Clinical Study On The Effect Of Gandouling Combined With Repetitive Transcranial Magnetic Stimulation On The Depressive Disorder Of Hepatolenticular Degeneration

Objective: To evaluate the clinical efficacy and safety of the Repeated transcranial magnetic stimulation(rTMS)and gandouling combined with rTMS on depressive disorder of Wilson disease,TCM syndrome score,Unified Wilson's Disease Rating Scale(UWDRS),Hamilton Depression Scale(HAMD),Self-Rating Depression Scale(SDS),24-hour urine copper,Treatment emergent symptom scale(TESS),and changes of homocysteine(HCY)and C-reactive protein(CRP)levels were measured.Methods:(1)94 WD patients who meet diagnostic criteria were randomly divided into three groups:the gandouling treatment group(31 cases),the rTMS treatment group(31 cases)and gandouling combined with rTMS group(the combined treatment group)(32 cases).During the treatment,1 case was removed from the gandouling treatment group,1 case was removed from rTMS treatment group,2 cases were removed from the combined treatment group.90 cases were finally enrolled into 3 group,30 cases in each group.The gandouling treatment group was treated with gandouling,the rTMS treatment group was treated with rTMS,and the combined treatment group was treated with gandouling and rTMS.Meanwhile,the three groups were treated with DMPS for six consecutive courses(48 days).(2)TCM syndrome score,UWDRS,HAMD,SDS,24 h urine copper,Tess,HCY and CRP levels were measured before and after treatment.Results:(1)TCM syndrome effect:the TCM syndrome scores of the combined treatment group and the ganduoling treatment group were both lower than those before treatment(P<0.01),indicating that the TCM syndrome scores of the two groups were improved.The TCM syndrome score of the combined treatment group was significantly lower than that of the gandouling treatment group(P<0.01),and the effective rate of the combined treatment group was significantly higher than that of the gandouling treatment group(P<0.05),indicating that the effect of the combined treatment group on improving TCM Syndrome score was better than that of the gandouling treatment group.(2)UWDRS:the UWDRS scores of the three groups were lower than that before treatment(P<0.01),indicating that the UWDRS scores of the three groups were improved.The UWDRS score of the combined treatment group was significantly lower than that of the gandouling treatment group and the rTMS treatment group(P<0.01),indicating that the effect of the combined treatment group on improving the UWDRS score was better than that of the other two groups.(3)HAMD total score and efficacy:the HAMD total scores of three groups were lower than that before treatment(P<0.01),indicating that the HAMD total scores of the three groups were improved.The HAMD total score of the combined treatment group was significantly lower than that of the gandouling treatment group and the rTMS treatment group(P<0.01),and the total effective rate of the combined treatment group was higher than that of the other two groups,indicating that the combined treatment group was better than the other two groups in reducing the score of HAMD scale.(4)HAMD factors:the expression levels of anxiety/somatization factor,sleep disorder factor,retardation factor,cognitive disorder factor and despair factor were significant differences between before and after treatment(P<0.01).Comparison of two groups after treatment:(1)The expression levels of anxiety/somatization factor,sleep disorder factor,retardation factor and cognitive disorder factor were significant differences between the combined treatment group and the gandouling treatment group(P<0.01);(2)The expression level of anxiety/somatization factor was significant differences between the combined treatment group and the rTMS treatment group(P<0.01);The expression levels of sleep disorder factor,retardation factor and cognitive disorder factor were significant differences between the combined treatment group and the rTMS treatment group(P<0.05);(3)There was no significant difference between the gandouling treatment group and the rTMS treatment group(P>0.05).(5)SDS:the SDS scores of the three groups after treatment were lower than those before treatment(P<0.01).The SDS scores of the combined treatment group after treatment were significantly lower than those of the ganduoling treatment group and the rTMS treatment group(P<0.01).(6)24-hour urine copper:the 24-hour urine copper scores of the three groups after treatment were significant differences(P<0.01).There was no significant difference between the combined treatment group and the gandouling treatment group(P>0.05).Meanwhile,there was a significant difference between the combined treatment group and the rTMS treatment group(P<0.01).And there was a significant difference between the gandouling treatment group and the rTMS treatment group(P<0.01).(7)HCY:the HCY levels of the three groups after treatment were lower than those before treatment(P<0.01),there was significant difference between the combined treatment group and the gandouling treatment group(P<0.05),and there was significant difference between the combined treatment group and the rTMS treatment group(P<0.01).(8)CRP:the levels of CRP in the three groups were lower than that before treatment(P<0.01).There was significant difference between the combined treatment group and the gandouling treatment group(P<0.05),and there was significant difference between the combined treatment group and the rTMS treatment group(P<0.01).(9)TESS:there was significant difference in adverse reactions between the combined treatment group and the gandouling treatment group(P<0.01),there was significant difference in adverse reactions between the gandouling treatment group and the rTMS treatment group at the end of the third course of treatment(P<0.01).There was no significant difference in adverse reactions between the three groups(P>0.05)at the end of the sixth course of treatment.There was no significant adverse reaction during the treatment,indicating that the safety of the three groups was high.Conclusion:(1)The clinical effect of gandouling combined with rTMS group is better than that of gandouling group and rTMS group;(2)The effect of gandouling combined with rTMS group on depressive disorder of WD is better than that of the gandouling group and the rTMS group through measuring HAMD,SDS,anxiety/somatization factors,sleep disorders,retardation factor and cognitive impairment factor;(3)The gandouling combined with rTMS can improve the depressive disorder of WD,and its mechanism may reduce HCY and CRP;(4)The gandouling combined with rTMS has no obvious adverse reactions and appears to high safety in the treatment of WD depression disorder.