ABSTRACT
ObjectiveTo 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）. MethodA 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 part Ⅲ （UWDRS Ⅲ） 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. ResultBefore 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 statistically significant difference in the TCM syndrome score among the three groups. After treatment， the TCM syndrome scores of all the three groups decreased （P<0.01）. Moreover， the treatment group had lower TCM syndrome score than the control group and CBT group （P<0.05）. Before treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores had no statistically significant differences among the three groups. After treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS in all the three groups declined （P<0.05）. Moreover， the CBT group and treatment group had lower UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores than the control group （P<0.05）， and the treatment group had lower BIS-11 and BPAQ scores than the CBT group （P<0.05）. ConclusionThe combination of Gandouling decoction and CBT can ameliorate impulse control disorders in the WD patients with combined phlegm and stasis.
ABSTRACT
ObjectiveTo explore the accuracy of clinical common serum fibrosis indexes hyaluronic acid （HA）， type Ⅳ collagen （CⅣ）， laminin （LN）， and type Ⅲ procollagen 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）. MethodThe 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. ResultHA， 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 CⅣ and LN demonstrated no significant difference from the control group. ConclusionLSM 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 improve the liver function and hepatic fibrosis of WD patients.
ABSTRACT
Objective::To observe the clinical efficacy of Gandouling decoction on hepatic function of patients with phlegm and blood stasis type Wilson's disease. Method::From January 2015 to December 2017, totally 72 cases of phlegm and blood stasis type Wilson's disease admitted to Encephalopathy Center in the First Affiliated Hospital of Anhui University of Chinese Medicine were randomly divided into treatment group and control group, with 36 cases in each group. Patients in both groups were injected with sodium dimercaptopropane sulfonate for routine treatment. At the same time, patients in control group received Hugan Tablets, and patients in treatment group received Gandouling decoction for a total of 6 treatment courses. Before and after treatment, traditional Chinese medicine(TCM)syndrome effective rate, serum enzyme index [alanine aminotransferase(ALT), aspartate aminotransferase (AST), alkaline phosphatase(AKP)], bilirubin metabolism index [total bilirubin(TBIL)], liver fibrosis index [laminin(LN), hyaluronic acid(HA), collagen type IV(CⅣ), procollagen type Ⅲ peptide(PⅢP)]and blood coagulation index [fibrinogen (FBG), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) ]were observed. Result::TCM syndrome effective rates of treatment group and control group were 86.11%(31/36) and 63.98%(23/36) respectively, with a significant difference between two groups (P<0.05). ALT, AST, AKP, TBIL decreased in two groups after treatment (P<0.01), and the effects of ALT, AST, AKP, TBIL in treatment group were significantly better than those in control group (P<0.01), liver fibrosis index decreased in both groups after treatment (P<0.01), and the effect in treatment group was significantly better than that in control group (P<0.01). Blood coagulation indexes were improved to different degrees in both groups (P<0.05, P<0.01), and there were significant differences between treatment group and control group in decreasing PT, APTT, TT levels (P<0.05, P<0.01) and increasing FBG level (P<0.01). Conclusion::Gandouling decoction can significantly improve hepatic function of patients with phlegm and blood stasis type Wilson's disease, which is manifested in improving serum enzymes and bilirubin indexes, reversing liver fibrosis, promoting clotting factors and reducing bleeding tendency, in order to delay the progress of the disease and improve the life quality of patients.
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=443, 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.
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=443, 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.
ABSTRACT
Objective To observe the effects of Gandouling on reactive oxygen species (ROS) level, the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) mRNA and protein of neural stem cells of the mice cultured in high concentration copper. Methods The model of neural stem cells of the mice was cultured in vitro with high concentration copper. The experimental rats were randomly divided into blank control group, model group, and Gandouling low-, medium-, and high-dose groups. Each medication group was given relevant concentration of Gandouling serum for gavage. The MTT was adopted to test proliferation level on neural stem cells; flow cytometer was used to examine the change of ROS level in cells; qPCR was used to measure the expression of Nrf2 mRNA;Western blot was used to measure the change of the level of protein Nrf2 in cells. Results Compared with the blank control group, the proliferation rate of neural stem cells was significantly decreased, ROS levels were significantly increased, and Nrf2 gene and protein expression was significantly decreased (P＜0.01). Compared with the model group, neural stem cells proliferation rate was significantly increased, ROS levels were significantly reduced, and Nrf2 gene and protein expression was significantly increased (P＜0.05, P＜0.01). Conclusion Gandouling can promote the proliferation of neural stem cells in mice by reducing ROS content in high copper-loaded mice and up-regulating Nrf2 expression.
ABSTRACT
Objective To optimize the HPLC conditions for active components of Coptidis Rhizoma; To establish qualitative and quantitative analysis method for related components of Coptidis Rhizoma in Gandouling Pills. Methods HPLC was used for the qualitative and quantitative analysis of related components of Coptidis Rhizoma in Gandouling Pills.With acetonitrile:0.05 mol/L potassium dihydrogen phosphate solution=50:50(per 100 mL was added 0.4 g sodium dodecyl sulfate, and then adjusted pH to 4.0 with phosphoric acid) as mobile phase, the flow rate was 1.0 mL/min and the detection wavelength was 345 nm. Results Four components of Coptidis Rhizoma can be identified, including berberine, coptisine, berberine hydrochloride and palmatine chloride, and the negative control had no disturbance. Berberine hydrochloride reference and the absorbance peak area value showed a good linear relationship within 0.058-0.580 μg sample volume, and palmatine chloride reference was the same within 0.030-0.300 μg sample volume. The average recovery was 98.18% and 99.99%, and RSD was 2.40% and 1.70%, respectively. Conclusion The method is simple, accurate and with good repeatability, which can be applied effectively to the quality control of Gandouling Pills.