基于Lab颜色模型探讨湿热内蕴型肝豆状核变性患者治疗前后舌象的特点

Change characteristics of tongue image in Wilson Disease patients due to retention of damp-heat in the interior before and after treatment based on Lab color model

目的:研究湿热内蕴型肝豆状核变性(WD)患者治疗前后舌象参数的变化特点,探讨舌象参数在中西医结合治疗WD临床疗效评价中的作用。方法:将117例湿热内蕴型WD患者随机分为治疗组和对照组。对照组给予二巯丙磺钠(DMPS)排铜治疗,治疗组在对照组的基础上联合肝豆汤(大黄6 g,黄连10 g,黄芩10 g,半枝莲15 g,穿心莲10 g,萆薢10 g)治疗,共4个疗程(32 d)。使用道生公司DS01-A舌面脉信息采集体质辨识系统(Lab颜色模型),拍摄患者入院及出院时舌象,并对所拍摄的舌象进行参数运算,观察治疗组与对照组治疗前后舌象参数(舌色及苔色Lab值)变化的特点。运用Pearson相关性检验,分析湿热内蕴型WD患者舌象参数与肝功能相关指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、前白蛋白(PA)、总胆汁酸(TBA)]水平的相关性。结果:①治疗组有效率高于对照组(93%vs 86%),治疗后治疗组中医证候积分低于对照组,差异均有统计学意义(P<0.05,P<0.01)。②治疗后两组患者舌色及苔色Lab-L值明显上升,Lab-a值和Lab-b值明显下降,与治疗前比较,差异有统计学意义(P<0.01);治疗组在改善舌象参数方面优于对照组,差异有统计学意义(P<0.05)。③治疗后两组患者ALT、AST、TBA水平明显下降,ALB、PA水平明显上升,与治疗前比较,差异有统计学意义(P<0.01)。治疗组肝功能指标改善优于对照组,差异有统计学意义(P<0.05)。④舌象参数与肝功能相关评价指标具有明显相关性(P<0.05)。结论:肝豆汤清热祛湿、通腑利尿,治疗WD具有较好的临床疗效。舌象Lab值的变化可反映患者肝损害的严重程度,舌象参数可以作为中医临床疗效评价的新指标。

Objective:To study the change characteristics of tongue image parameters in patients with Wilson Disease(WD)due to retention of damp-heat in the interior before and after treatment,and to explore the role of tongue image parameters in the evaluation of clinical efficacy of integrated traditional Chinese and western medicine treatment of WD.Methods:117 WD patients with retention of damp-heat in the interior were randomly divided into treatment group and control group.The patients in the control group were treated with sodium dimercaptopropane sulfonate(DMPS)for copper removal,and the patients in the treatment group were treated with Gandou Decoction(6 g of Dahuang,10 g of Huanglian,10 g of Huangqin,15 g of Banlianzhi,10 g of Chuanxinlian and 10 g of Bixie)on the treatment basis of the control group for 4 courses(32 days).DS01-A physical identification system of tongue surface pulse information acquisition(Lab color model)made by Daosheng Company was used.The tongue images of patients at admission and discharge were taken,and the parameters of the tongue images were calculated.The change characteristics of tongue image parameters(Lab value of tongue color and coating color)before and after treatment were observed in the treatment group and the control group.Pearson correlation test was used to analyze the correlation between tongue image parameters and liver function related indexes(alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),prealbumin(PA)and total bile acid(TBA))in WD patients with retention of damp-heat in the interior.Results:①The effective rate of the treatment group was higher than that of the control group(93%vs 86%),and the TCM symptom score of the treatment group was lower than that of the control group after treatment.The differences were statistically significant(P<0.05,P<0.01).②After treatment,Lab-L values of tongue color and coating color in both groups were significantly increased,Lab-a values and Lab-b values were significantly decreased,and compared with that before treatment,the difference was statistically significant(P<0.01);the treatment group was better than the control group in improving tongue image parameters,and the difference was statistically significant(P<0.05).③After treatment,the levels of ALT,AST and TBA were significantly decreased in both groups,and ALB and PA levels were significantly increased,and compared with that before treatment,the difference was statistically significant(P<0.01);The improvement of liver function indexes in the treatment group was better than that in the control group(P<0.05).④Tongue image parameters were significantly correlated with liver function evaluation indexes(P<0.05).Conclusion:Gandou Decoction has a good clinical effect in treating WD by clearing heat and removing dampness,facilitating fu-organs and promoting diuresis.The change of tongue image Lab value can reflect the severity of liver damage,and tongue image parameters can be used as a new index to evaluate the clinical efficacy of traditional Chinese medicine.