摘要
目的了解肝豆汤加减治疗湿热内蕴型肝豆状核变性(Wilson病)的临床疗效,并探讨其作用机制。方法选取2016年1—8月在安徽中医药大学第一附属医院脑病中心住院治疗的湿热内蕴型Wilson病患者78例,采用随机数字表法分为对照组和观察组,各39例。两组患者入院后均以谷胱甘肽、二巯丙磺酸钠保肝驱铜为基础治疗,观察组在基础治疗的同时采用清热解毒、通腑利尿之中药肝豆汤加减治疗,两组患者均以4周为1个疗程。比较两组患者治疗前后的中医证候积分、血清同型半胱氨酸(Hcy)水平、血清肝纤维化标志物[透明质酸酶(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)]水平及中医证候疗效。结果治疗前两组患者中医证候积分比较,差异无统计学意义(P>0.05);治疗后观察组患者中医证候积分低于对照组,差异有统计学意义(P<0.05)。两组患者中医证候疗效比较,差异无统计学意义(P>0.05)。治疗前两组患者血清Hcy水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清Hcy水平低于对照组,差异有统计学意义(P<0.05)。治疗前两组患者血清HA、Ⅳ-C、PCⅢ、LN水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清HA水平低于对照组,差异有统计学意义(P<0.05);但治疗后两组患者血清Ⅳ-C、PCⅢ、LN水平比较,差异无统计学意义(P>0.05)。结论在进行西医综合保肝驱铜治疗的同时,临床辨证使用肝豆汤加减治疗湿热内蕴型Wilson病可以改善患者的临床症状,调节血清肝纤维化标志物和Hcy水平,改善肝功能。其作用机制为通过通腑利尿法竞争性抑制铜离子在胃肠道的吸收,同时增加体内多余铜的排泄,从而减轻铜毒导致的脏器功能损伤。
Objective To investigate the therapeutic effect and mechanism of action of modified Gandou decoction in the treatment of Wilson's disease with endogenous damp-heat syndrome. Methods We enrolled 78 cases of Wilson' s disease with endogenous damp-heat syndrome who received inpatient treatment in Encephalopathy Treatment Center,the First Affiliated Hospital of Anhui University of Chinese Medicine from January to August 2016 and divided them into the observation group and the control group with 39 in each based on random number table. Both groups received glutathione( GSH) and sodium dimercaptosulphonate( DMPS) as the basic treatment for protecting liver function and decoppering. The observation group additionally received modified Gandou decoction for heat-clearing,detoxifying,clearing bowels and promoting diuresis. Four-week treatment was defined as one course of treatment. TCM syndrome scores,clinical effects, levels of serum homocysteine( Hcy),markers of liver fibrosis [hyaluronidase( HA),type Ⅳ collagen( Ⅳ-C),type Ⅲ procollagen( PC Ⅲ) and laminin( LN) ]and TCM syndrome treatment were measured and compared in both groups before and after treatment. Results The TCM syndrome scores did not differ significantly between the groups before treatment( P > 0. 05), but they decreased significantly in the observation group after treatment( P < 0. 05). TCM syndrome treatment in both groups were improved significantly,but showed no differences between the groups( P > 0. 05). The levels of Hcy were found to be similar in both groups before treatment( P > 0. 05); after treatment,they were decreased obviously in the observation group( P < 0. 05). The levels of HA,Ⅳ-C,PCⅢ and LN were similar in both groups before treatment( P > 0. 05); after treatment,the levels of HA decreased obviously in the observation group( P < 0. 05),but the levels of Ⅳ-C,PCⅢ and LN were still similar in both groups( P > 0. 05). Conclusion For patients with Wilson's disease with endogenous damp-heat syndrome,modified Gandou decoction based on syndrome differentiation combined with western drugs for protecting liver function and decoppering can improve the clinical symptoms,levels of markers of liver fibrosis and serum Hcy as well as the liver function. The mechanism is acted by decreasing gastrointestinal absorption of copper via clearing bowels and promoting diuresis and advancing the discharge of excess copper,so that the organ function damage caused by copper deposition is alleviated remarkably.
引文
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