祛瘀化痰法对肝豆状核变性患者神经功能的影响

马守亮; 杨文明; 韩冰; 李悦悦; 许志豪; 宋成玮; 韩辉

doi:10.16766/j.cnki.issn.1674-4152.002485

祛瘀化痰法对肝豆状核变性患者神经功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002485

马守亮^{1, 2},
杨文明^{1, 2, ,},
韩冰³,
李悦悦³,
许志豪³,
宋成玮³,
韩辉^{1, 2}

1.
安徽中医药大学第一附属医院脑病中心，安徽合肥 230031
2.
国家中医药管理局优势病种肝豆状核变性协作组，安徽合肥 230031
3.
安徽中医药大学研究生院，安徽合肥 230031

基金项目:

国家自然科学基金项目 81973825

中国民族医药学会科研项目 2020ZY141-410901

安徽省重点研究和开发计划项目 1804h08020243

详细信息

通讯作者:
杨文明, E-mail: yangwm8810@126.com

中图分类号: R742.4R242
计量
- 文章访问数: 395
- HTML全文浏览量: 195
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-08
- 网络出版日期: 2022-09-21

Effects of removing blood stasis and resolving phlegm on the nerve function in Wilson's Disease

MA Shou-liang^{1, 2},
YANG Wen-ming^{1, 2
, ,},
HAN Bing³,
LI Yue-yue³,
XU Zhi-hao³,
SONG Cheng-wei³,
HAN Hui^{1, 2}

1.
Encephalopathy Center, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230031, China

摘要

摘要: 目的观察祛瘀化痰法对肝豆状核变性患者神经功能的影响及临床疗效。方法收集2019年1月—2021年6月安徽中医药大学第一附属医院脑病中心住院的痰瘀互结型肝豆状核变性患者60例资料，将60例痰瘀互结型肝豆状核变性患者按随机数表法分为治疗组和对照组，每组30例，治疗2个疗程，观察2组患者治疗前后肝豆状核变性患者神经功能积分和临床疗效以及24 h尿铜情况。结果治疗2个疗程末治疗组和对照组神经功能评分[(25.63±9.06)分、(57.13±12.03)分]均低于治疗前[(64.03±11.41)分、(66.40±13.27)分，均P＜0.05]，治疗组治疗2个疗程末神经功能评分低于对照组(P＜0.05)；治疗组临床总有效率更高(93.3% vs. 70.0%, χ²=5.455，P=0.020)；治疗2个疗程末治疗组和对照组24 h尿铜[(1 690.40±369.90)μg/24 h、(1 376.75±311.91)μg/24 h]均高于治疗前[(202.33±38.11)μg/24 h、(206.66±38.38)μg/24 h，均P＜0.01]，治疗组治疗后尿铜较对照组明显升高(P＜0.05)。结论祛瘀化痰法能明显改善肝豆状核变性患者的神经功能，改善临床疗效，提高患者的生活质量。
- 祛瘀化痰法 /
- 肝豆状核变性 /
- 神经功能
Abstract: Objective To observe the effect of removing blood stasis and resolving phlegm on the nerve function in patients with Wilson ' s disease. Methods A total of 60 Wilson's disease patients with phlegm and blood stasis who were hospitalised in the Encephalopathy Center of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2019 to June 2021 were treated for the research. These patients were randomly divided into treatment group and comparison group according to the random number table method, with 30 patients in each group. The treatment comprised two courses. During the treatment, Wilson ' s disease neurological function score, clinical efficacy and 24 h urine copper in the two groups were observed. Results At the end of 2 courses of treatment, the neurological function scores of the treatment and comparison group [(25.63±9.06) points and (57.13±12.03) points] were lower than those before treatment [(64.03±11.41) points and (66.40±13.27) points, all P < 0.05]. At the end of 2 courses of treatment, the neurological function score of the treatment group was lower than that of the comparison group (P < 0.05). The clinical efficacy of the treatment group was more significant (93.3% vs. 70.0%, χ²=5.455, P=0.020). At the end of 2 courses of treatment, the 24 h urinary copper values in the treatment and comparison groups [(1 690.40±369.90) μg/24 h and (1 376.75±311.91) μg/24 h] were higher than those before treatment [(202.33±38.11) μg/24 h and (206.66±38.38) μg/24 h, all P < 0.01]. The urine copper value in the treatment group was significantly higher than that in the comparison group after treatment (P < 0.05). Conclusion Removing blood stasis and resolving phlegm can significantly improve the neurological function of patients with Wilson's disease, the clinical efficacy and the quality of life of patients.
- Removing stasis and resolving phlegm /
- Hepatolenticular degeneration /
- Nerve function

