肝豆汤联合驱铜治疗方案对湿热内蕴型肝豆状核变性患者肝脏代谢和认知功能的影响

Effect of Gandou Tang Combined with Copper Repellent Therapy on Liver Metabolism and Cognitive Function in Patients with Wilson's Disease with Damp Heat Accumulation Type

目的:探讨肝豆汤联合驱铜治疗方案对湿热内蕴型肝豆状核变性(WD)患者肝脏代谢和认知功能的影响。方法:按照随机数字表法将2018年1月至2021年12月期间我院收治的80例WD患者分为观察组(n=40,接受肝豆汤联合驱铜治疗)、对照组(n=40,接受驱铜治疗)。观察两组中医证候积分、24 h尿铜、肝功能指标、肝纤维化指标和认知功能变化情况。结果:治疗4个疗程后,两组手足震颤、言语含糊、行动困难、步履艰难、肢僵挛缩、口涎不止、口苦或臭、头目昏眩、纳谷不香、腹胀痞满、尿赤便结、鼻衄齿衄、黄疸水臌评分均降低,且观察组均低于对照组(P<0.05)。治疗4个疗程后,两组24 h尿铜升高,且观察组高于对照组(P<0.05)。治疗4个疗程后,两组丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)、总胆红素(TBIL)均下降,且观察组均低于对照组(P<0.05)。治疗4个疗程后,两组透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)、层黏连蛋白(LN)、Ⅳ型胶原(CⅣ)均下降,且观察组均低于对照组(P<0.05)。治疗4个疗程后,两组视空间与执行功能、命名、注意力、语言、抽象能力、延迟回忆、定向力评分均升高,且观察组均高于对照组(P<0.05)。结论:肝豆汤联合驱铜治疗方案治疗湿热内蕴型WD患者,可有效缓解临床症状,调节肝脏代谢,改善认知功能。

Objective:To explore the effect of the combination of Gandou Tang and copper repellent therapy on liver metabolism and cognitive function in patients with Wilson's disease(WD)with Damp heat accumulation type.Methods:80 WD patients who were admitted to our hospital from January 2018 to December 2021 were divided into observation group(n=40,treated with Gandou Tang combined with copper repellent therapy)and control group(n=40,treated with copper repellent therapy)according to the random number table method.The changes in TCM syndrome scores,24-hour urine copper,liver function indicators,liver fibrosis indicators,and cognitive function in two groups were observed.Results:Four courses afer treatment,the scores of tremor of hands and feet,slurred speech,difficulty in action,trudge,limb stiffness contracture,excessive salivation,bitter or foul mouthed,head dizzy,no pleasure in eating,abdominal distension and fullness,urinary red stool node,epistaxis and epistaxis,jaundice and waterdrop in both groups decreased,and the observation group was lower than that of the control group(P<0.05).Four courses after treatment,the 24 hour urine copper levels in both groups increased,and the observation group was higher than that of the control group(P<0.05).Four courses after treatment,alanine aminotransferase(ALT),aspartate transaminase(AST),and total bilirubin(TBIL)in both groups decreased,and the levels in the observation group were lower than those of the control group(P<0.05).Four courses after treatment,the levels of hyaluronic acid(HA),type Ⅱ procollagen peptide(PⅢP),laminin(LN),and type Ⅳ collagen(CIV)in both groups decreased,and the observation group was lower than that of the control group(P<0.05).Four courses after treatment,the scores of visual space and executive function,naming,attention,language,abstract ability,delayed recall,and directional ability in both groups increased,and the observation group was higher than that of the control group(P<0.05).Conclusion:The combination of Gandou Tang and copper repellent therapy can effectively alleviate clinical symptoms,regulate liver metabolism,and improve cognitive function in patients with WD with damp heat accumulation type.