Study On Bone Metabolism Disorder And Chinese Medicine Intervention In Hepatolenticular Degeneration Based On The Theory Of "Evil Liver And Kidney"

Objective:To collect the basic clinical data of patients with bone metabolic disorders in WD and observe the effects of the prescriptions of invigorating liver and kidney and eliminating pathogens and removing copper on bone mineral density,24-hour urine copper,UWDRS score,TCM syndrome score,biochemical indicators of bone metabolism?blood calcium,phosphorus,parathyroid hormone,1,25-?OH?₂D₃,BGP,BAP,NTX-1?and cytokines of patients with bone metabolic disorders in WD.Influences of sub-indicators?IL-4,IL-6,IL-10,TNF-?,IGF-1?on bone metabolism in WD were investigated.Method:1.The course of disease,TCM classification,clinical classification and clinical manifestations of 160 WD patients with bone metabolic disorders were collected and recorded in detail.2.Sixty healthy volunteers were all from the physical examination center of our hospital.The bone mineral density,bone metabolism biochemical indexes?blood calcium,blood phosphorus,parathyroid hormone,1,25-?OH?₂D₃,BGP,BAP,NTX-1?and cytokine indexes?IL-4,IL-6,IL-10,TNF-?,IGF-1?were compared between the two groups.3.160 WD patients with bone metabolic disorders matched by age,sex,course of disease and BMI were randomly divided into basic treatment group and traditional Chinese medicine group with 80 cases in each group.Among them,2 cases in the traditional Chinese medicine group withdraw from the treatment halfway.Both groups were treated with routine treatment of removing copper and calcium.The traditional Chinese medicine group was given supplementary prescriptions of tonifying liver and kidney and removing pathogens and removing copper on the basis of the basic treatment group.The above indexes were observed before and after four courses of treatment in the two groups.24 hours urinary copper,UWDRS score,TCM syndrome score changes.Result:1.WD patients with bone metabolism disorder may have different degrees of bone and joint damage in the course of disease,and may also have symptoms of bone and joint onset.The degree of abnormal bone mineral density varies.2.Compared with healthy group,the bone mineral density of WD patients with bone metabolic disorder was abnormal in varying degrees,and their serum BGP,BAP and NTX-1 levels were higher than those of healthy group?P<0.01?;1,25-?OH?₂vitD₃,PTH,blood calcium were significantly lower than those of healthy group?P<0.01?,blood phosphorus was not significant?P>0.05?;IL-4,IL-6,IL-10,TNF-?were higher than those of healthy group?P<0.01?,and IGF-1 was lower than those of normal group?P<0.01?.3.The bone mineral density of WD patients in the basic treatment group and the traditional Chinese medicine group improved in varying degrees,but there was no statistical significance?P>0.05?.The levels of BGP,BAP,NTX-1,IL-4,IL-6,IL-10 and TNF-?in the traditional Chinese medicine group decreased,while the levels of1,25-?OH?₂D₃,PTH,blood Ca and IGF-1 increased?P<0.01?,and there were significant differences between the two groups after treatment?P<0.01?.At the same time,the24-hour urinary copper,UWDRS score and TCM syndrome score in the TCM group were significantly improved,compared with the basic treatment group,the difference was statistically significant?P<0.01?.Conclusion:1.Bone mineral density?BMD?of WD patients was impaired to varying degrees.The course of WD patients may be accompanied by joint pain,deformity,fatigue and other symptoms,or the symptoms of osteoarthritis were occult onset,and the related indicators of bone metabolism were abnormal to varying degrees.2.The empirical prescription based on the theory of"evil Fu liver and kidney"can promote the excretion of copper in urine of WD patients,reduce UWDRS score and TCM syndrome score.The combined use of empirical prescription and calcium can effectively improve serum biochemical bone turnover indexes?blood Ca,BGP,BAP,NTX-1,1,25-?OH?₂vitD₃,PTH?and cytokine indexes?IL-4,IL-6,IL-10,TNF-??.The level of alpha and IGF-1 is better than that of calcium supplementation alone.The mechanism of improving bone metabolism disorder of WD by empirical prescription may be related to the improvement of WD condition and the regulation of bone metabolism function.