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表 1 2组痰瘀互结型Wilson病伴神经功能障碍患者基本资料比较

Table 1. Comparison of the basic data of patients with Wilson's disease with neurological dysfunction between the two groups

组别	例数	性别(例)		年龄(x±s，岁)	病程(x±s，月)
组别	例数	男性	女性	年龄(x±s，岁)	病程(x±s，月)
治疗组	30	16	14	24.07±3.32	21.53±7.01
对照组	30	15	15	23.53±4.62	21.97±5.32
统计量		0.067^a		0.520^b	0.274^b
P值		0.796		0.605	0.785
注：^a为χ²值，^b为t值。

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表 2 2组痰瘀互结型Wilson病伴神经功能障碍患者治疗前后神经功能评分比较(x±s，分)

Table 2. Comparison of neurological function scores before and after treatment in two groups of Wilson's disease patients with mutual junction of phlegm and stasis with neurological dysfunction(x±s, points)

组别	例数	治疗前	治疗1个疗程末	治疗2个疗程末	F值	P值
对照组	30	66.40±13.27	63.20±12.50^a	57.12±12.03^a	4.180	0.018
治疗组	30	64.03±11.41	47.30±9.29^a	25.63±9.06^a	111.763	＜0.001
t值		0.741	5.592	11.461
P值		0.462	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组痰瘀互结型Wilson病伴神经功能障碍患者治疗前后24 h尿铜变化(x±s, μg/24 h)

Table 3. Changes of 24 h urine copper before and after treatment in two groups of Wilson's disease patients with mutual junction of phlegm and stasis with neurological dysfunction(x±s, μg/24 h)

组别	例数	治疗前	治疗1个疗程末	治疗2个疗程末	F值	P值
对照组	30	206.66±38.38	1 162.24±315.23^a	1 376.75±311.91^a	176.043	＜0.001
治疗组	30	202.33±38.11	1 390.56±395.34^a	1 690.40±369.90^a	186.852	＜0.001
t值		0.438	2.472	3.551
P值		0.663	0.016	0.001
注：与同组治疗前比较，^aP＜0.01。

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参考文献(24)

