Investigation On The Correlation Between Hepatic Lipid Metabolism Disorder And TCM Syndrome Elements In Hepatolenticular Degeneration

Objective:(1)To observe the difference of lipid metabolism indexes between patients with Wilson disease and healthy people,and to analyze the possible pathological mechanism of lipid metabolism disorder in patients with Wilson,so as to improve the clinical understanding of lipid metabolism disorder in Wilson disease;(2)To observe the characteristics of TCM syndromes in patients with Wilson disease with lipid metabolism disorder,so as to provide relevant reference for the diagnosis and treatment of traditional Chinese and western medicine.Methods:(1)According to the established inclusion and exclusion criteria,120 patients with Wilson disease were collected as the experimental group.Dahwan score scale and Child-Pugh grading scale were used to score and grade the degree of liver function decline.According to the grading standard of Wilson disease,the patients were divided into brain type,liver type and mixed type.60 healthy people were taken as the control group.The levels of related indexes of lipid metabolism in the two groups were detected.To analyze the correlation between lipid metabolism disorder and age,sex,course of disease,degree of liver function decline and classification in patients with Wilson disease.(2)According to the level of lipid metabolism disorders,patients with Wilson disease were included in the lipid metabolism disorder group and the normal lipid metabolism group.According to the standard of syndrome differentiation of Wilson and the integral scale of TCM syndrome,the TCM syndrome type,location elements and disease elements of the patients were defined.Statistical analysis of TCM syndrome characteristics of the two groups.(1)Through statistical analysis,it was found that the levels of lipid metabolism related indexes(TC,TG,HDL-C,LDL-C,APO-A1,APO-B)in patients with Wilson disease were lower than those in the healthy control group.The incidence of lipid metabolism disorder was 40.8%(49/120),which was significantly higher than that in the healthy control group(6/60).There was significant difference between the two groups(P <0.05).(2)The analysis of factors related to lipid metabolism in patients with Wilson disease showed that the indexes related to lipid metabolism(TC,TG,HDL-C,LDL-C,APO-A1,APO-B)in patients with Wilson disease were not significantly correlated with the course of disease,sex and age,but were related to the degree of liver function decline and clinical classification.The more serious the patient’s impairment of liver function,the lower the level of lipid metabolism related indexes(TC,TG,HDL-C,LDL-C,APO-A1,APO-B).There was significant difference in the incidence of lipid metabolism among liver type,brain type and mixed type(P < 0.05).(3)In terms of the distribution of TCM syndrome types,the syndrome of combination of phlegm and blood stasis is the most common,accounting for 27.5%(33/120).The next were damp-heat internal accumulation syndrome,liver-kidney yin deficiency syndrome,liver-qi stagnation syndrome and spleen-kidney yang deficiency syndrome,accounting for 17.5%(19/120),15.8%(21/120)and 15.0%(16/120),respectively,but the distribution of syndrome types had nothing to do with the incidence of lipid metabolism disorders(P > 0.05).In the score of TCM syndrome factors,there was no statistical difference between the two groups(lipid metabolism disorder group and normal lipid metabolism group)in the investigation of the correlation(brain pulp,kidney,spleen)and pathogenic factors(phlegm turbid,internal dampness,blood stasis,yin deficiency,blood deficiency).However,the syndrome scores of the liver in the diseased position of the two groups were 17.84 ±3.47 and 15.55 ±4.81 respectively,and there was significant difference between the two groups(P < 0.05).(4)In the lipid metabolism disorder group,the distribution frequency of disease Results:elements was in descending order: liver(83.6%),brain pulp(71.4%),kidney(46.9%)and spleen(32.6%).The etiological factors were turbid phlegm(73.4%),blood stasis(59.8%),yin deficiency(42.8%),internal dampness(36.7%)and blood deficiency(32.6%).The distribution frequency of disease elements in the non-lipid metabolic disorder group was in descending order: brain marrow(60.5%),liver(53.5%),kidney(42.6%)and spleen(36.6%).The etiological and pathogenic factors were turbid phlegm(67.7%),blood stasis(64.7%),yin deficiency(50.7%),internal dampness(40.8%)and blood deficiency(28.1%).There was only significant difference in the distribution frequency of liver between the two groups(P < 0.05).Conclusions:(1)The incidence of lipid metabolism disorder in patients with Wilson was higher than that in healthy people,mainly with the decrease of related indexes(TC,TG,HDL-C,LDL-C,APO-A1,APO-B);(2)The disturbance of lipid metabolism in Wilson disease is related to the degree of liver function decline and clinical classification,but not to the course of disease,age and sex;(3)There is no correlation between the incidence of lipid metabolism disorders of Wilson disease and the distribution of TCM syndrome types;in syndrome factors,the most common disease site of Wilson disease patients with lipid metabolism disorder is liver,and the most common disease element of patients with normal lipid metabolism is brain;the most common etiological factor of both is turbid phlegm.