肝豆灵汤联合认知行为疗法治疗痰瘀互结型Wilson病冲动控制障碍的疗效  

Effect of Gandouling Decoction Combined with Cognitive Behavioral Therapy on Impulse Control Disorders in Wilson's Disease with Syndrome of Combined Phlegm and Stasis

作　　者：徐磊[1] 张恩召 王慧 李小敏 韩辉[1] 朱虹[1] 王莉[1] XU Lei;ZHANG Enzhao;WANG Hui;LI Xiaomin;HAN Hui;ZHU Hong;WANG Li(The First Affiliated Hospital,Anhui University of Chinese Medicine,Hefei 230031,China;Graduate School,Anhui University of Chinese Medicine,Hefei 230038,China)

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

出　　处：《中国实验方剂学杂志》2023年第21期147-154,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81673811);安徽省重点研究和开发计划项目(1804h08020243)。

摘　　要：目的:观察肝豆灵汤联合认知行为疗法(CBT)治疗痰瘀互结型Wilson病(WD)患者冲动控制障碍的临床疗效。方法:前瞻性纳入2018年8月至2023年2月就诊于安徽中医药大学第一附属医院脑病科的90例痰瘀互结型WD伴冲动控制障碍(ICD)患者,随机分为对照组、CBT组和观察组各30例。对照组予西药常规治疗(基础驱铜),CBT组在对照组基础上加用CBT,观察组在CBT组基础上加用肝豆灵汤。8d为1个疗程,治疗4个疗程。分析治疗前后3组患者24h尿铜(24 h U-Cu)、游离铜(NCC)、中医证候积分量表、统一WD评定量表Ⅲ部分(UWDRSⅢ)、Barratt冲动量表中文版(第11版)(BIS-11)、Buss-Perry攻击问卷(BPAQ)、修订版外显攻击行为量表(MOAS)、副反应量表(TESS)评分。结果:治疗前,3组患者间24 h U-Cu和NCC水平比较,差异无统计学意义,资料具有可比性。与本组治疗前比较,3组患者24 h U-Cu均有显著升高(P<0.01),NCC水平均有明显降低(P<0.05,P<0.01)。治疗后3组间患者24 h U-Cu水平差异无统计学意义;与对照组治疗后比较,观察组患者NCC水平明显降低(P<0.05),CBT组NCC水平差异无统计学意义;与CBT组比较,观察组患者NCC水平明显降低(P<0.05)。治疗前,3组患者间中医证候积分比较,差异无统计学意义。与本组治疗前比较,3组患者中医证候积分均有显著下降(P<0.01)。与对照组和CBT组比较,观察组患者中医证候积分明显降低(P<0.05)。治疗前,3组患者各项评分比较,差异均无统计学意义。与本组治疗前比较,3组各项评分均明显降低(P<0.05)。与对照组比较,CBT组和观察组患者UWDRSⅢ、BIS-11、BPAQ和MOAS评分均明显降低(P<0.05);与CBT组比较,观察组患者BIS-11和BPAQ评分明显降低(P<0.05),UWDRSⅢ和MOAS评分差异无统计学意义。结论:肝豆灵汤联合CBT治疗能够更好的改善痰瘀互结型WD患者的冲动控制障碍。Objective:To observe the clinical efficacy of Gandouling decoction combined with cognitive behavioral therapy(CBT)in the treatment of impulse control disorders in patients with Wilson's disease(WD,syndrome of combined phlegm and stasis).Method:A prospective study was conducted on 90 WD patients with the syndrome of combined phlegm and stasis and impulse control disorders(ICD)treated in the Department of Encephalopathy of the First Affiliated Hospital of Anhui University of Chinese Medicine from August 2018 to February 2023.They were randomized into a control group,a CBT group,and a treatment group,with 30 patients in each group.The control group received routine Western medicine treatment(basic copper removal).The CBT group received cognitive behavioral therapy in addition to the therapy in the control group,and the treatment group received Gandouling decoction in addition to the therapy in the CBT group.Each course of treatment was 8 days,and the patients were treated for 4 courses.Before and after treatment,the 24-hour urine copper(24 h U-Cu),non-ceruloplasmin-bound copper(NCC),traditional Chinese medicine(TCM)syndrome score,unified WD rating scale partⅢ(UWDRSⅢ)score,Barratt Impulse Scale Version 11(BIS-11)score,Buss-Perry aggression questionnaire(BPAQ)score,modified overt aggression scale(MOAS)score,and treatment emergent symptom scale(TESS)score of three groups of patients were determined and statistically analyzed.Result:Before treatment,there was no statistically significant difference in the level of 24 h U-Cu or NCC among the three groups.After treatment,all the three groups showed an increase in 24 h U-Cu(P<0.01)and a decrease in the NCC level(P<0.05,P<0.01).There was no significant difference in the 24 h U-Cu level among the three groups after treatment.After treatment,the NCC level showed no significant difference between the control group and the CBT group,while the NCC level in the treatment group was lower than that in the control group and CBT group(P<0.05).Before treatment,there was no statist

关 键 词：肝豆灵汤 认知行为疗法 痰瘀互结型 WILSON病 冲动控制障碍 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R287R259R541.4