The Clinical Observation And FMRI Brain Imaging Mechanism Discussion Of Kaixin Jieyu Prescription On Vascular Depression

Objectives:To observe the clinical effects of Kaixin Jieyu Prescription, and explore the brain mechanism of curative effect from functional imagingby investigate the changes of brain function on vascular depression before and after Chinese medicine treatment by fMRI.Methods:1. The observation of clinical curative effect:During the time of September 2014 to February 2016,60 patients met the inclusion criteria of Vascular Depression were included from the department of geriatric, psychological and psychosomatic medicine of Guang’anmen hospital. All of them were randomly divided into 2 groups, Chinese medicines group （n=36） and Western medicine group （n=24）. General information on the two groups at baseline （including gender, age, education level, etc.） had no significant difference. KJP （granule） was taken respectively in the morning and evening in Chinese medicines group, one dose a day, and fluoxetine was taken in western medicines group one pill a day.The treatment was 8 weeks. It was observed before treatment and 8 weeks of treatment in the changes of Hamilton Depression Scale score and TCM symptom scale score.2. The study of brain functional imaging:we randomly selected 7 cases to involve the fMRI test, which were from Chinese medicines group and western medicines group in the clinical trials. And selected 6 normal cases as control group which age^ sex and education-matched. fMRI data were collected two times at baseline and after 8 weeks of treatment in Chinese medicines group, and only once in control group. Magnetic Resonance Imaging had two sequences including conventional head MRI scanning and resting-state functional magnetic resonance scaning. Compare the changes of ALFF value and ReHo value in the whole brain before and after treatment in two groups. And compare with control group.Results:1. The observation of clinical curative effect:（1） From the comparison of clinical efficacy in two groups, we observed that the total effective rate of Chinese medicine group was 83.33% and the total effective rate of western medicine group was 87.50%. The two groups had no difference in clinical efficacy （P> 0.05）. From the improvement of Chinese symptom, we observed that the total effective rate of Chinese medicine group was 86.21% and the total effective rate of western medicine group was 71.83%. There was no difference between the two groups in the efficacy of clinical symptoms （P> 0.05）.（2） Hamilton Depression Rating Scale and TCM symptom score scale score change:Intra-group comparison:Compared with baseline, the score of HAMD Scale and TCM symptom scale significantly decreased （P<0.01） in traditional Chinese medicine and western medicine group after 8W treatment; Group comparison:The difference of scale scores between Chinese medicine group and western medicine group was not significant （P> 0.05） after 8W treatment.（3） The comparision of TCM symptom:Compared with prior treatment, the symptom of "depression", "lack of interest", "weak", "upset", "insomnia" were significantly improved in two groups （P<0.01, P<0.05）. In addition, the symptom of "palpitations", "shortness of breath", "chest distress", "good at a deep sigh", " spontaneous perspiration"were significantly improved in Chinese medicine group （P <0.01, P<0.05）. Compared with Western medicine group, TCM group was better in improving the symptom of "chest distress"and "good at a deep sigh" （P<0.05）.2. The result of fMRI（1） The result of ALFF valueComparison of vascular depression group （n= 14） and healthy controls （n= 6）: The brain areas which ALFF value decreased were the left side of ventrolateral prefrontal cortex （BA45）, right superior frontal gyrus, right insula, right precentral gyrus, right middle occipital gyrus. The ALFF value increased areas were left cerebellum （BA6） and right cerebellum （BA2）.Compared with prior treatment, the ALFF value increased areas were left Frontal lobe gyrus orbit （BAl 1）, left inferior parietal lobule （BA40） in Chinese medicine group （n=7） after 8W treatment. And the ALFF value decreased areas were right posterior cingulate cortex, right middle frontal gyrus, left inferior frontal gyrus and left insula in western medicine group （n=7） after 8W treatment.The comparison between two groups:There was no significant different between Chinese medicine groupand western medicine group at baseline.Compared with western medicine group, the brain areas which ALFF value decreased were precentral, right dorsal lateral prefrontal cortex; ALFF value increased areas wereright inferior temporal gyrus, right precuneus;The comparison between healthy controls and vascular depression after 8w treatment:the brain areas which ALFF value decreased in Chinese medicine group were right inferior frontal cortex, left cuneus, right middle cingulate cortex, right inferior temporal cortex, right precentral gyrus, right inferior parietal lobe, the increased areas were Cerebelum₁, left Cerebelum₆; the decreased areasin western medicine group were right postcentral cortex, right inferior occipital cortex, right middle cingulum, right inferior orbit frontal cortex, the inceased areas were right cerebellum₁, left inferior orbit Frontal.（2） The result of ReHo valueComparison of vascular depression group （n= 14） and healthy controls （n= 6）: The brain areas which ReHo value decreased were left dorsolateral prefrontal cortex, right anterior cingulate cortex, left thalamus, right superior frontal gyrus. The brain areas which ReHo value increased were right cerebellum, right ventral part of pons.Compared with prior treatment, the ReHo value increased areas after 8 W treatment were left fusiform gyrus, left inferior parietal lobule, pons postmedian, right middle temporal gyrus and the decreased area was right cerebellum in Chinese medicine group. The ReHo value increased areas after 8W treatment weremiddle of pons, left temporal gyrus, right inferior parietal lobule, right superior temporal gyrus.The comparison between two groups:There was no significant different between Chinese medicine group and western medicine group at baseline. Compared with western medicine group, the brain areas which ReHo value decreased wereright middle frontal cortex, left precentral cortex; ReHo value increased areas wereleft superior temporal pole, left cerebelum₉.The comparison between healthy controls and vascular depression after 8w treatment:the brain areas which ALFF value decreased in Chinese medicine group were right middle frontal cortex, left inferior frontal cortex, left precuneus cortex, the increased areas was right cerebelum; the decreased areasin western medicine group was right superior temporal cortex, the inceased areas wereleft middle frontal cortex, left superior frontal cortex.Conclusions（1） KJP had antidepressant effect, the clinical efficacy was same to fluoxetine. It was better in improving the TCM symptom "chest distress", "good at a deep sigh" than fluoxetine. It reflected the advantage of "yiqi kaiyu" in traditional Chinese medicine.（2） Compared with healthy control group, some brain areas exert abnormal function.（3） As the symptoms improved, the brain function was also changed after antidepressant treatment. These brain areas were all related to emotion regulation. It may be possible that the changes of brain function in these regions is one of the brain mechanism of antidepressant effect.（4） The brain areas which exist change were different in Chinese medicine group and western medicine group before and after treatment. The mechanisms of action between KJP and fluoxetine in treatment of vascular depression may be different.