| Objective:(1)To observe the changes of early renal injury indexes in patients with Dampheat intrinsic Wilson’s disease and explore the effects of Gandou Decoction on e arly renal injury indexes in patients with Damp-heat intrinsic Wilson’s disease: se rum cystatin C(Cys C),urinary albumin creatinine ratio(UACR),urinary immuno globulin(UIg G),urinary transferrin(UTRF),urinary microalbumin(Um Alb),urinary beta2-microglobulin(Ubeta2-MG),Ualpha1-microglobulin(Ualpha1-MG),urinary N-ace tyl-beta-D-glucosaminidase(UNAG),urinary retinol binding protein(URBP);(2)To evaluate the effect of Gandou Decoction on the indexes of early kidney i njury,total clinical efficacy and TCM syndrome score of damp-heat intrinsic Wil son disease,and to evaluate the clinical efficacy and safety.Method:(1)80 patients with Damp-heat intrinsic Wilson’s disease and 40 health examinee s were selected as the subjects in this clinical experiment.80 patients with Dam p-heat intrinsic Wilson’s disease were divided into control group and treatment gr oup with 40 cases in each.The control group was given low copper diet and li ver protection treatment,and DMPS injection 20 mg/kg intravenous drip once a day for 6 days,intermittently for 2 days,to supplement calcium,iron and other elements,a total of 8 days in a course of treatment;the treatment group was gi ven oral Chinese medicine decoction on the basis of the treatment of the control group;80 patients with Damp-heat intrinsic Wilson disease before treatment and40 healthy check-up patients were observed for early kidney injury indicators an d six courses after treatment in the control group,the treatment group for early kidney injury indicators,clinical efficacy,TCM syndrome scores and other indica tors,to evaluate the effect of Gandou Decoction on early kidney injury indicators.Clinical effect of early kidney injury in damp-heat intrinsic Wilson disease.(2)Using SPSS 21.0 analyses data,normal data to express (?) ±s format,Two indepe ndent samples were used for t-test for data comparison,and chi-square test was used for data analysis.Graph Pad Prism V6.0 software is used for drawing.Result:(1)Indicators of early renal injury Compared with the physical examination group,the early renal injury indicators of Wilson’s disease serum cystatin C(Cys C),urinary albumin creatinine ratio(U ACR),urinary immunoglobulin(UIg G),urinary transferrin(UTRF),urinary micro albumin(Um Alb),beta2-microglobulin(Ubeta2-MG),urinary alpha 1-microglobulin(U alpha1-MG),urinary N-acetyl-beta-D-aminoglycosidase(UNAG),urinary retinol bi nding protein(URBB)were significantly higher than that in the physical examina tion group(P < 0.01),suggesting that early kidney injury existed in patients wit h Damp-heat intrinsic Wilson disease.(2)The influence of early renal injury index After 6 courses of treatment,serum cystatin C(Cys C),urinary albumin creatinine ratio(UACR),urinary immunoglobulin(UIg G),urinary microalbumin(Um Alb),urinary beta 2 microglobulin(Ubeta 2-MG),urinary alpha 1 microglobulin(Ualp ha 1-MG),urinary retinol binding protein(URBP)in both groups decreased signi ficantly(P < 0.01),and the treatment group decreased more significantly than th e control group(P < 0.01).Urinary transferrin(UTRF),urinary N-acetyl-beta-D-g lucosaminidase(UNAG)were not significantly decreased(P > 0.05),and there w as no significant difference between the treatment group and the control group(P > 0.05).(3)Total clinical efficacy index of two groups After 6 courses of treatment,the total effective rate of the treatment group was92.50% and that of the control group was 76.92%(P < 0.05),which showed that the total clinical effect of the treatment group was significantly better than that of the control group.(4)Two groups of scale indicators1)TCM Syndrome Scale: before treatment,the integral value of TCM syndromes in treatment group and control group was compared(P > 0.05);after 6 courses of treatment,the integral value of both groups decreased(P < 0.01),and the tr eatment group decreased more significantly than the control group(P < 0.01).2)Unified Wilson Disease Score III(UWDRS-III): Before treatment,the scores of UWDRS-III in the treatment group and the control group were compared(P> 0.05);after 6 courses of treatment,the scores of the two groups were decrea sed(P < 0.01),and the decrease of the treatment group was more obvious than that of the control group(P < 0.01).(5)24-hour urinary copper index Urine copper in treatment group and control group increased significantly 24 hou rs after treatment(P < 0.01)and 24 hours after treatment(P < 0.01)and 24 ho urs after treatment(P < 0.01)in treatment group and control group.Urine coppe r in treatment group increased more significantly than that in control group after4 courses(P < 0.01),but it was lower than that in 2 courses(P < 0.01),and the increase in treatment group was more obvious than that in control group afte r 6 courses(P < 0.01).Urinary copper increased slightly in 24 hours(P < 0.01),compared with the control group(P > 0.05).The study showed that urinary co pper level increased first,then decreased,and then gradually stabilized.The effec t of copper excretion in the treatment group was more obvious than that in the control group in 2 and 4 courses.(6)Safety indicators1)Blood routine: WBC,RBC and PLT in the two groups were compared before treatment(P > 0.05);WBC,RBC and PLT in the treatment group decreased sli ghtly after 6 courses of treatment(P > 0.05),while WBC,RBC and PLT in the control group decreased significantly(P < 0.05);the study showed that GDT co mbined with DMPS had no significant effect on blood routine,and DMPS alone could reduce the side effects of blood routine three-lineage cells.2)Liver and kidney function: ALT,AST,BUN and Scr of the two groups befor e treatment were compared(P > 0.05);ALT and AST of the two groups after 6courses of treatment were all decreased(P < 0.01),but the treatment group wa s more significantly reduced(P < 0.01);BUN and Scr of the two groups after6 courses of treatment were slightly decreased(P > 0.05),but there was no stati stical significance;the study showed that GDT had little effect on renal function,and might have little effect on renal function in early renal injury.The change of damage index was not obvious.(7)Adverse reactions The incidence of fever,rash,nausea and poor appetite was 7.50% in the treatme nt group and 25.64% in the control group(P < 0.05),which indicated that GDT could reduce the incidence of adverse reactions.Conclusion:(1)There is a certain degree of early renal injury in patients with Damp-heat int rinsic Wilson disease.(2)GDT combined with DMPS can improve the early renal injury index of Wils on’s disease,increase 24 hours urinary copper and is superior to DMPS alone.(3)GDT combined with DMPS can improve the total clinical efficacy of patient s with Damp-heat intrinsic Wilson disease,improve TCM syndrome score and U WDRS-III neurological symptom score,and is superior to DMPS alone,with goo d safety and less adverse reactions. |