[1]	张波克, 周导, 朱俊, 等. 血清肝纤维化四项在肝豆状核变性肝硬化进展中的变化及临床价值[J]. 中国临床研究, 2020, 33(7): 900-903. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202007008.htm ZHANG B K, ZHOU D, ZHU J, et al. Changes and clinical value of serum hepatic fibrosis in the progression of hepatolenticular degeneration cirrhosis[J]. Chinese Journal of Clinical Research, 2020, 33(7): 900-903. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202007008.htm
[2]	XIE J J, WU Z Y. Wilson's disease in China[J]. Neurosci Bull, 2017, 33(3): 323-330. doi: 10.1007/s12264-017-0107-4
[3]	SANDAHL T D, LAURSEN T L, MUNK D E, et al. The prevalence of Wilson's disease: An update[J]. Hepatology, 2020, 71(2): 722-732. doi: 10.1002/hep.30911
[4]	李祥, 程婷, 汪瀚, 等. 肝豆状核变性抑郁障碍中医证型与血浆5-HT、NE的临床关系研究[J]. 江西中医药大学学报, 2019, 31(3): 35-37, 46. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXB201903013.htm LI X, CHENG T, WANG H, et al. Clinical study on the relationship between TCM syndro-mes and plasma 5-HT and NE in hepatolenticular degeneration depression disorder[J]. Journal of Jiangxi College of Traditional Chinese Medicine, 2019, 31(3): 35-37, 46. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXB201903013.htm
[5]	贾建平, 陈生弟. 神经病学[M]. 北京: 人民卫生出版社, 2018: 337-342. JIA J P, CHEN S D. Neurology[M]. Beijing: People's Medical Publishing House, 2018: 337-342.
[6]	汪美霞, 汪长春. 杨文明从痰瘀论治肝豆状核变性[J]. 中医药临床杂志, 2017, 29(7): 983-985. https://www.cnki.com.cn/Article/CJFDTOTAL-AHLC201707008.htm WANG M X, WANG C C. Yang Wenming treated hepatolenticular degeneration from phlegmand blood stasis[J]. Clinical Journal of Traditional Chinese Medicine, 2017, 29(7): 983-985. https://www.cnki.com.cn/Article/CJFDTOTAL-AHLC201707008.htm
[7]	石雅, 李艳, 马春燕. 中药内服联合驱铜治疗对Wilson病患者神经系统症状及肝纤维化指标的影响[J]. 现代中西医结合杂志, 2020, 29(33): 3719-3722. doi: 10.3969/j.issn.1008-8849.2020.33.018 SHI Y, LI Y, MA C Y. Effect of Chinese medicine oral administration combined with copper remover therapy on neurological symptoms and liver fibrosis index of Wil-son's disease[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2020, 29(33): 3719-3722. doi: 10.3969/j.issn.1008-8849.2020.33.018
[8]	徐磊, 蔡永亮, 蒋怀周, 等. 肝豆灵片治疗肝豆状核变性痰瘀互结证的疗效观察[J]. 中国实验方剂学杂志, 2017, 23(15): 173-177. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201715030.htm XU L, CAI Y L, JIANG H Z, et al. Observation on the curative effect of Gandouling tablets in treating the syndrome of mutual junction of phlegm and blood stasis in hepatolenticular degeneration[J]. China Journal of Experimental Traditional Medical Formulae, 2017, 23(15): 173-177. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201715030.htm
[9]	盛玉琴, 杨文明, 张娟. 艾灸联合肝豆汤改善Wilson病早期脾功能亢进的临床研究[J]. 中华全科医学, 2021, 19(5): 851-855. doi: 10.16766/j.cnki.issn.1674-4152.001933 SHENG Y Q, YANG W M, ZHANG J. Clinical study of moxibustion combined with Gandou decoction in improving hypersplenism in early stage of Wilson's disease[J]. Chinese Journal of General Practice, 2021, 19(5): 851-855. doi: 10.16766/j.cnki.issn.1674-4152.001933
[10]	程婷, 李祥, 黄鹏, 等. 肝豆状核变性-伏邪致病新论[J]. 辽宁中医药大学学报, 2019, 21(8): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201908017.htm CHENG T, LI X, HUANG P, et al. Hepatolenticular degeneration: A new theory on the pathogenesis of Volt evil[J]. Journal Of Liaoning University Of Traditional Chinese Medicine, 2019, 21(8): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201908017.htm
[11]	宋成玮, 韩辉, 忻凌, 等. 中医药治疗肝豆状核变性痰瘀互结证用药规律研究[J]. 中医药临床杂志, 2021, 33(4): 693-697. https://www.cnki.com.cn/Article/CJFDTOTAL-AHLC202104026.htm SONG C W, HAN H, XIN L, et al. Study on the law of traditional Chinese medicine in the treatment of hepatolenticular degeneration[J]. Clinical Journal of Traditional Chinese Medicine, 2021, 33(4): 693-697. https://www.cnki.com.cn/Article/CJFDTOTAL-AHLC202104026.htm
[12]	王训, 韩咏竹, 杨任民. 肝豆状核变性的中西医药物治疗概况[J]. 内科理论与实践, 2021, 16(5): 294-298. https://www.cnki.com.cn/Article/CJFDTOTAL-NKLL202105003.htm WANG X, HAN Y Z, YANG R M. Overview of traditional Chinese and Western medicine treatment of hepatolenticular degeneration[J]. Journal of Internal Medicine Concepts and Practice, 2021, 16(5): 294-298. https://www.cnki.com.cn/Article/CJFDTOTAL-NKLL202105003.htm
[13]	于露, 王艳昕. 肝豆状核变性的中医治疗进展[J]. 光明中医, 2017, 32(14): 2134-2136. doi: 10.3969/j.issn.1003-8914.2017.14.069 YU L, WANG Y X. Progress in traditional Chinese medicine treatment of hepatolenticular degeneration[J]. Guangming Journal Of Chinese Medicine, 2017, 32(14): 2134-2136. doi: 10.3969/j.issn.1003-8914.2017.14.069
