基于TE技术探讨肝豆灵联合短期驱铜治疗对Wilson病肝纤维化的临床疗效  

Clinical Efficacy of Gandouling Combined with Short-term Decoppering on Hepatic Fibrosis of Wilson's Disease Based on Transient Elastography

作　　者：张宇 汪美霞[2,3] 张静 赵倩[1] 张梦 陈一民 李中磊 ZHANG Yu;WANG Meixia;ZHANG Jing;ZHAO Qian;ZHANG Meng;CHEN Yiming;LI Zhonglei(Department of Graduate School,Anhui University of Chinese Medicine,Hefei 230038,China;The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China;Key Laboratory of Xin'an Medicine,Ministry of Education,Hefei 230038,China)

机构地区：[1]安徽中医药大学研究生院,合肥230038 [2]安徽中医药大学第一附属医院,合肥230031 [3]新安医学教育部重点实验室,合肥230038

出　　处：《中国实验方剂学杂志》2022年第13期123-129,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局中医药循证能力建设项目(2019XZZX-NB001);国家自然科学基金项目(81973825,82104783);安徽省青年领军后备人才项目。

摘　　要：目的:通过对瞬时弹性成像技术(TE)检测参数联合分析,探讨肝硬度值(LSM)与无创血清学模型天冬氨酸转氨酶与血小板比值指数(APRI)评分、基于4因子的肝纤维化指数(FIB-4)及肝纤维化血清学指标透明质酸(HA)、Ⅳ型胶原(CⅣ)、层黏连蛋白(LN)及Ⅲ型前胶原N端肽(PⅢNP)检测Wilson病肝纤维化程度的相关性及肝豆灵(GDL)对其干预研究,以期为GDL治疗Wilson病(WD)患者肝纤维化的临床疗效提供参考。方法:系统回顾性收集76例WD患者,统计治疗前LSM与肝纤维化血清学指标(HA、PⅢNP、CⅣ、LN)水平及无创血清学模型(APRI评分、FIB-4指数),采用Pearson相关性检验分析探讨LSM与肝纤维化血清学指标HA、CⅣ、LN、PⅢNP及无创血清学模型APRI评分、FIB-4指数的相关性。根据治疗方案将76例WD患者分为观察组(40例)和对照组(36例),对照组给予二巯丙磺钠(DMPS)治疗,观察组在西医治疗基础上加用中药肝豆灵片,共6个疗程(8 d为1个疗程)。评估肝豆灵干预治疗对HA、PⅢNP、CⅣ、LN、LSM及APRI、FIB-4的影响。结果:HA、CⅣ、LN、PⅢNP、APRI、FIB-4与肝脏硬度LSM呈正相关(r=0.517、0.438、0.281、0.457、0.778、0.847,P<0.01)。与治疗前比较,观察组患者血清HA、CⅣ、LN、PⅢNP水平明显下降(P<0.05,P<0.01);对照组治疗后HA、CⅣ、LN水平明显降低(P<0.05),血清PⅢNP水平差异无统计学意义。两组患者LSM、FIB-4指数、APRI评分均明显降低(P<0.05,P<0.01);组间比较,与对照组治疗后比较,观察组LSM、FIB-4、APRI、HA、PⅢNP水平明显降低(P<0.05,P<0.01);CⅣ、LN差异无统计学意义。结论:LSM联合血清HA、PⅢNP、CⅣ、LN及无创血清学模型(FIB-4指数、APRI评分)可有效地反映WD肝纤维化程度,通过联合模型能够提高对WD患者肝纤维化疾病严重程度判断的准确性。同时,在西医驱铜治疗基础上,联合中药肝豆灵可显著改善WD患者的肝功能及肝纤维化程度,发挥抗肝纤维�Objective:To explore the accuracy of clinical common serum fibrosis indexes hyaluronic acid(HA),typeⅣcollagen(CⅣ),laminin(LN),and typeⅢprocollagen peptide(PⅢNP),in combination with liver stiffness measurement(LSM,measured by transient elastography)and non-invasive markers of fibrosis aspartate aminotransferase to platelet ratio index(APRI)and fibrosis-4(FIB-4)in the prediction of the hepatic fibrosis of Wilson's disease(WD)and to observe the clinical effect of Gandouling(GDL).Method:The data of 76 WD patients were collected and the LSM,serum fibrosis indexes(HA,PⅢNP,CⅣ,LN),APRI,and FIB-4 before treatment were recorded.The correlation of LSM with serum fibrosis indexes,APRI,and FIB-4 was discussed via Pearson′s correlation analysis.According to the therapeutic schemes,patients were classified into the control group(36 cases)and treatment group(40 cases).Patients in control group were treated with sodium dimercaptopropylsulfonate(DMPS),while those in the treatment group received GDL in addition to the western medicine therapy.The treatment lasted 6 courses(8 days/course)and the influence of GDL on the indictors was evaluated.Result:HA,CⅣ,LN,PⅢNP,APRI,and FIB-4 were in positive correlation with LSM(r=0.517,0.438,0.281,0.457,0.778,0.847,P<0.01).HA,CⅣ,LN,and PⅢNP in the treatment group were lower after treatment than before treatment(P<0.05,P<0.01).HA,CⅣ,and LN in the control group were lower after treatment than before treatment(P<0.05,P<0.01),and PⅢNP showed no significant difference.LSM,FIB-4,and APRI in both groups decreased after treatment(P<0.05).After treatment,LSM,FIB-4,APRI,HA,and PⅢNP in the treatment group were lower than those in the control group(P<0.05,P<0.01),but CⅣand LN demonstrated no significant difference from the control group.Conclusion:LSM in combination with serum fibrosis indexes(HA,PⅢNP,CⅣ,LN),FIB-4,and APRI can help accurately identify the level of the hepatic fibrosis in WD.Moreover,on the basis of decoppering by western medicine,GDL can significantly impro

关 键 词：肝纤维化 肝豆状核变性 肝豆灵 瞬时弹性成像技术 肝硬度值 肝纤维血清学指标 

分 类 号：R242[医药卫生—中医临床基础] R969.4[医药卫生—中医学] R256.4R856.5R2-031R742.4