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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
Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson’s disease accompanied by splenomegaly and hypersplenism
文章发布日期:2019年03月08日  来源:  作者:马守亮,杨文明,韩 辉,等  点击次数:209次  下载次数:50次

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【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、PLT、Hb水平较对照组明显增加,差异均有统计学意义(t值分别为-5.49、-3.43、-3.53,P值均<001)。2组术后2个疗程末,门静脉血流量均有所下降,治疗组较对照组改善门静脉血流量更加显著(t=12.05,P<0.01)。结论肝豆灵片能够提高WD合并脾大、脾功能亢进脾切除患者的临床疗效。
【Abstract】:ObjectiveTo 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. MethodsA total of 60 WD patients with splenomegaly and 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. The patients in the control group were given conventional Western medicine treatment including decoppering for 4 courses (each course of treatment was 8 days), followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treatment 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 used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsThe 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 significantly 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 venous flow, and the treatment group had a significantly greater improvement in portal venous flow than the control group (t=12.05, P<0.01). ConclusionGandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.
【关键字】:肝豆状核变性; 脾切除术; 治疗学; 肝豆灵片
【Key words】:hepatolenticular degeneration; splenectomy; therapeutics;Gandouling tablet
【引证本文】:MA SL, YANG WM, HAN H, et al. Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson’s disease accompanied by splenomegaly and hypersplenism[J]. J Clin Hepatol, 2019, 35(3): 596-599. (in Chinese)
马守亮, 杨文明, 韩辉, 等. 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[J]. 临床肝胆病杂志, 2019, 35(3): 596-599.

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