肝豆汤联合言语训练治疗湿热内蕴型Wilson病构音障碍的临床疗效  

Clinical Efficacy of Gandou Decoction Combined with Speech Training on Treatment of Dysarthria with Endoretention of Damp-heat in Wilson's Disease

作　　者：马守亮[1] 李悦悦 董童雨 戎荣 杨文明[1] 韩辉[1] 盛玉琴[1] MA Shouliang;LI Yueyue;DONG Tongyu;RONG Rong;YANG Wenming;HAN Hui;SHENG Yuqin(The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China;Taihe Hospital of Traditional Chinese Medicine,Fuyang 236600,China;Graduate School of Anhui University of Chinese Medicine,Hefei 230012,China)

机构地区：[1]安徽中医药大学第一附属医院,合肥230031 [2]太和县中医院,安徽阜阳236600 [3]安徽中医药大学研究生院,合肥230012

出　　处：《中国实验方剂学杂志》2024年第10期83-89,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局第七批全国老中医专家学术经验继承资助项目(2022);安徽省新冠病毒科研应急攻关专项公开竞争项目(2022e07020082);安徽省第一届骨干人才培养项目(皖卫函【2022】392号);国家自然科学基金面上项目(81973825)。

摘　　要：目的:通过观察肝豆汤(GDD)联合言语训练治疗Wilson病(WD)湿热内蕴型构音障碍患者的临床疗效,评价GDD的有效性,为WD湿热内蕴型构音障碍患者选择合适的治疗方案提供更多临床数据及理论支持。方法:抽取符合条件的WD湿热内蕴型患者且存在构音障碍症状者60例,依照随机分组法将其分为对照组和观察组,每组30例。对照组为言语训练+二巯基丙磺酸钠(DMPS),观察组在对照组的基础上联合肝豆汤治疗,8 d为1个疗程,共治疗4个疗程。比较两组治疗前后临床总有效率(Goldstein临床分级)、中国康复研究中心构音障碍分级评定评分、中医证候积分、24 h尿铜含量、改良Frenchay构音障碍评定量表评分。结果:治疗后,观察组患者总有效率为90.0%(27/30),对照组患者总有效率为70.0%(21/30),观察组患者总有效率明显高于对照组(Z=-1.986,P<0.05)。与本组治疗前比较,两组患者改良Frenchay构音障碍评分、中国康复研究中心构音障碍分级评定、24 h尿铜均明显升高(P<0.05,P<0.01),中医证候积分显著降低(P<0.01)。与对照组治疗后比较,除呼吸、颌评分外,观察组患者在反射功能、唇运动、软腭运动、喉运动、舌运动及言语功能改善更明显(P<0.05,P<0.01),总体来说观察组较对照组改善构音障碍疗效更优;中国康复研究中心构音障碍分级、24 h尿铜含量均显著升高(P<0.01),观察组疗效更优。研究期间患者DPMS排铜治疗及口服GDD过程中均未出现发热、皮疹、口腔及眼睑黏膜红肿、剥脱性皮炎、呕吐腹泻或过敏性休克等严重不良反应,无病例脱落情况。结论:GDD联合言语训练治疗可以使湿热内蕴型WD构音障碍患者症状改善,疗效提高,在一定程度上提升患者的生活水平,可广泛运用于临床。Objective:To evaluate the effectiveness of Gandou decoction(GDD)by analyzing theclinical efficacy of GDD combined with speech training on the treatment of dysarthria with endoretention of damp-heat in Wilson's disease(WD),so as to provide more clinical data and theoretical support for the selection of appropriate treatment schemes for WD patients with dysarthria with endoretention of damp-heat.Method:A total of 60 eligible WD patients with dysarthria with endoretention of damp-heat were selected and divided into a control group and a treatment group according to the random grouping method,with 30 cases in each group.The control group was treated with speech training+sodium dimercaptopropanesulfonate(DMPS),and the treatment group was combined with GDD on the basis of the control group,with eight days as a course of treatment for 32 days.The total clinical effectiveness rate(Goldstein clinical classification),dysarthria grading assessment from China Rehabilitation Research Center,TCM syndrome scores,24-hour urine copper content,and modified Frenchay dysarthria rating scale scores of the two groups were compared before and after treatment.Result:After treatment,the total effective rate of the observation group was 90.0%(27/30),and that of the control group was 70.0%(21/30).The total effective rate of the observation group was significantly higher than that of the control group(Z=-1.986,P<0.05).After treatment,the modified Frenchay dysarthria score,dysarthria grading assessment from China Rehabilitation Research Center,and 24-h urine copper in the two groups were significantly increased(P<0.05,P<0.01),and the TCM syndrome score was significantly decreased(P<0.01).Compared with the control group after treatment,except for the respiratory and jaw score,the modified Frenchay dysarthria score of the observation group was significantly increased(P<0.05,P<0.01).The dysarthria grading from China Rehabilitation Research Center and 24-h urine copper content were significantly increased(P<0.01),and the observation group had be

关 键 词：肝豆汤 言语训练 湿热内蕴型 WILSON病 构音障碍 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R287R259R246.6