[14]	何望生, 杨文明, 汪瀚, 等. 肝豆灵汤改善痰瘀互结型Wilson病患者肝脏功能的临床观察[J]. 中国实验方剂学杂志, 2020, 26(8): 105-111. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202008015.htm HE W S, YANG W M, WANG H, et al. Clinical observation of Gandouling Decoction in improving liver function of Wilson's disease with phlegm and stasis[J]. China Journal of Experimental Traditional Medical Formulae, 2020, 26(8): 105-111. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202008015.htm
[15]	马守亮, 杨文明, 韩辉, 等Wilson病合并脾肿大、脾功能亢进患者脾切除围手术期肝豆灵片干预的临床效果[J]. 临床肝胆病杂志, 2019, 35(3): 596-599. doi: 10.3969/j.issn.1001-5256.2019.03.028 MA S L, YANG W M, HAN H, et al. Clinical effect of Ganduling tablets in the perioperative period of splenectomy in Wilson's disease patients with splenomegaly and hypersplenism[J]. Journal of Clinical Hepatol, 2019, 35(3): 596-599. doi: 10.3969/j.issn.1001-5256.2019.03.028
[16]	赵漫丽, 陈怀珍. 肝豆灵片辅助治疗肝豆状核变性步态障碍痰瘀互结证60例临床观察[J]. 甘肃中医药大学学报, 2019, 36(1): 51-55. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZX201901011.htm ZHAO M L, CHEN H Z. Clinical observation on Gandouling Pian(肝豆灵片) in adjuvant treatment of 60 cases of Wilson's disease with symptoms of gait disorder and phlegm accumulating with stagnation[J]. Journal of Gansu University of Chinese Medicine, 2019, 36(1): 51-55. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZX201901011.htm
[17]	秦洛宜. 姜黄、莪术、郁金的化学成分与药理作用研究分析[J]. 临床研究, 2019, 27(2): 3-4. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN201902002.htm QIN L Y. Study on Chemical Constituents and pharmacological effects of Turmeric, Curcuma turmeric and Turmeric turmeric[J]. Clinical Research, 2019, 27(2): 3-4. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN201902002.htm
[18]	王飞, 刘建雄, 王明明, 等. 大黄提取物灌胃对脑梗死大鼠血脑屏障通透性的改善作用及其机制[J]. 山东医药, 2021, 61(9): 48-51. doi: 10.3969/j.issn.1002-266X.2021.09.012 WANG F, LIU J X, WANG M M, et al. Effect of rhubarb extract gavage on blood-brain barrier permeability in rats with cerebral infarction and its mechanism[J]. Shandong Medical Journal, 2021, 61(9): 48-51. doi: 10.3969/j.issn.1002-266X.2021.09.012
[19]	丁凡, 王拥军, 张岩. 丹参活性成分的药理作用和临床应用研究进展[J]. 中华中医药杂志, 2021, 36(2): 659-662. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202102009.htm DING F, WANG Y J, ZHANG Y. Advances in pharmacological action and clinical application of active components of Salvia miltiorrhiza[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36(2): 659-662. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202102009.htm
[20]	刘仰斌, 张志花. 鸡血藤提取物对脑缺血再灌注损伤大鼠ATP酶活性影响的实验研究[J]. 牡丹江医学院学报, 2017, 38(1): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB201701004.htm LIU Y B, ZHANG Z H. Effect of Suberect spatholobi extract on ATPase activity in rats with cerebral ischemia-reperfusion injury[J]. Journal of Mudanjiang Medical College, 2017, 38(1): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB201701004.htm
[21]	李淑娇, 王宇卿. HPLC-ABTS-DAD-Q-TOF/MS在线筛选黄连抗氧化活性物质[J]. 中国中药杂志, 2018, 43(12): 2570-2574. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY201812024.htm LI S J, WANG Y Q. HPLC-ABTS-DAD-Q-TOF/MS was used to screen the antioxidant substances of Coptis coptidis[J]. China Journal of Chinese Materia Medica, 2018, 43(12): 2570-2574. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY201812024.htm
[22]	方明珠, 尚德师, 陈代平. 茯苓泽泻汤合四逆散治疗后循环缺血性眩晕疗效及对患者血管内皮功能的影响[J]. 中国药物与临床, 2021, 21(18): 3120-3124. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202118023.htm FANG M Z, SHANG D S, CHEN D P. Effect of Fuling Zexie Decoction and Sini Powder in the treatment of ischemic vertigo in posterior circulation and its effect on vascular endothelial function[J]. Chinese Remedies & Clinics, 2021, 21(18): 3120-3124. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202118023.htm
[23]	阚桐, 王越, 王瑞刚. 金钱草提取物通过调控miR-129-5p表达对脑缺血再灌注大鼠脑损伤的保护作用[J]. 中国药师, 2021, 24(1): 12-15, 69. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYSG202101003.htm KAN T, WANG Y, WANG R G. The protective effect of extract of Rhizoma chinensis on brain injury in rats with cerebral ischemia-reperfusion by regulating Mir-129-5p expression[J]. China Pharmacist, 2021, 24(1): 12-15, 69. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYSG202101003.htm
[24]	江海林, 杨文明, 唐露露, 等. 肝豆灵片对Wilson病患者局部脑血流量的影响[J]. 中华中医药杂志, 2019, 34(10): 4974-4977. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201910140.htm JIANG H L, YANG W M, TANG L L, et al. Effect of Gandouling tablets on regional cerebral blood flow in patients with Wilson's disease[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2019, 34(10): 4974-4977. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201910140.htm