Study On FMRI Evaluating Repair And Regeneration Of Myelin Sheath, Axon And Nerve Fiber Of Tonifying The Kidney Treating Multiple Sclerosis Patients

ObjectiveCompared with the western medicine treatment effects, we research and confer repair and regeneration of myelin sheath, axon and nerve fiber of TCM tonifying the kidney treating the relapsing-remitting multiple sclerosis patients by detecting MR Spectroscopy and Diffusion Tensor Image to provide the TCM diagnosis theory scientific evidence.Materials and Methods1. Patient source and divisionThe experiment patients come from Sep.2012to Jan.2014Beijing Tiantan Hospital TCM and neurology department out-hospital patients. We establish the health control group. There are56diagnosed relapsing remitting multiple sclerosis(RRMS) patients, including40ones from TCM and16ones from the neurology departments. The health control group includes11healthy persons. According to the TCM diagnosis criteria, the TCM patients are divided into the kidney deficiency type and the other TCM types. The tonifying the kidney group includes29kidney deficiency type patients. The other TCM type treatment group includes11the other TCM type patients. The western medicine treatment group includes16kidney deficiency type patients.2. Treatment and observed indexes(1) Treatment The tonifying the kidney group patients are given Erhuang formula for Gan Shen yin deficiency ones and Erhuang formula adding Fuzi for Pi Shen yang deficiency ones. The other TCM type treatment group patients are divided into Qi deficiency phlegm stasis type and phlegm heat stasis type. The Qi deficiency phlegm stasis type patients are given Huangqi guizhi wu wu formula and the phlegm heat stasis type ones are given Huanglian wendan formula and Taohong siwu formula. The western medicine treatment patients are given the normal western medicine.(2) Observed indexes and periods The patients are recorded the general data, including the age of first attack, disease duration, relapsing times, TCM clinic syndromes distribution, neurologic systematic syndromes distribution, Expended Disability Score Standard(EDSS) and TCM syndromes scores. The patients and health control group persons receive MRI detection and are recorded the lesion and normal sides data of MR Spectroscopy(MRS) and Diffusion Tensor Imaging(DTI) data. MRS data include N-acetylaspartate(Naa), Choline(Cho) and Creatine(Cr). The MRS observed indexes include Naa/Cr and Cho/Cr ratios of lesion and normal sides. The DTI observed indexes include Apparent Diffusion Coefficient(ADC) and Fractional Anisotropy(FA) of lesion and normal sides. The observing period is9months. After the continuous9months treatment, the three RRMS patients are recorded TCM and neurologic syndromes distribution. They are evaluated EDSS and TCM syndromes scores. They also receive MRI detection and the observed indexes are mentioned on the above.Section1:Before treatment, the TCM clinic syndromes distribution, neurologic systematic syndromes distribution, EDSS and TCM syndromes scores difference is observed between the tonifying the kidney and western medicine treatment groups. The MRS and DTI observed indexes difference is compared among the two groups and the health control group. Before and after treatment, the tonifying the kidney and western medicine treatment groups’ TCM and neurologic syndromes distribution, EDSS and TCM syndromes scores are compared. Besides, the two groups’MRS and DTI observed indexes changes are compared.Second2:Before treatment, we observe the TCM clinic syndromes distribution, neurologic systematic syndromes distribution, EDSS and TCM syndromes scores of the tonifying the kidney and other TCM treatment groups. We compare the MRS and DTI indexes difference among the two groups and the health control group. Before and after treatment, we also compare the TCM and neurologic syndromes distribution, EDSS and TCM syndromes scores, MRS and DTI indexes changes between the the tonifying the kidney and other TCM treatment groups.ResultsSection1:FMRI estimate the nerve damage and repair difference between the tonifying the kidngy and western medicine treating MS patients1. TCM syndromes distribution Before treatment, there is no distribution difference between the tonifying the kidney and western medicine treatment groups with P>0.05. After treatment, the tonifying the kidney group’s number of patients complaining bodily pain, impotent limbs, heels irritation, limbs numbness, giddiness, cephalalgia, blurred vision, insomnia, dreamy