Effect Of Early Treatment Of Chinese Herbal Medicine On Patients With Acute Stroke And Subsequent Post-Stroke Depression And Relevant Study On ~1H-MRS

Objective:1) To observe the effect of early treatment by Ditanhuayu Decoction on patients with acute stroke and subsequent Post-stroke depression(PSD),NIHSS and ADL(Barthel Index,BI).2) To study the correlation between proton magnetic resonance spectroscopy(~1H-MRS) and PSD on early stage.Methods:1) 102 patients with acute stroke were randomly divided into two groups,62 people into treatment group of Chinese herbal medicine and the rest into control group.In treatment group,34 patients were treated with over 2 weeks and 28 patients were treated within 1month.The depression disorder,clinical neurological deficits and activities of daily living were assessed by Hamilton Depression Rating Scale(HAMD-17),National Institutes of Health Stroke Scale(NIHSS) and Barthel Index(BI) for disability,respectively. These scales were measured for each patient within 3 days after admission as well as 2weeks,1month and 3months after onset of stroke.The comparsion of efficacy was according to the rate of depression and the differences among the scores of each scale. 2) 25 cases randomly chosen from 102 cases above were examined with ~1H-MRS imaging. According to the results of 3 months follow-up,these 25 cases were divided into two groups,PSD group 13 cases and non-PSD(NPSD) group 12 cases.The control group included 20 subjects,the bilateral prefrontal lobes and the bilateral hippocampus areas were scanned for 10 subjects,respectively.The ratios of metabolites such as NAA/Cr, Cho/Cr and mI/Cr in white matter of prefrontal lobes and hippocampus areas on both sides of 25 subjects were measured.Results:1.Early treatment of Chinese herbal medicine can reduce the rate of PSD,even major depression with the comparison of the control group.Furthermore,the 1 month treatment can significantly down regulate the rate of PSD at 3 months after stroke(P＜0.0125) with the comparison of the control group.2.At all follow-up points,early treatment group improved the scores of rating scales of HAMD,NIHSS and BI better than control group,wherein,within 3 months follow-up the efficacy and the score of rating scales of 1 month treatment were better than that of the over 2 weeks(P＜0.05 or 0.01).3.Compared with the control group,NAA/Cr ratios in bilateral white matters of prefrontal lobes and hippocampus areas of PSD group were significantly lower(P＜0.05 or 0.01) but Cho/Cr ratios were higher,especially on left prefrontal lobe and left hippocampus area(P＜0.01).A significant increasing of the ratio of Cho/Cr on the left sides and reducing of the ratio of NAA/Cr on left hippocampus area can be observed in PSD patients with the comparison of NPSD subjects(P＜0.05).Conclusion:1.The incidence of PSD was very high and it could be reduced by early treatment of Ditanhuayu Decoction.2.Early treatment of Ditanhuayu Decoction can obviously improve the depression symptoms and significant recover the clinical neurological deficits and activities of daily living of stroke patients.3.As a noninvasive imaging technique,in vivo proton magnetic resonance spectroscopy (~1H-MRS) can directly assess the living biochemistry metabolites in localized brain regions.4.Acute stroke patients with lower NAA/Cr and higher Cho/Cr ratios in bilateral white matters of prefrontal lobes and hippocampus areas have higher the risks on PSD and the evaluation of the variability of these metabolites may contribute to the prediction of the development of depression after stroke.