibers in the affected CST(primary motor cortex,PLIC and cerebral peduncle).