rest, urgent urination, obliviousness, fidget, hectic fever and night sweat is obviously lowered than the western medicine treatment group’s number with P<0.05. It shows the tonifying the kidney group’s TCM syndromes get recovery remarkably.2. Neurologic syndromes distribution Before treatment, there is no distribution difference between the tonifying the kidney and western medicine treatment groups with P>0.05. After treatment, the tonifying the kidney group’s number of patients complaining impotent limbs, sensation paralysis, blurred vision, failed urination, ataxia, decreased cerebrum cortex function and relapsing syndromes is obviously lowered than the western medicine treatment group’s number with P<0.05. It shows the tonifying the kidney group’s neurologic syndromes get recovery remarkably. 3. EDSS and TCM syndromes scores Before treatment, there is no EDSS and TCM syndromes scores difference between the tonifying the kidney and western medicine treatment groups with P>0.05. After treatment, the tonifying the kidney group’s EDSS and TCM syndromes scores are obviously lowered than those of the western medicine treatment group with P<0.05. The two groups’EDSS and TCM syndromes scores decrease after treatment. The tonifying the kidney group’s EDSS and TCM syndromes scores decrease more obviously with P<0.05. It shows the tonifying the kidney group’s neurologic function get recovery remarkably.4. MR Spectroscopy(MRS) Before treatment, the tonifying the kidney and western medicine treatment groups’NAA/CR ratios are obviously lower and CHO/CR ratios are obviously higher than the ratios of the health control group with P<0.05. It shows the two groups’demyelination and axonal damage is obvious. There is no difference between the ratios of the two groups with P>0.05. After treatment, the western medicine treatment group’s NAA/CR ratio is obviously lower than the ratio of the health control group. The western medicine treatment group’s CHO/CR ratio is obviously higher than the ratio of the health control group with P<0.05. There is no difference between the two ratios of the tonifying the kidney group and the health control group with P>0.05. The tonifying the kidney group’s NAA/CR ratio is obviously higher than the ratio of the western medicine treatment group. The tonifying the kidney group’s CHO/CR ratio is obviously lower than the ratio of the western medicine treatment group with P<0.05. The tonifying the kidney group’s NAA/CR ratio increasing and CHO/CR ratio decreasing margins are obviously wider than the margins of the western medicine treatment group with P<0.05. It shows the tonifying the kidney group’s myelin sheath repair and axon regeneration is obviously better than that of the western medicine treatment group.5. Diffusion Tensor Imaging(DTI) Before treatment, the tonifying the kidney and western medicine treatment groups’ADC ratios are obviously higher and CHO/CR ratios are obviously lower than the ratios of the health control group with P<0.05. It shows the two groups’nerve fiber damage is obvious. There is no difference between the ratios of the two groups with P>0.05. After treatment, the western medicine treatment group’s ADC ratio is obviously higher than the ratio of the health control group. The western medicine treatment group’s FA ratio is obviously lower than the ratio of the health control group with P<0.05. There is no difference between the two ratios of the tonifying the kidney group and the health control group with P>0.05. The tonifying the kidney group’s FA ratio is obviously higher than the ratio of the western medicine treatment group. The tonifying the kidney group’s ADC ratio is obviously lower than the ratio of the western medicine treatment group with P<0.05. The tonifying the kidney group’s FA ratio increasing and ADC ratio decreasing margins are obviously wider than the margins of the western medicine treatment group with P<0.05. It shows the tonifying the kidney group’s nerve fiber tract repair is obviously better than that of the western medicine treatment group.Section2:FMRI estimate the nerve damage and repair difference between the different TCM types diagnosing and treating MS patients1. TCM syndromes distribution Before treatment, there is no distribution difference between the tonifying the kidney and the other TCM treatment groups with P>0.05. After treatment, the tonifying the kidney group’s number of patients complaining spasm, giddiness, cephalalgia and thirsty is obviously lowered than the other TCM treatment group’s