基于数字化目诊信息探讨肝豆灵联合短期驱铜治疗对肝豆状核变性肝型患者的临床疗效

Gandouling Combined with Short-term Copper-expelling Therapy in Patients with Hepatic Wilson’s Disease Based on Digital Diagnosis Information on Eyes

目的:开展数字化目诊信息研究,探讨肝豆状核变性[又称Wilson病(WD)]肝型患者目络特征及肝豆灵(GDL)干预研究,以期为肝豆灵治疗WD肝型患者的临床疗效提供参考。方法:收集82例WD肝型患者(WD组)和健康志愿者68例[正常组(NC组)]。所有受试者均应用目诊仪采集眼部图像,进行目络特征的数字化提取。分析WD组的重要目络特征与NC组之间的差异。采用Pearson相关性检验分析探讨WD肝型患者目络特征与肝损害血清学指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)]水平及Child-Pugh评分的相关性。将82例WD肝型患者随机分为观察组(42例)和对照组(40例),对照组给予二巯丙磺钠(DMPS)治疗,观察组在西医治疗基础上加用中药肝豆灵片,共6个疗程(8 d为1个疗程)。评估肝豆灵干预治疗对ALT、AST、ALB水平及目络特征积分和Child-Pugh评分的影响。结果:(1)与NC组比较,WD组在目络特征“丘”(P<0.05)和“血脉”(P<0.05)积分更高。(2)WD肝型患者的ALT、AST水平、Child-Pugh评分与目络特征“丘”和“血脉”积分呈正相关,ALB水平与目络特征“丘”和“血脉”积分呈负相关。(3)与治疗前比较,两组患者血清ALT、AST水平、Child-Pugh评分及目络特征“丘”和“血脉”积分均显著降低(P<0.01),ALB水平均显著上升(P<0.01)。(4)与对照组治疗后比较,观察组ALT、ALB水平及目络特征“丘”和“血脉”积分明显改善(P<0.05);观察组Child-Pugh评分显著改善(P<0.01);AST组间比较差异无统计学意义。结论:与正常人比较,WD肝型患者的目络特征在“丘”和“血脉”上积分更高,代表WD肝型患者以湿、热征象为主,且“丘”和“血脉”积分与肝损害严重程度呈正相关。同时,在西医驱铜治疗基础上,联合中药肝豆灵可显著改善WD患者的肝功能,提高临床疗效。

Objective:To explore the characteristics of eye collaterals of patients with hepatic Wilson’s disease(WD)and intervention effect of Gandouling(GDL)based on digital diagnosis information on eyes,in order to provide references for the clinical efficacy of GDL in the treatment of patients with hepatic WD.Method:Eighty-two patients with hepatic WD(WD group)and 68 healthy volunteers(normal control group,NC)were enrolled.Eye images of all subjects were collected by the ophthalmoscope,followed by digital extraction of eye collateral characteristics.Differences in main eye collateral characteristics between the WD group and the NC group were analyzed.Pearson correlation test was used to analyze the eye collateral characteristics,serological indexes of liver damage[alanine aminotransferase(ALT),aspartate transaminase(AST),and albumin(ALB)],and Child-Pugh score in patients with hepatic WD.The 82 patients with hepatic WD were divided into a treatment group(42 cases)and a control group(40 cases).All patients were treated with sodium 2,3-dimercapto-1-propane sulfonate(DMPS),while those in the treatment group received additional GDL Tablets.One course of treatment contained eight days,and the treatment lasted six courses.The effects of GDL intervention on the levels of ALT,AST,and ALB,as well as the eye collateral characteristics score and Child-Pugh score were evaluated.Result:(1)Compared with the NC group,the WD group had higher scores of"Qiu"(P<0.05)and"Xuemai"(P<0.05),which are the characteristics of eye collaterals.(2)The levels of ALT and AST,and Child-Pugh score in patients with hepatic WD were positively correlated with the scores of"Qiu"and"vessel",while the ALB level was negatively correlated with the"bulge"and"Xuemai"scores.(3)Compared with the conditions before treatment,the serum ALT and AST levels,Child-Pugh score,and the"Qiu"and"Xuemai"scores of the two groups were reduced(P<0.01),and the ALB levels were increased(P<0.01).(4)Compared with the control group after treatment,the treatment group showed improved levels of ALT and ALB and the scores of"Qiu"and"Xuemai"(P<0.05)and better Child-Pugh score(P<0.01).There was no significant difference in AST between the two groups.Conclusion:Compared with healthy people,hepatic WD patients showed higher scores of"Qiu"and"Xuemai",indicating that patients with hepatic WD were mainly characterized by dampness and heat,and the scores of"Qiu"and"Xuemai"were positively correlated with the severity of liver damage.Meanwhile,copper-expelling therapy combined with GDL can significantly improve the liver function of WD patients and improve the clinical efficacy.