The Effect Of Gandou Decoction With Modification On Bile Acid,Lipid Metabolism And Intestinal Flora In Patients With Hepatolenticular Degeneration Of Damp Heat Internal Type

Objective:To observe the effect of Gandou Decoction with modification on bile acid,lipid metabolism and intestinal flora in patients with hepatolenticular degeneration of damp heat internal type;to explore the relationship between dyslipidemia,intestinal flora and serum bile acid in patients with hepatolenticular degeneration(HLD);by studying the clinical effect and safety of HLD to further evaluate the clinical application prospect of Gandou Decoction with modification.Methods:60 patients with HLD which is consistent with case internalized standard were divided into the treatment group and the control group randomly,each group was included in 30 cases,and randomly selected 30 healthy subjects in the physical examination center for comparison.The control group was treated with DMPS and basic copper removing therapy schemes,while the treatment group was treated with Gandou Decoction with Modification on the basis of the control group.The treatment scheme was carried out for four courses of 32 days.At the beginning of the treatment scheme and the end of the fourth course,the changes of TCM syndrome integral table,intestinal flora,blood lipid,serum bile acid,liver function and 24 h urine copper were compared and statistically analyzed.Results:⑴Total clinical effective rate:after 4 courses of treatment,the total effective rate of the treatment group was 90.0%;the total clinical effective rate of the control group was66.7%;the therapeutic effect of the treatment group was better than that of the control group(p<0.05).⑵ The total score of TCM syndrome in the treatment group and the control group decreased significantly after treatment(P<0.05),and that in the treatment group decreased more significantly(P<0.01).⑶Main liver enzymes comparison:the main liver enzymes of the treatment group and the control group after four courses of treatment were significantly improved(P<0.01),and the liver enzyme of the treatment group decreased more significantly at the end of four courses of treatment(P<0.05).⑷The serum total bile acid of the treatment group and the control group was higher than that of the healthy group before treatment(P<0.01).After four courses of treatment,the serum bile acid of the treatment group and the control group decreased,but the decrease of the treatment group was more obvious(P<0.01).⑸ Intestinal microflora comparison:before treatment,the Enterobacteriaceae and Enterococcus in the treatment group and the control group were higher than those in the healthy group(P<0.01),while the Lactobacillus,Bacteroides and Bifidobacterium in the treatment group were lower than those in the healthy group(P<0.01).After four courses of treatment,the Lactobacillus,Bacteroides and Bifidobacterium in the treatment group were all increased,while the Enterobacteriaceae and Enterococcus in the control group were all decreased(P<0.01).The intestinal microflora in the control group was not significantly higher than that before treatment the difference(P>0.05).⑹ Comparison of serum lipid:after 4 courses of treatment,compared with before treatment,TC,TG and LDL-C in the two groups were all decreased(P<0.01),HDL-C was increased,HDL-C in the treatment group was significantly increased(P<0.01),but there was no statistical significance in the control group(P>0.05),TC,TG and LDL-C in the treatment group were significantly decreased(P<0.05).⑺24-hour urine copper comparison:after two courses of treatment,24-hour urine copper in the treatment group and the control group increased(P<0.01),but there was no statistical significance between the two groups;after four courses of treatment,24-hour urine copper in the two groups increased more than before,and the increase in the treatment group was greater(P<0.05).Conclusion:(1)The patients with damp heat internal type and abnormal lipid metabolism hepatolenticular degeneration have the disorder of intestinal flora and bile acid metabolism;Gandou Decoction with modification can correct the abnormal lipid metabolism and regulate the imbalance of intestinal flora and bile acid metabolism in patients with hepatolenticular degeneration.(2)The pathogenesis of abnormal lipid metabolism in hepatolenticular degeneration patients may be multi-layered,which may be related to excessive copper deposition in liver,intestinal flora disorders,bile acid metabolism abnormalities,etc.(3)Gandou Decoction with modification Combined with basic copper removing treatment can improve the syndrome of traditional Chinese medicine in patients with hepatolenticular degeneration,the copper removing effect is good and the safety is high,which is worth further discussion.