number with P<0.05. It shows the tonifying the kidney group’s TCM syndromes get better recovery.2. Neurologic syndromes distribution Before treatment, there is no distribution difference between the tonifying the kidney and other TCM treatment groups with P>0.05. After treatment, the tonifying the kidney group’s number of patients complaining ataxia is obviously lowered than the other TCM treatment group’s number with P<0.05. It shows the tonifying the kidney group’s neurologic syndromes get better recovery.3. EDSS and TCM syndromes scores Before treatment, there is no EDSS and TCM syndromes scores difference between the tonifying the kidney and other TCM treatment groups with P>0.05. After treatment, the tonifying the kidney group’s EDSS and TCM syndromes scores tend to be lower than those of the other TCM treatment group with P>0.05. The tonifying the kidney group’s EDSS and TCM syndromes scores decreasing margins tend to be wider than those of the other TCM treatment group. It shows the tonifying the kidney group’s neurologic function tends to get better recovery.4. MR Spectroscopy(MRS) Before treatment, the tonifying the kidney and other TCM treatment groups’NAA/CR ratios are obviously lower and CHO/CR ratios are obviously higher than the ratios of the health control group with P<0.05. It shows the two groups’ demyelination and axonal damage is obvious. There is no difference between the ratios of the two groups with P>0.05. There is no difference among the two ratios of the tonifying the kidney, TCM treatment and the health control groups after treatment with P>0.05. The tonifying the kidney group’s NAA/CR ratio tends to be higher than the ratio of the other TCM treatment groups. The tonifying the kidney group’s CHO/CR ratio tends to be lower than the ratio of the other TCM treatment group with P<0.05. The tonifying the kidney group’s NAA/CR ratio increasing and CHO/CR ratio decreasing margins tend to be wider than the margins of the other TCM treatment group with P>0.05. It shows the tonifying the kidney group’s myelin sheath repair and axon regeneration tends to be better than that of the other TCM treatment group.5. Diffusion Tensor Imaging(DTI) Before treatment, the tonifying the kidney and other TCM treatment groups’ADC ratios are obviously higher and FA ratios are obviously lower than the ratios of the health control group with P<0.05. There is no difference between the ratios of the two groups with P>0.05. After treatment, the other TCM treatment group’s ADC ratio is obviously higher than the ratio of the health control group. The other TCM treatment group’s FA ratio is obviously lower than the ratio of the health control group with P<0.05. There is no difference between the two ratios of the tonifying the kidney group and the health control group with P>0.05. The tonifying the kidney group’s ADC ratio is obviously lower than the ratio of the other TCM treatment group. The tonifying the kidney group’s FA ratio is obviously higher than the ratio of the other TCM treatment group with P<0.05. The tonifying the kidney group’s FA ratio increasing and ADC ratio decreasing margins are obviously wider than the margins of the other TCM treatment group with P<0.05. It shows the tonifying the kidney group’s nerve fiber tract repair is obviously better than that of the other TCM treatment group.Conclusion1. Compared with the western medicine treatment and other TCM treatment groups, the tonifying the kidney group’s TCM clinic and neurologic systematic syndromes decrease obviously after treatment. It shows tonifying the kidney treating MS can effectively improve the clinical syndromes.2. Compared with the western medicine treatment group, the tonifying the kidney group’s EDSS and TCM syndromes scores decrease obviously after treatment. It shows tonifying the kidney treating MS can improve neurologic function remarkably.3. Compared with the western medicine treatment group, the tonifying the kidney group’s NAA/CR ratio increase and CHO/CR ratio decrease obviously after treatment. It shows tonifying the kidney treating MS can effectively promote myelin sheath repair and axon regeneration.4. Compared with the western medicine treatment and other TCM treatment groups, the tonifying the kidney group’s ADC ratio decrease and FA ratio increase obviously after treatment. It shows tonifying the kidney treating MS can effectively promote nerve fiber tract repair.Above all, tonifying the kidney treating MS can effectively promote the damaged nerve repair and regeneration.