Correlation Research Of Wilson's Disease Cognitive Impairment With TCM Syndrome Type And Intestinal Flora Changes

Objective: 1.Hepatolenticular degeneration?HLD?,also known as Wilson's disease?WD?,Through observing WD patients,according to their WD score scale?UWDS?,Montreal Cognitive Assessment?Mo CA?and other related scores,to screen patients with cognitive impairment and understand the correlation between WD cognitive impairment and TCM syndrome types by combining their TCM syndrome types.2.Through Mo CA score,the injury degree of 6 cognitive domains of WD cognitive impairment and the correlation between the severity of WD cognitive impairment and TCM syndromes were observed 3.The species and abundance of intestinal microorganisms in WD patients with cognitive impairment and WD patients without cognitive impairment were detected by high-throughput sequencing platform,and the correlation between cognitive impairment and intestinal microorganisms in WD patients was observed.To provide new ideas for the treatment of WD with cognitive impairment.Methods: 1.92 cases of WD patients were selected from the Department of Encephalopathy of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine according to the diagnostic criteria of WD cognitive impairment and the inclusion and exclusion criteria.According to the diagnostic criteria of WD traditional Chinese medicine syndrome types,they were classified,and the data were processed by statistical methods such as frequency and percentage to explore the correlation between WD cognitive impairment and TCM syndrome types.2.92 WD patients were divided into 6 cognitive domains according to Mo CA single score,including visual space and executive power,attention,language,abstraction,delayed recall,and directional power.The damage degree of 6 cognitive domains of WD cognitive impairment was observed.According to Mo CA score,the degree of cognitive abnormality is classified into mild,moderate and severe levels.According to the score of patients,frequency and percentage are used to explore the correlation between the severity of WD cognitive impairment and TCM syndromes.3.According to WD diagnostic criteria and inclusion and exclusion criteria,38 cases of WD patients with cognitive impairment and 32 cases of WD patients without cognitive impairment were selected as research objects from the Department of Encephalopathy,First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The two groups of patients were divided into WD cognitive group and WD control group.Stool samples of the two groups of patients were taken and analyzed by Polymerase Chain Reaction?PCR?and high-throughput sequencing to detect the types and abundance of intestinal microorganisms and observe the correlation between WD patients with cognitive impairment and intestinal microorganisms.Results: 1.In 92 cases of WD cognitive impairment,the proportion of patients with damp-heat accumulation,phlegm-blood stasis accumulation,liver-qi stagnation,liver-kidney yin deficiency and spleen-kidney yang deficiency were 25%?23/92?,40.22%?37/92?,8.69%?8/92?,11.96%?11/92?and 14.13%?13/92?,respectively.The results showed that the largest proportion of WD cognitive impairment patients was phlegm-blood stasis accumulation,followed by damp-heat accumulation;2.92 cases of WD patients with cognitive impairment have different degrees of damage in six cognitive domains,and there are differences in cognitive domains of different syndrome types of damage.Among them,attention damage is more in damp-heat accumulation syndrome,spleen-kidney yang deficiency syndrome,delayed memory,visual space and executive power damage are more in phlegm-blood stasis syndrome,language and abstract ability of liver-qi stagnation syndrome are more damaged,and delayed memory and directional power damage are more in liver-kidney yin deficiency syndrome.92 WD patients were divided into mild and moderate-severe levels according to the severity of cognitive impairment.After data statistics,it was found that the proportion of mild cognitive impairment in patients with damp-heat accumulation syndrome,phlegm-blood stasis syndrome,liver-qi stagnation syndrome,liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome was 26.09%,24.32%,50%,45.45% and 69.23%,respectively.The proportion of moderate-severe cognitive impairment was 73.91%,75.68%,%,54.55% and 30.77%,respectively.The results show that the severity of WD cognitive impairment is related to traditional Chinese medicine syndromes,with more moderate-severe cognitive impairment in patients with damp-heat accumulation syndrome and phlegm-blood stasis syndrome,and more mild cognitive impairment in patients with liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome;3.?1?After analyzing the samples of WD cognitive group and WD control group at domain level,P=0.01,the difference is statistically significant;?2?After comparing the relative abundance of two groups of samples at Phylum level,it is found that there are differences in flora between WD cognitive group and WD control group,among which there are significant differences in Firmicutes,Bacteroidetes,Proteobacterias and Actinobacterias.Moreover,we found that bacteroides and actinomycetes in WD cognitive group were significantly more than those in WD control group?P<0.001?,while chlamydomonas and Proteobacteria were significantly less than those in WD control group?P<0.001?;?3?After comparing the relative abundance of the two groups of samples at Family level,it was found that there were significant differences in flora between WD cognitive group and WD control group.The WD cognitive group includes Bacteroidaceae,Bifidobacteriaceae,Alcaligenaceae,Veillonellaceae,Lactobacillaceae,Porphyromonas,Rikenellaceae was significantly more than WD control group?P<0.001?.In WD cognitive group,Enterobacteriaceae,Lachnospiraceae,Ruminococcaceae,Prevotella,Streptococcaceae,Clostridiaceae 1,The number of Coriobacteriaceae and bacteroidae?Bacteroidales S24-7 group?was significantly lower than that of WD control group?P<0.01?;?4?After comparing the relative abundance of the two groups of samples at the Genus level,it is found that the flora of WD cognitive group is significantly different from that of WD control group.And WD cognitive group Bacteroides?bacteroides?,Bifidobacterium?bifidobacterium?,Lachnoclostridium,pallas' s bacteria?Parasutterella?,Lactobacillus?lactobacillus?,bacilli?Dialister?,lactococcus?ruminococus₂?,The number of Parabacteroides and Alistipes was significantly higher than that of WD control group?P<0.001?.In WD cognitive group,Klebsiella,Faecalibacterium,Prevotella-9,Streptococcus,Rectobacteria?[Eubacterium]_rectale_gro up?,Blaut's?Blautia?were significantly less than those in WD control group?P<0.001?.Conclusion: 1.According to the research of this topic,there is a correlation between WD with cognitive impairment and TCM syndromes of patients.Among them,cognitive impairment is the most common in patients with phlegm-blood stasis syndrome,followed by damp-heat accumulation syndrome;2.There is a correlation between the severity of 2.WD cognitive impairment and TCM syndromes.Among them,patients with damp-heat accumulation syndrome and phlegm-blood stasis syndrome have more moderate and severe cognitive impairment,while patients with liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome have more mild cognitive impairment;3.There is a correlation between WD cognitive impairment and intestinal flora.The abundance of flora in WD cognitive group is significantly different from that in WD control group at the level of phylum,family and genus.?1?At the phylum level,WD cognitive impairment is positively correlated with the abundance of bacteroides and actinomycetes,and negatively correlated with the abundance of chlamydomonas and Proteobacteria;?2?At the family level,WD cognitive impairment is positively correlated with the flora abundance of Bacteroideae,Bifidobacterium,Alcaligenes,Warrensis,Lactobacillaceae,Zidanaceae,and Physiologic,and negatively correlated with the flora abundance of Enterobacteriaceae,Molluscaceae,Lactococcus,Platycomycetes,Streptococcaceae,Clostridium,Corynebacterium,and Bacteroideae;?3?At the genus level,WD cognitive impairment is positively correlated with the flora abundance of Bacteroides,Bifidobacterium,Lachnoclostridium,pallas' s bacteria,Lactic acid bacteria,Microbacter,Lactococcus,Collins' s bacteria and other mycobacteria,and negatively correlated with the flora abundance of Klebsiella,Meconium,Prevost's bacteria,Streptococcus,Rectum and Blaut's bacteria.