The Clinical Efficacy Of Medullary Stagnation In The Treatment Of Tic Disorder And Its Effect On Immune Cells

Objective:1.Evaluating the effect of Jingxinzhidong decoction in treating Tic Disorder for 12 weeks by using the Yale Global Tic Severity Scale and the TCM Syndrome Scale.2.Via comparing the level of the immune cells,such as,CD3+T、CD4+T、CD8+T、CD4+/CD8+、CD4+/CD25+T、CD4+/CD25+/CD12+T、CD8+/CD28-T、CD8+/CD28+T,to tell the differences between the TD ones and the healtly ones.3.Based on the previous studies,observing the alterations of CD3+T、CD4+T、CD8+T、CD4+/CD8+、CD4+/CD25+T、CD4+/CD25+/CD12+、CD8+/CD28+T and CD8+/CD28+T in TD children patients before and after 12 weeks treatment with Jingxinzhidong decoction,to explore the influence mechanism of Jingxinzhidong decoction on immune cells.Methods:TD children outpatients or the healthy children undergoing medical examination in Guang’anmen hospital of China Academy of Chinese Medical Sciences were targeted as research objects from June in 2016 to November in 2017.284 children were diagnosed as tic disorder by applying DSM-V and Pediatrics in traditional Chinese Medicine as the inclusion criteria,and screening and excluding cases were strictly conducted based on the selection requirements.By using the systematic sampling method,this research included 71 cases of TD children in the case group.There were 5 patients had dropped out totally(2 patients had hemolysis during blood collection and 3 patients were lost to follow up)in the case group during the trial.Finally,66 children were included in the case group,and 38 children were included in the control group.All included cases received Jingxinzhidong decoction for 12 weeks,the YGTSS and the TCM Syndrome Scale assessed by professional doctors were utilized to evaluate the illness severity before and after the treatment.Score-reducing rate was applied to assess the effect and the hepatorenal function and urine routine were monitored during the research to ensure safety.Venous blood(2ml)drawed from the children of both before and after the treatment of the TD groups and the healthy children were collected by the clinical laboratory of Guang’anmen Hospital,China Academy of Chinese Medical Sciences.The T-lymphocyte subsets were tested in the tumor laboratory of Guang’anmen Hospital of China Academy of Chinese Medical Sciences with flow cytometry,with a strict quality control.All the experimental data in this paper was analyzed by statistical software SPSS 25.The measurement data was expressed with the average number and standard deviation(X ± S).When the data of two groups were in normal distribution and the variance is homogeneous,the independent sample T test was used to analyze the data.The nonparametric test was used in the count data,and the comparison of the two sets of data was applied to the composition ratio,and the chi square test(X2 test)was used.The rank sum test was used for statistics.All the statistical tests were both tested by bilateral test.The difference between the two groups of data was expressed with P<0.05.If the value of P>0.05,there was no difference between the two groups of data,and no statistical significance was found.Results:1.The effect of Jingxinzhidong decoctionAfter 12 weeks of Jingxinzhidong decoction in 66 TD children patients,according to the the reduction rate of the YGTSS indicated 17 cases were markedly effective,36 cases were effective,13 cases were invalid,the total effective rate was 80.30%.No abnormal liver and kidney function were found in this research.There were two children with urine protein(±)and one child with urinary occult blood(+)in the routine urianlysis,but the results of the routine urianlysis were normal at the next week.The other children in the case group did not have any other adverse events.2.Comparing the TD’s immune cells with the healthy onesThe level of serum CD8+T in case group before treatment was significantly higher than that in control group(P<0.05),and the level of serurum CD4+/CD25+/CD12+T was significantly lower than that in control group(P<0.05).The more severe the condition was,the higher the CD8+T level and the lower CD4+/CD25+/CD12+T level was.In addition,the mental factors in children with higher CD8+T cell level changed significantly.Tourette’s movements were mostly concentrated on the head,face and the abdomen.Although the level of serum CD8+T decreased after treatment in the case group and tended to reach the level in the control group,it was still statistically significant higher than the control group(P<0.05).No statistical significance was found in the other CDs.In this study,there was no significant difference in serum CD3+T,CD4+T,CD4+/CD8+,CD4+/CD25+T,CD8+/CD28-T and CD8+/CD28+T between TD children and healthy children(P>0.05).3.Comparison of immune cells before and after treatment in TD childrenThe level of serum CD3+T,CD4+T,CD4+/CD8+,CD4+/CD25+/CD12+T,CD4+/CD25+T and CD8+/CD28+T in TD group after treatment were increased than before,among them,CD4+T,CD4+/CD8+,CD4+/CD25+/CD12+T and CD4+/CD25+T increased significantly(P<0.05).And no statistical significance was observed in the decrease of CD8+T and CD8+VCD28-T(P>0.05).4.Comparison of immune cells from the perspective of sexFrom the gender perspective,it was found that the CD4+/CD25+T level was significantly higher in the male children than that of the female children in the control group,before and after the treatment(P<0.05).The CD3+T of the female children before the treatment was significantly higher than that of the male children(P<0.05).The CD4+T level of the male children before the treatment was higher than that of the female children(P<0.05).The level of CD4+/CD25+/CD12+T in male children before and after the treatment was significantly higher than that in female children(P<0.05).5.The relationship between the course of disease and immune cellsThere was a positive correlation between the course of disease and the serum CD8+T(r=0.247,P<0.05),and there was a negative correlation between the course and CD4+/CD8+(r=-0.263,P<0.05).6.A cluster of symptomsIn the case group,there were 37 children with abnormal emotion.31 cases of childrien with dread,14 cases with attention disorder,14 children with abdominal pain,9 cases of aphthous ulcers and 8 cases with recurrent respiratory infection.After the treatment of Jingxinzhidong decoction,there was a significant improvement in abnormal emotion,dread,abdominal pain,aphthous ulcers,and recurrent respiratory infection(P<0.05).The improvement was not significant in the attention disorder children(P>0.05).Conclusion:1.There were differences in the levels of immune cells between the TD children and the healthy children,indicating that there was a certain degree of imbalance of immune cells in children with tic disorder.especially for the CD8+T.The level of immune cells were changed after treatment and tended to reach the normal level which proved that Jingxinzhidong decoction can regulate the immune expression of TD children.2.The level of the immune cells was influenced by the TD children’ sex,the duration of TD,the emotional abnormality and dread.3.In this experiment.the children with tic disorder were treated with Jingxinzhidong decoction for 12 weeks:according to the Yale scale,the total effective rate was 80.30%.During the 12 weeks,all children had no abnormal liver and kidney function.This result reconfirmed the accuracy of the therapeutic theory in tic disorder treatment from heart proposed by Prof.Han Fei,and the enhancement of immune response and immune effect.