Wilson病合并脾肿大、脾功能亢进患者脾切除围手术期肝豆灵片干预的临床效果

马守亮; 杨文明; 韩辉; 王艳昕; 董婷; 盛玉琴

doi:10.3969/j.issn.1001-5256.2019.03.028

Wilson病合并脾肿大、脾功能亢进患者脾切除围手术期肝豆灵片干预的临床效果

DOI: 10.3969/j.issn.1001-5256.2019.03.028

1. 安徽中医药大学第一附属医院脑病中心
2. 国家中医药管理局优势病种肝豆状核变性协作组

基金项目:

国家自然科学基金项目(81473534)；安徽省科技攻关项目(160a0802070)；

详细信息

中图分类号: R742.4;R657.6
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出版历程
- 出版日期: 2019-03-20

Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson's disease accompanied by splenomegaly and hypersplenism

Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine

Research funding:

摘要

摘要:
目的观察Wilson病（WD）合并脾肿大、脾功能亢进患者围手术期肝豆灵片干预的临床效果及相关指标变化。方法选取2016年7月-2018年7月安徽中医药大学第一附属医院脑病中心WD合并脾肿大、脾功能亢进的住院患者60例,随机分为对照组和治疗组,每组各30例。对照组采用西药驱铜等常规治疗4个疗程（8 d为1个疗程）后行脾切除手术治疗,手术后第1周末开始常规驱铜药物治疗,继续用药2个疗程;治疗组采用与对照组相同用药方案的基础上加用肝豆灵片治疗。观察临床疗效、24 h尿铜、周围血常规、肝功能、门静脉血流量等指标变化。计量资料2组间比较采用成组设计t检验,计数资料2组间比较采用χ2检验。结果治疗组总有效率为90%（27/30）,明显高于对照组的60%（18/30）,差异有统计学意义（χ2=4. 43,P=0. 03）。术后2个疗程末治疗组24 h尿铜明显低于对照组,差异有统计学意义（t=41. 07,P<0. 05）。术后2个疗程末治疗组ALT、AST水平较对照组明显下降,差异均有统计学意义（t值分别为7. 29、6. 13,P值均<0. 01）。术后2个疗程末治疗组中RBC、PL...
- 肝豆状核变性 /
- 脾切除术 /
- 治疗学 /
- 肝豆灵片
Abstract:
Objective To investigate the clinical effect of perioperative Gandouling intervention in patients with Wilson's disease ( WD) complicated by splenomegaly and hypersplenism and the changes in related indices. Methods A total of 60 WD patients with splenomegalyand hypersplenism who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from July 2016 to July 2018 were enrolled and randomly divided into control group and treatment group, with 30 patients in each group. Thepatients in the control group were given conventional Western medicine treatment including decoppering for 4 courses ( each course of treatmentwas 8 days) , followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treat-ment group were given Gandouling in addition to the treatment in the control group. Clinical outcome and changes in 24-hour urinary copper, peripheral hemogram, liver function parameters, and portal venous flow indices were observed. The two independent samples t-test was usedfor comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between twogroups. Results The treatment group had a significantly higher overall response rate than the control group [90% ( 27/30) vs 60% ( 18/30) , χ2= 4. 43, P = 0. 03]. Compared with the control group at the end of two courses of treatment after surgery, the treatment group had sig-nificantly lower 24-hour urinary copper ( t = 41. 07, P < 0. 05) and levels of alanine aminotransferase and aspartate aminotransferase ( t = 7. 29 and 6. 13, both P < 0. 01) and significantly higher levels of red blood cell count, platelet count, and hemoglobin ( t =-5. 49, -3. 43, and-3. 53, all P < 0. 01) . At the end of two courses of treatment after surgery, both groups had a reduction in portal venousflow, and the treatment group had a significantly greater improvement in portal venous flow than the control group ( t = 12. 05, P < 0. 01) .Conclusion Gandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.
- hepatolenticular degeneration /
- splenectomy /
- therapeutics /
- Gandouling tablet

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参考文献(13)

[1] MA SL, CAI YL, XU L, et al. Treatment of hepatolenticular de-generation with polyene phosphatidylcholine combined withGandouling tablets:A report of 32 cases[J]. Clin J TraditChin Med, 2012, 24 (3) :207-208. (in Chinese) 马守亮, 蔡永亮, 徐磊, 等.多烯磷脂酰胆碱联合肝豆灵片治疗肝型肝豆状核变性32例[J].中医药临床杂志, 2012, 24 (3) :207-208.

