应用ARFI技术探讨肝豆汤治疗湿热内蕴型Wilson病肝纤维化的临床研究  

Application of ARFI technology to explore the clinical study of Gandou Tang in treating liver fibrosis of wilson's disease with damp⁃heat accumulation

作　　者：韩卉 汪美霞[1] 陶庄 张艳云 张宇 蒋真真 王飞 孙阔 HAN Hui;WANG Mei-xia;TAO Zhuang;ZHANG Yan-yun;ZHANG Yu;JIANG Zhen-zhen;WANG Fei;SUN Kuo(The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China;The Graduate School of Anhui University of Traditional Chinese Medicine,Hefei 230038,China)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230031 [2]安徽中医药大学研究生院,安徽合肥230038

出　　处：《海南医学院学报》2023年第9期688-693,共6页Journal of Hainan Medical University

基　　金：青年岐黄学者培养项目[国中医药人教函(2022)256号];安徽省重点研究与开发计划(202204295107020001);安徽省青年领军后备人才项目[NO.中发展(2022)4号];国家自然科学基金项目(81973825,82104783)。

摘　　要：目的:应用声脉冲辐射力成像技术(Acoustic radiation force impulse, ARFI)测量肝豆状核变性(Wilson’s disease, WD)患者肝脏剪切波速度(Shear wave velocity, SWV),探讨SWV与肝纤维化血清学指标Ⅳ型胶原(typeⅣcollagen,CⅣ)、透明质酸(hyaluronic acid,HA)、Ⅲ型前胶原N端肽(type Ⅲ procollagen peptide,PⅢNP)、层黏连蛋白(laminin,LN)及APRI评分(Aspartate Aminotransferase to Platelet Ratio Index)、FIB-4指数(Fibrosis-4 index)的相关性,并观察肝豆汤(Gandou Tang, GDT)治疗湿热内蕴型WD肝纤维化的临床疗效。方法:将符合纳入标准的80例WD患者分为治疗组和对照组,每组40例,对照组给予二巯丙磺钠(Sodium Dimercaptopropylsulfonate, DMPS)治疗,治疗组在对照组基础上加用中药方剂肝豆汤,8 d 1个疗程,共6个疗程。对比治疗前后SWV与肝纤四项(PⅢNP、HA、CⅣ、LN)水平及APRI评分、FIB-4指数,采用Pearson相关性检验分析探讨SWV与HA、CⅣ、LN、PⅢNP及APRI评分、FIB-4指数的相关性,并根据治疗方案评估肝豆汤干预治疗对SWV、肝纤四项及APRI、FIB-4的影响。结果:(1)肝脏剪切波速度(SWV)与FIB-4(r=0.83)、APRI(r=0.82)、HA(r=0.87)、CⅣ(r=0.71)、LN(r=0.85)、PⅢNP(r=0.77)呈正相关。(2)治疗前两组患者SWV水平、血清PⅢNP、HA、CⅣ、LN、APRI、FIB-4水平比较,差异均无统计学意义(P>0.05);治疗后两组PⅢNP、HA、LN、SWV、APRI、FIB-4水平均明显下降(P<0.05, P<0.01),且治疗组各项水平低于对照组。CⅣ水平无明显特异性变化(P>0.05)。结论 :SWV值可反应WD肝纤维化程度,与血清HA、PⅢNP、CⅣ、LN及FIB-4指数、APRI评分成正相关。在西医保肝驱铜治疗的基础上加用中药肝豆汤治疗,能有效改善湿热内蕴型WD患者肝纤维化程度。Objective:Acoustic radiation force impulse(ARFI)was applied to measure Shear wave velocity(SWV)of liver in patients with Wilson's disease(WD).To investigate the relationship between SWV and the serological indexes of liver fibrosis,such as typeⅣcollagen(CⅣ),hyaluronic acid(HA),typeⅢprocollagen peptide(PⅢNP),laminin(LN)),APRI score(Asparate Aminotransfer to Platelet Ratio Index),and FIB‑4 index(FIB‑4 index).The clinical efficacy of Gandou Tang(GDT)in the treatment of liver fibrosis in WD with damp‑heat internalization was also observed.Methods:A total of 80 cases of WD patients who met the inclusion criteria were divided into the treatment group and the control group,with 40 cases in each group.The control group was treated with Sodium Dimercaptopropylsulfonate(DMPS)and the treatment group was additionally treated with the traditional Chinese medicine GDT.One course for 8 days,a total of 6 courses.The levels of SWV and four serological indicators of liver fibrosis(PⅢNP,HA,CⅣ,LN),APRI score and FIB‑4 index were compared before and after treatment.Pearson correlation test was used to analyze the correlation between SWV and HA,CⅣ,LN,PⅢNP,APRI score and FIB‑4 index.The effects of GDT on SWV,liver fiber,APRI and FIB‑4 were evaluated according to the treatment plan.Results:①The SWV was positively correlated with FIB‑4(r=0.83),APRI(r=0.82),HA(r=0.87),CⅣ(r=0.71),LN(r=0.85)and PⅢNP(r=0.77).②Before treatment,there were no significant differences in SWV level,PⅢNP,HA,CⅣ,LN,APRI and FIB‑4 levels between two groups(P>0.05).After treatment,the levels of PⅢNP,HA,LN,SWV,APRI and FIB‑4 in both groups were significantly decreased(P<0.05,P<0.01),and the levels in the treatment group were lower than those in the control group.There were no significant specific changes in CⅣlevel(P>0.05).Conclusion:SWV value can reflect the degree of WD liver fibrosis,and is positively correlated with HA,PⅢNP,CⅣ,LN,FIB‑4 index and APRI score.On the basis of the treatment of protecting liver and e

关 键 词：肝纤维化 肝豆状核变性 肝豆汤 声脉冲辐射力成像技术 肝脏剪切波速度 

分 类 号：R259[医药卫生—中西医结合]