Clinical Study Of Dysarthria In Wilson Disease

Objective: ?Observe the occurrence of dysarthria in patients with Wilson 's disease(WD),and further analyze the related factors affecting dysarthria;?Observe the relationship between dysarthria and TCM syndromes in HLD patients;?To observe the clinical efficacy of Gandouling combined with speech training in patients with phlegm-stasis-associated HLD dysarthria and the changes of related indicators before and after treatment,providing more ideas and basis for Chinese medicine treatment of HLD.Methods: ?Collect and select 85 inpatients with HLD who meet the conditions for admission as the case group and 30 healthy people as the control group.The two groups of subjects were evaluated by the modified Frenchay Dyskinesia Rating Scale(FDA)and standard swallowing function assessment.The scales(SSA)and the unified HLD rating scale(UWDRS)were used to classify HLD patients in the case group,observe the occurrence of articulation disorders in the two groups of subjects,and further study the articulation disorders and Relationship between general conditions,dysphagia,severity of illness,and clinical classification of HLD.?Count the distribution of TCM syndromes in HLD patients,and further analyze the relationship between dysarthria and TLD syndromes in HLD patients.?Fifty-six HLD patients who met the enrollment criteria were selected,and the patients were divided into a control group treated with simple speech training and 28 patients treated with Gandouling combined with speech training according to the principle of randomized control.Both groups received Basic copper drainage treatment,8 days as a course of treatment,4 consecutive courses of treatment,observe the clinical efficacy and FDA scores,UWDRS scores,24 h urine copper,and TCM syndrome scores of the two groups before and after treatment.The reaction happened.Results: ?Occurrence of dysarthria in HLD: 53 of the 85 HLD patients had dysarthria,with an incidence of 62.35%,and 6 of the normal control group had dysarthria,the incidence was 20%.There was a significant difference(P<0.01);the FDA score of the HLD group was lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).?Related factors of dysphagia in HLD: The dysphagia of HLD patients is related to the severity of the disease and dysphagia(all P values are less than 0.01);it is related to the clinical classification of HLD.Among 85 HLD patients,There are 32 cases,30 cases,23 cases of liver type,mixed type,and 26 cases(81.25%),13 cases(43.33%),and 14 cases(60.86%)of patients with dysarthria.There was a significant difference between the three groups(P<0.01).The brain type patients had lower FDA scores than the liver and mixed types.There was a statistical difference between the three groups(P<0.05).After multiple comparisons,the brain and liver types were significantly different,Brain type and mixed type,the differences were statistically significant(P<0.01,P<0.05 respectively),and there was no significant difference between liver type and mixed type(P>0.05);compared with patients' age,course of disease,education No significant correlation was found between the degrees(P>0.05).?The relationship between articulation disorders of HLD and TCM syndrome types of HLD: 85 cases of HLD patients had TCM syndrome types,and articulation disorders occurred in HLD patients with different TCM syndrome types,of which 37 cases had phlegm and blood stasis.Of the patients with dysfunction syndrome,25 cases had dysphonia,the incidence rate was 67.57%;9 of the 18 patients with damp-heat syndrome had dysarthria,the incidence was 50.00%;14 patients with liver and kidney yin deficiency syndrome There were 6 cases with dysarthria,the incidence rate was 42.85%;6 of the 10 patients with spleen and kidney yang deficiency syndrome were associated with dysarthria,the incidence rate was 60.00%;2 of the 6 patients with liver qi stagnation syndrome were associated with There is dysarthria,the incidence is 33.33%.After comparison,there was no significant difference between the five syndrome types(P>0.05).?Changes of related indexes after liver and bean spirit treatment(1)Clinical efficacy: After treatment,the total effective rates of the two groups were 78.57% in the treatment group and 60.71% in the control group.Compared with the control group,the clinical effect of the treatment group was better than the control group,and the difference was statistically significant(P<0.05).(2)UWDRS score and FDA score: There was no significant difference in UWDRS and FDA scores between the two groups of patients before treatment(P>0.05).After treatment,the UWDRS and FDA scores of the two groups were significantly improved than before treatment,and the differences were statistically significant(P<0.01),and the improvement of UWDRS and FDA scores in the treatment group was more significant than that in the control group.(3)24h urinary copper: There was no significant difference in the 24 h urinary copper content between the two groups of patients before treatment(P>0.05).After treatment,the 24 h urinary copper content of the two groups was significantly higher than before and there was a significant difference(P<0.01).Compared with the control group,the 24 h urine copper in the treatment group increased more significantly(P<0.01).(4)TCM syndrome scores: There was no significant difference in TCM syndrome scores between the two groups of patients before treatment(P>0.05).After treatment,the TCM syndrome scores of the two groups of patients decreased,and the TCM syndrome scores of the treatment group were lower than those of the control group.Is obvious(P<0.01).(5)Observation of safety indicators and adverse reactions: The incidences of adverse reactions in the two groups were 10.71% and 17.85%,respectively,with no significant difference(P>0.05).Conclusion: ?HLD patients have a higher incidence of dysarthria and impairment of articulation function.Clinically,the ability to identify and diagnose early symptoms of patients should be strengthened,and the optimal treatment time should be grasped.?There is a correlation between articulation disorder and overall disease severity and dysphagia in HLD patients;it is related to the clinical classification of HLD;there is no obvious correlation with age,course of disease and years of education.?All TCM syndrome types in HLD patients are distributed,and patients with different TCM syndrome types have dysphagia,but there is no obvious relationship between the occurrence of dysarthria and HLD TCM syndrome types.?Gandouling can improve the symptoms of dysarthria in patients with phlegm-stasis-associated Wilson disease to a certain extent,and lower the FDA score,UWDRS score,and TCM symptom score.?Gandouling has the functions of promoting blood circulation,removing phlegm,dissolving sputum,and diuretic and removing copper,which can increase the 24-hour urine output of patients.The clinical effect of combined speech training is more obvious than that of the simple speech training group.