SWI Detection Of Brain Iron Content In WD Patients And Its Relationship With Neurological Function And TCM Syndrome

Objective:(1)SWI was used to detect the phase values of putamen,caudate nucleus,globus pallidus,thalamus,substantia nigra,red nucleus in WD patients(WD group)and healthy normal people(NC group),and to compare the differences in iron content of the above-mentioned nuclei.(2)To study the iron metabolism indexes of Wilson disease patients,including serum iron(SI),serum Ferritin,transferrin(Tf),24-hour urine iron,and try to explain the mechanism of abnormal iron metabolism in WD patients.(3)To compare the differences in iron content among different TCM syndromes in WD group,analyze the correlation between iron content in each nucleus and TCM syndrome factor score and the unified Wilson disease rating scale(neurological function score)in cerebral type WD group,and to evaluate the relationship between brain iron content and neurological function and TCM classification in WD patients.Methods: According to the inclusion and exclusion criteria,the subjects were divided into: 53 patients with WD who had not been treated by copper expulsion or who had not been treated with copper expulsion drugs in the past year(WD group),including 33 patients with cerebral type,20 patients with hepatic type,24 patients with syndrome of phlegm and blood stasis,17 patients with damp-heat smoldering;28 healthy normal control group(NC group),both groups had no statistical significance in age and gender Differences.Serum iron(SI),Ferritin,transferrin(Tf)and 24-hour urine iron were measured in all subjects.SWI technique was used to measure and compare the phase values of the above nuclei in all subjects,and to observe the content of brain iron in WD patients.The unified Wilson disease rating scale(neurological function score)was used to evaluate the neurological impairment of WD patients with cerebral type.The TCM syndrome type was determined by TCM syndrome factor rating scale,and the relationship between iron content of each nuclei and neurological function and TCM classification was analyzed.SPSS 24.0 was used for data analysis.Results:(1)Comparison of iron content in nuclei of NC group: The iron content of caudate nucleus on the left and right sides was significantly different(P< 0.01),the iron content of globus pallidus on the left and right sides was significantly different(P< 0.05),the iron content of other nuclei on the left and right sides has no statistical difference(P> 0.05).(2)Comparison of iron content in different nuclei of WD group: except the substantia nigra,the iron content of other nuclei on the left and right sides was significantly different(P< 0.01).(3)Comparison of iron content and iron metabolism index between WD group and NC group: There was significant difference between the two groups(P<0.01).There were significant differences in Ferritin and Tf between the two groups(P<0.01).There was no significant difference in SIi and 24-hour urinary iron(P> 0.05).(4)Comparison of iron content in nuclei of two subgroups of WD group and NC group: There was a significant difference in iron content between cerebral type WD and hepatic type WD(P< 0.01).There was no significant difference in iron content in the red nucleus between the hepatic WD group and the NC group(P>0.05),but there was significant difference in other nuclei(P<0.05).(5)Comparison of iron content among different TCM Types in WD group: There was significant difference in iron content of each nucleus between the damp-heat smoldering and the syndrome of phlegm and blood stasis(P< 0.05).(6)Correlation between neurological function score and iron content of each nucleus and factor score of TCM syndrome in cerebral type WD: Comparison of the neurological function score and iron content,there was a positive correlation between them.As follows: putamen(left: r= 0.491,P= 0.004;right:r=0.494,P= 0.003),globus pallidus(left: r= 0.487,P= 0.004;right: r= 0.508,P=0.003),head of caudate nucleus(left: r= 0.449,P= 0.009;right: r= 0.474,P= 0.005),thalamus(left: r= 0.414,P= 0.017,right: r= 0.447,P= 0.009),substantia nigra(left: r= 0.497,P= 0.003,right: r= 0.449,P= 0.009),red nucleus(left: r= 0.501,P= 0.004,right: r= 0.438,P= 0.011).It was also positively correlated with the factors of phlegm turbidity(r= 0.506,P= 0.019)and blood stasis(r= 0.594,P= 0.006),but not significantly correlated with internal humidity and internal heat(P> 0.05).Conclusions:(1)In addition to the copper metabolism disorder,WD patients also had significant iron metabolism abnormality.The disturbance of peripheral iron metabolism in WD patients may be related to the abnormal expression of related protein and the disorder of iron transport in vivo.Ferritin and TF can be used as the criteria of iron metabolism abnormality in WD.(2)Iron levels in the brain are elevated in WD patients.The iron content of brain could objectively evaluate the neurological impairment of WD patients.The asymmetry of its neurological symptoms may be related to the uneven distribution of iron content on the left and right sides of each nuclear mass(especially the basal ganglia region).(3)The accumulation of brain iron was more likely in WD with the syndrome of phlegm and blood stasis.Phlegm and blood stasis play an important role in the occurrence and development of WD nervous system symptoms.