The Characteristics Of Magnetic Resonance Spectroscopy In Wilson Disease With Cognitive Impairment And The Effect Of Gan Dou Ling On Wilson Disease With Cognitive Impairment

Objective Using MRS technical analysis the change of brain tissue metabolism patients with WD,and discusses characteristics of different types of MRS between patients with WD;To observe the effects of hepatic bean spirit after the intervention of MRS,evaluating hepatic bean spirit the clinical utility of WD cognitive dysfunction.Methods Have group of 60 patients with WD cognitive impairment and 30 patients with WD non cognitive impairment.To evaluate those 90 WD patients with MMSE,Mo CA and MRS testing whose interest area located in the bilateral hippocampus,hypothalamus and putamen.We measure metabolism density of N-b Phthalein-Nmda(NAA),Choline(Cho)and Creatine(Cr)in each area and calculate the corresponding ratio of NAA/Cr,Cho/Cr and NAA/Cho.Compare the differences of Metabolites ratio between group with WD disease and group without disease.Compare the differences of Metabolites ratio among group with WD cognitive dysfunction,group with WD non cognitive dysfunction and group without disease.60 patients with WD cognitive dysfunction are divided into two groups randomly,one is treatment group and the other one is control group.Using liver beans spirit combined with western medicine 2 thiol propyl sulfonic acid sodium(DMPS)to treat first group while DMPS to treat second group only.After6 treatment,once again,we analysis MRS and evaluate MMSE and Mo CA responding treatment group and control group.Compare the differences of metabolite ratio and rating scale before and after the treatment.Results1)In hippocampus area: compared with the healthy group,the NAA/Cr of WD group decrease,with significant difference statistically(P<0.01),the NAA/Cho,Cho/Cr no statistically significant difference(P>0.05).WD cognitive impairment group compared with the healthy group NAA/Cr,NAA/Cho,Cho/Cr are reduced,all have significant difference(P<0.01).WD cognitive deficits compare with non cognitive impairment group NAA/Cr and NAA/Cho are decreased,with significant difference statistically(P<0.01),Cho/Cr is no statistically significant difference(P>0.05).WD non cognitive impairment group compared with healthy group,NAA/Cr is reduced,with statistically significant difference(P<0.05),NAA/Cho and Cho/Cr are no significant difference statistically(P>0.05).Compared with before treatment,the NAA/Cr and Cho/Cr of group of Gan Dou Ling are increased,with significant difference statistically all(P<0.01),the NAA/Cho has no statistical significant change(P>0.05).After treatment,NAA/Cr of control group is increased,with statistically significant difference(P<0.05),changes of Cho/Cr and NAA/Cho has no statistical significance(P>0.05).Comparison between groups after treatment,compared with control group,the NAA/Cr and Cho/Cr of Gan Dou Ling group increased,with significant difference statistically(P<0.01),the NAA/Cho change has no statistical significance(P>0.05).2)In the thalamus area: WD group compared with healthy group,NAA/Cr and NAA/Cho are reduced,with significant difference statistically(P<0.01),Cho/Cr has no statistically significant difference(P>0.05).WD cognitive impairment group compared with healthy group,NAA/Cr and NAA/Cho decreased,with significant difference statistically all(P<0.01),Cho/Cr has no statistically significant difference(P>0.05).WD cognitive impairment group with and without cognitive impairment,lower than the NAA/Cr,NAA/Cho,with significant difference statistically(P<0.01),Cho/Cr has no statistically significant difference(P>0.05).WD non cognitive impairment group compared with the healthy group,NAA/Cr and NAA/Cho are reduced,with significant difference statistically(P<0.01),Cho/Cr has no statistically significant difference(P>0.05).Compared with before treatment,the NAA/Cr and NAA/Cho of Dan Dou Ling increased,with significant difference statistically(P<0.01),Cho/Cr change has no statistical significance(P>0.05).Control group after treatment of NAA/Cho increased,with statistically significant difference(P<0.05),the NAA/Cr and Cho/Cr change has no statistical significance(P>0.05).Comparison between groups after treatment,Dan Dou Ling group compared with control group the NAA/Cr and NAA/Cho increased,with significant difference statistically all(P<0.01),Cho/Cr change has no statistical significance(P>0.05)3)In the putamen area: WD group compared with healthy group,NAA/Cr and Cho/Cr are reduced,with significant difference statistically all(P<0.01),the NAA/Cho difference has no statistical significance(P>0.05).WD cognitive impairment group compared with healthy group,NAA/Cr,Cho/Cr and NAA/Cho decreased,with significant difference all(P<0.01).WD cognitive deficits and the cognitive impairment group comparison of NAA/Cr,Cho/Cr and NAA/Cho and reduce,with significant difference all(P<0.01).WD non cognitive impairment group compared with healthy group,NAA/Cr,Cho/Cr and NAA/Cho decreased,with significant difference all(P<0.01).Compared with treatment before,the NAA/Cr,Cho/Cr and NAA/Cho Gan Dou Ling group increased,with significant difference all(P<0.01).After treatment,NAA/Cr,Cho/Cr and NAA/Cho of control group change has no statistical significance(P>0.05).Comparison between groups after treatment,NAA/Cr and Cho/Cr of Gan Dou Ling group increased,with significant difference statistically(P<0.01),the NAA/Cho change has no statistical significance(P>0.05).4)Compared with before treatment,the treatment group can improve cognitive impairment in patients with WD Mo CA scores(P<0.01),MMSE score before and after treatment no significant statistical difference(P>0.05);The control group before and after treatment MMSE score and Mo CA scores change has no statistical significance(P>0.05).Conclusion1)Compared with healthy subjects,the brain metabolite levels of WD patients in lateral hypothalamus,hippocampus and putamen have different degrees of lower,which reduced with NAA/Cr is most obvious.Compared with the hypothalamus and hippocampus,putamen area had the lowest levels of metabolites,which means the most serious neurons damage in this area.2)Compared with WD patients with non cognitive dysfunction,The brain metabolite levels of WD patients with cognitive impairment in the hypothalamus,hippocampus and putamenreduced reduced to some extent,to the most obvious characteristics with NAA/Cr.That means the damage of neurons in WD patients with cognitive impairment is more serious than one of WD patients with non cognitive dysfunction.3)Compared with the traditional western medicine,Gan Dou Ling with DMPS can improve cognitive function in patients with WD.