| Objectives:(1)To observe the impairment of executive function in patients with hepatolenticular degeneration;(2)To observe the correlation between executive dysfunction and TCM syndromes in patients with hepatolenticular degeneration;(3)To observe the clinical efficacy and changes of corresponding indexes of ganduling tablets in the treatment of executive function impairment in patients with hepatolenticular degeneration with phlegm and blood stasis.It provides a new basis for the understanding and treatment of WD with traditional Chinese medicine,and a new research idea for the treatment of WD with traditional Chinese medicine.Methods:(1)WD patients 90 and healthy subjects 30 who met the inclusion criteria from January 2017 to October 2018 were selected as the research objects.All the subjects were evaluated for their executive functions through the executive function scale(BADS)to explore the impairment of the executive functions of WD patients.The basic data of all subjects,WD patients' rating scale and clinical classification were statistically analyzed to study the relationship between executive dysfunction and these related factors.(2)According to the evaluation results of the WD patients' executive function scale involved in the study,the patients were divided into the executive function disorder group and the non-executive function disorder group.Syndrome differentiation and classification were carried out by observing,hearing,asking and cutting,respectively,so as to further study the incidence of executive function disorder in patients with various syndromes.(3)Hospitalized patients who met the inclusion criteria were randomly divided into treatment group and control group,with 30 patients in each group.The control group was treated with DMPS.On the basis of the control group,the treatment group was treated with gandouling tablets for 4 consecutive courses.The total clinical efficacy,TCM syndrome score,WD rating scale(UWDRS),behavioral rating scale(BADS),blood HCY,24 h copper urine and adverse reactions were observed and compared between the two groups before and at the end of 4 treatment courses,respectively.Results:(1)according to the BADS evaluation of the two groups of subjects,55 people in WD group had executive dysfunction,with a incidence of 61.11%.There were 8 patients with executive dysfunction in the health examination group,with a incidence of 26.67%.WD group was significantly different from the healthy group(P<0.01).(2)the WD executive function of the related factors analysis showed that WD cases of executive function score and age,sex,course of the disease,not depression,associated with the severity of the disease,clinical classification,cerebral type,liver group and mixed group is statistically significant(P < 0.05),of which the execution of a function in patients with cerebral damage is most obvious.(3)in terms of TCM syndrome differentiation,all syndromes of WD patients had executive dysfunction,including 42 cases of phlegm and blood stasis syndrome(45.56%),24 cases of damp-heat intrinsic syndrome(27.78%),12 cases of liver-kidney Yin deficiency(13.33%),7 cases of liver-qi stagnation syndrome(7.78%),and 5 cases of spleen-kidney Yang deficiency(5.56%).The incidence of executive dysfunction was 65.85% in WD patients with phlegm and blood stasis.The incidence of executive dysfunction in WD patients with dampness-heat intrinsic type was 56%.The incidence of executive dysfunction was 58.33% in WD patients with liver-kidney Yin deficiency.The incidence of executive dysfunction was 42.86% in WD patients with liver-qi stagnation type.In WD patients with spleen-kidney Yang deficiency,the incidence of executive dysfunction was 80%.The difference in the incidence of executive dysfunction in WD TCM syndromes was tested by chi-square test,P>0.05,without statistical significance.Therefore,the distribution of TCM syndromes may not be related to the incidence of executive dysfunction.(4)clinical studies show that:(1)clinical effective rate: after 4 courses of treatment,the effective rate of the two groups of patients was about 90.00%,including 10 cases of significant effect,17 cases of effective,3 cases of ineffective,0 cases of deterioration;The effective rate was about 60% in the control group,including 2 cases of deterioration,10 cases of inefficacy,12 cases of effectiveness,and 6 cases of significant effect.The difference of P less than 0.05 is statistically significant.(2)UWDRS scores: there was no significant difference between the two groups before treatment(P>0.05).Compared with the group before treatment,the UWDRS scores of the two groups after treatment were all decreased,which was significantly lower in the treatment group,and the difference was statistically significant,among which the treatment group(P<0.01)and the control group(P<0.05).After treatment,the UWDRS score in the treatment group was significantly lower than that in the control group(P<0.05),indicating that the UWDRS score in the treatment group was significantly better than that in the control group.(3)Comparison results of TCM syndrome points: before treatment,there was no significant difference in syndrome points between the two groups(P>0.05);Compared with the group before treatment,the difference between the control group(P<0.05)and the treatment group(P<0.01)after treatment was statistically significant.Compared with the control group,the improvement in the treatment group was more significant(P<0.05).It can be seen that the clinical efficacy of the treatment group in improving TCM syndrome points is more obvious than that of the control group.(4)Comparison of BADS score: there was no significant difference in the executive function score(BADS score)between the two groups before treatment(P>0.05).After treatment,BADS scores of the two groups were improved,and the difference between the treatment group and the control group was statistically significant(P<0.01),while that between the two groups was not statistically significant(P>0.05).After treatment,BADS scores in the treatment group were significantly different from those in the control group(P<0.01).(5)Comparison of urine copper value at 24h: before treatment,there was no significant difference between the two groups in 24 h urine copper value(P>0.05).Compared with the group before treatment,the 24 h urine copper in the two groups after treatment had a significant increase(P <0.01),with a very significant difference.After treatment,the urine copper value in the treatment group was significantly higher than that in the control group(P<0.01).(6)Comparison of homocysteine levels: before treatment,there was no statistically significant difference in HCY levels between the two groups(P>0.05).Compared with the same group before treatment,the reduction in the treatment group after treatment was extremely significant(P<0.01),while that in the control group(P<0.05).There were significant differences between the two groups after treatment(P<0.01).(7)adverse reactions: the incidence of adverse reactions in the control group was 43.33%,the incidence of adverse reactions in the treatment group was 16.67%,the difference between the two groups was statistically significant(P<0.05),relative to western medicine,Chinese medicine ganduling tablets can reduce the occurrence of adverse reactions to a certain extent.Conclusion: 1.WD patients have some degree of executive function dysfunction,and its incidence rate is higher than that of healthy people.2.WD executive function disorder is related to clinical classification and severity of disease,while brain type and/or patients with severe disease have more obvious executive function disorder,which has nothing to do with age,gender,disease course and depression.3.There is no obvious relationship between WD syndrome and executive dysfunction.4.The combination of ganduolin tablet and western medicine is better than western medicine in improving clinical efficacy,executive function score,TCM syndrome score and serum Hcy,providing a new therapeutic idea for Wilson disease combined with clinical intervention of executive dysfunction.5.Gandouling tablets have good drug safety. |
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