[2] CHENG N, WANG K, HU WB, et al. Wilson’s disease in thesouth Chinese Han population[J]. Can J Neurol Sci, 2014, 41 (3) :363-367.

[3] HU WB, HAN YZ, XUE BC, et al. Epidemiological study ofhepatolenticular degeneration at Hanshan County, Ahui Prov-ince[J]. Natl Med J Chin, 2011, 91 (13) :894-897. (inChinese) 胡文彬, 韩咏竹, 薛本春, 等.安徽省含山县肝豆状核变性的流病学研究[J].中华医学杂志, 2011, 91 (13) :894-897.

[4] YANG WM, HAN H, BAO YC, et al. TCM etiology, pathogen-esis and syndrome differentiation and treatment of epatolentic-ular degeneration[J]. J Beijing Univ Tradit Chin Med, 2012, 19 (4) :6-9. (in Chinese) 杨文明, 韩辉, 鲍远程, 等.中医对肝豆状核变性病因病机及辨证论治的探索[J].北京中医药大学学报:中医临床版, 2012, 19 (4) :6-9.

[5] JIANG YP, WANG J, JIANG WW. A new edition of neurologicaldiseases[M]. Shanghai:Shanghai Science Popularization Press, 2014:363-365. (in Chinese) 蒋雨平, 王坚, 蒋雯魏.新编神经疾病学[M].上海:上海科学普及出版社, 2014:363-365.

[6] BAO YC. Contemporaryn neurolgy in Traditional Chinese medicne[M]. Beijing:People's Health Publishing House, 2003:523-527. (in Chinese) 鲍远程.现代中医神经病学[M].北京:人民卫生出版社, 2003:523-527.

[7] SHEN Y, WANG HM. Surgical treatment for Wilson’s diseaseaccompanied by hypersplenia[J]. World J Integr Tradit WestMed, 2003, 12 (9) :910-911. (in Chinese) 沈瑜, 王汉明.肝豆状核变性合并脾功能亢进的外科治疗[J].现代中西医结合杂志, 2003, 12 (9) :910-911.

[8] YANG RM. Hepatolenticular degeneration[M]. Hefei:Anhui Sci-ence and Technology Press, 1995:204-205. (in Chinese) 杨任民.肝豆状核变性[M].合肥:安徽科技出版社, 1995:204-205.

[9] YANG RM. Treatment for Wilson’s disease by drug[J]. JApoplexy Nerv Dis, 2005, 22 (3) :199. (in Chinese) 杨任民.肝豆状核变性药物治疗[J].中风与神经疾病杂志, 2005, 22 (3) :199.

[10] SUN Y, YANG RM. Practical neurology of integrater traditionalChinese and Western Medicine[M]. Beijing:People’s HealthPublishing House, 1999:532-533. (in Chinese) 孙怡, 杨任民.实用中西医结合神经病学[M].北京:人民卫生出版社, 1999:532-533.

[11] YANG RM. Wilson Disease[M]. Beijing:People’s Health Pub-lishing House, 2015:366-367. (in Chinese) 杨任民.肝豆状核变性[M].北京:人民卫生出版社, 2015:366-367.

[12] HAN H, YANG WM, ZHANG J, et al. Characteristics of TCMsyndromes for hepatolenticular degeneration[J]. Clin J TraditChin Med, 2014, 26 (1) :16-19. (in Chinese) 韩辉, 杨文明, 张娟, 等.肝豆状核变性的中医证候特征[J].中医药临床杂志, 2014, 26 (1) :16-19.

[13] LI X, CAI J, XU YW, et al. A case of hepatolenticular degen-eration with hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34 (9) :1967-1971. (in Chinese) 李响, 蔡洁, 徐钰雯, 等.肝豆状核变性合并肝细胞癌1例报告[J].临床肝胆病杂志, 2018, 34 (9) :1967-1971.

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