Clinical Study On The Effect Of Gantou Decoction Combined With DMPS On Gallbladder Systolic Function In Patients With Damp-heat Intrinsic Wilson's Disease

Objectives:?1?To observe the changes of cholecystokinin?CCK?,vasoactive intestinal peptide?VIP?,somatostatin?SS?,gallbladder color Doppler ultrasonography,24h urine copper and liver function in patients with damp-heat WD,and to explore whether there is any gallbladder contractile dysfunction in this type of patients.?2?To study the effect of Gantou decoction combined with DMPS on gallbladder contractile function,to evaluate its clinical efficacy and drug safety,and to explore the role of gallbladder contractile function in bile copper excretion.To provide a new theoretical basis for the clinical treatment of damp-heat intrinsic WD.Methods:?1?On the basis of inclusion and exclusion criteria,shedding and elimination criteria,60 cases of WD were collected and randomly divided into control group?n=30?and treatment group?n=30?.20 physical examiners were randomly selected as health group,and the sex of the three groups was compared.There was no significant difference in age,but there was no significant difference in the course of disease between the control group and the treatment group.?2?The control group was treated with Gantou decoction combined with DMPS,for 4consecutive courses of treatment?6 days in each course,2 days interval?and followed up for 1 week.The gallbladder contractile function indexes such as CCK,VIP,SS,gallbladder color Doppler were observed in the three groups.The changes of clinical curative effect,TCM syndrome score,UWDRS score,24 h urine copper,liver function index,clinical safety index and adverse reaction were observed before and after treatment in the treatment group and the control group.Results:?1?Analysis of gallbladder systolic function in patients with WD:1)Serological indexes:compared with the healthy group,the CCK,VIP,SS value of WD patients was significantly higher than that of the healthy group,and the difference was very significant?P<0.01?.2)Gallbladder color Doppler:compared with healthy group,fasting gallbladder volume?V0?and postprandial gallbladder volume?V1?of WD patients were significantly increased,while gallbladder emptying index?GBEF%?was significantly decreased.The difference was statistically significant?P<0.05?.?2?Analysis of clinical curative effect index of Gantou decoction combined with DMPS:1)Evaluation of Therapeutic effect of TCM Syndromes:The total effective rate was93.33%in the treatment group and 86.67%in the control group.There was significant difference between the two groups?P<0.05?.2)Changes of TCM Syndrome integral:In the treatment group,the scores at the end of two courses and the end of four courses were significantly different from those before treatment?P<0.01?,and the symptom score of the end of treatment was significantly lower than that of before treatment?P<0.01?.In the control group,there was a significant difference in the scores at the end of two courses of treatment and before treatment?P<0.05?,and there was a significant difference in the scores of four courses of treatment and before treatment?P<0.01?.There was no significant difference between the two groups at the end of the course of treatment?P>0.05?,but there was a significant difference in the scores of TCM symptoms between the two groups at the end of the course of treatment?P<0.05?.3)UWDRS score:compared with the control group,the scores at the end of two courses of treatment were significantly lower in the treatment group than in the control group,and there was significant difference between the treatment group and the control group?P<0.05?.4There was significant difference between the end of treatment and pre-treatment?P<0.01?,and there was significant difference between the end of treatment and the end of 2 courses of treatment?P<0.05?.Compared with the control group,the therapeutic effect of the treatment group was better than that of the control group?P<0.05?.The degree of decrease in the treatment group was higher than that in the control group?P<0.05?.4)Serological indexes:?1?CCK:there was significant difference between the two groups before and after treatment?P<0.05?,but there was no difference in the control group?P>0.05?.There was significant difference in CCK value between the two groups after treatment?P<0.05?,and the degree of decrease in the treatment group was more obvious than that in the control group.?2?VIP value:in the two groups,the value of VIP decreased after treatment compared with that before treatment,and there was no significant difference between the two groups?P<0.05?.The difference was statistically significant?P<0.05?.There was a significant difference in VIP between the two groups after treatment?P<0.05?.?3?SS value:two groups had a significant difference after treatment?P<0.05?.There was a significant difference in SS value after treatment?P<0.05?,and there was a significant decrease in the two groups before and after treatment?P<0.05?,and there was a significant difference between the two groups before and after treatment?P<0.05?,and there was a significant difference between the two groups?P<0.05?.5)Gallbladder color Doppler index:?1?V₀:There was significant differences between the two groups?P<0.05?.?2?V₁:There was significant difference between the two groups before and after treatment?P<0.01?,and there was significant difference between the control group and the control group?P<0.05?.There was significant difference between the two groups after treatment?P<0.05?,and the decrease in the treatment group was more obvious than that in the control group.?3?GBEF%:There was significant difference between the two groups before and after treatment?P<0.01?and in the control group?P<0.05?,and there was significant difference between the two groups after treatment?P<0.01?.6)24-hour urine copper value:At the end of the fourth course of treatment,the 24-hour urinary copper level in the two groups was significantly higher than that in the same group?P<0.05?,but there was no significant difference between the two groups?P>0.05?.7)Liver function:?1?AST:the AST value of the two groups after treatment was higher than that of the same group before treatment,the difference was significant?P<0.05?.There was a significant difference between the two groups?P<0.05?.?2?ALT:The ALT value of the two groups after treatment was significantly higher than that of the same group before treatment?P<0.05?,and there was significant difference between the two groups?P<0.05?.?3?TBIL:After treatment,the TBIL value of the two groups was significantly lower than that of the same group before treatment?P<0.05?,but there was no significant difference between the two groups?P>0.05?.8)Safety:before and after treatment,there was no significant difference in each safety index between the two groups?P>0.05?,and there was no significant difference in adverse reactions between the two groups?P>0.05?.Conclusion:?1?There was a degree of gallbladder contractile dysfunction in the patients with damp-heat intrinsic WD.?2?Combined with DMPS,the combined DMPS can improve the clinical symptoms of the traditional Chinese medicine in the patients with damp-heat,effectively reduce the relevant indexes of the gallbladder contraction function such as CCK,VIP,SS,and gallbladder emptying index,and relieve the function of the nervous system and the mental symptoms in the WD patients,and improve the liver function of the patients.?3?Gantou decoction combined with DMPS is safe,and the overall curative effect is better than that of DMPS,alone in the clinical treatment of damp-heat intrinsic Wilson disease.