不同中医证型的Wilson病患者智力水平及智力结构探讨
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摘要
目的观察Wilson病(Wilsons disease,WD)患者不同中医证型的晶体智力与流体智力水平及其与年龄、性别、病程、临床严重程度分级(Goldstein分级)评分及中医证型之间的关系。方法对84例中医辨证符合湿热内蕴证(39例)、肝肾阴虚证(24例)、气血亏虚证(21例)的WD患者以及38例健康者进行韦氏智力测评(Wechsler Adult Intelligence Scale,WAIS)及瑞文标准推理测评(Ravens Standard Progressive Matrices,RSPM)。结果与正常组比较,肝肾阴虚证患者操作智商(performance intelligence quotient,PIQ)及全智商(fall intelligence quotient,FIQ)评分均减少(P<0.05),气血亏虚证患者言语智商(verbal intelligence quotient,VIQ)、PIQ及FIQ均减少(P<0.05),湿热内蕴证患者各评分差异无统计学意义(P>0.05);与湿热内蕴证比较,肝肾阴虚证患者VIQ及FIQ均减少(P<0.05),气血亏虚证患者VIQ、PIQ及FIQ均减少(P<0.05);与肝肾阴虚证比较,气血亏虚证患者PIQ及FIQ均减少(P<0.05)。与正常组比较,气血亏虚证患者"类同比较""比较推理""系列关系""抽象推理"评分及RSPM总分均减少(P<0.05),湿热内蕴证及肝肾阴虚证患者各项得分差异均无统计学意义(P>0.05);与湿热内蕴证比较,肝肾阴虚证患者各项得分差异均无统计学意义(P>0.05),气血亏虚证患者的"类同比较""比较推理""系列关系""抽象推理"评分及RSPM总分均减少(P<0.05);与肝肾阴虚证比较,气血亏虚证患者的"类同比较"评分降低(P<0.05)。3种中医证型WD患者FIQ、RSPM总分与Goldstein评分均呈负相关(P<0.05),FIQ与病程呈负相关(P<0.05)。结论 3种中医证型中气血亏虚证WD患者智力损伤最明显,其次是肝肾阴虚证,而湿热内蕴证无智力损伤。3种证型患者晶体及流体智力水平与Goldstein评分均具有相关性,晶体智力水平与病程具有相关性。
Objective To investigate the levels of crystalized intelligence and fluid intelligence in patients with different traditional Chinese medicine(TCM)syndrome types of Wilson's disease(WD)and their association with age,sex,course of disease,Goldstein grade,and TCM syndrome type.Methods A total of84 patients with WD were enrolled,among whom 39 had internal retention of damp-heat,24 had liver-kidney Yin deficiency,and 21 had deficiency of Qi and blood based on TCM syndrome differentiation,and 38 healthy individuals were enrolled as normal group.All subjects were assessed using Wechsler Adult Intelligence Scale(WAIS)and Raven's Standard Progressive Matrices(RSPM).Results Compared with the normal group,the patients with liver-kidney Yin deficiency had significantly lower performance intelligence quotient(PIQ)and full intelligence quotient(FIQ)(P<0.05),and those with deficiency of Qi and blood had significantly lower verbal intelligence quotient(VIQ),PIQ,and FIQ(P<0.05);there were no significant differences in VIQ,PIQ,and FIQ between the patients with internal retention of damp-heat and the normal group(P>0.05).Compared with those with internal retention of damp-heat,the patients with liver-kidney Yin deficiency had significantly lower VIQ and FIQ(P<0.05),and the patients with deficiency of Qi and blood had significantly lower VIQ,PIQ,and FIQ(P<0.05).The patients with deficiency of Qi and blood had significantly lower PIQ and FIQ than those with liver-kidney Yin deficiency(P<0.05).Compared with the normal group,the patients with deficiency of Qi and blood had significantly lower total RSPM score and scores of similar comparison,reasoning comparison,series relationship,and abstract reasoning(P<0.05),and there were no significant differences in these scores between the normal group and the patients with internal retention of damp-heat or liver-kidney Yin deficiency(P>0.05).There were no significant differences in all scores between the patients with internal retention of damp-heat and those with liver-kidney Yin deficiency(P>0.05);compared with those with internal retention of damp-heat,the patients with deficiency of Qi and blood had significantly lower total RSPM score and scores of similar comparison,reasoning comparison,series relationship,and abstract reasoning(P <0.05);compared with those with liver-kidney Yin deficiency,the patients with deficiency of Qi and blood had a significant reduction in the score of similar comparison(P<0.05).In the patients with the three TCM syndrome types of WD,FIQ and total RSPM score were negatively correlated with Goldstein score(P<0.05),and FIQ was negatively correlated with the course of disease(P<0.05).Conclusion WD patients with deficiency of Qi and blood have the highest degree of intellectual damage,followed by those with liver-kidney Yin deficiency,and no intellectual damage is observed in WD patients with internal retention of dampheat.The levels of crystalized intelligence and fluid intelligence are correlated with Goldstein score,and the level of crystalized intelligence is correlated with the course of disease.
Objective To investigate the levels of crystalized intelligence and fluid intelligence in patients with different traditional Chinese medicine(TCM)syndrome types of Wilson's disease(WD)and their association with age,sex,course of disease,Goldstein grade,and TCM syndrome type.Methods A total of84 patients with WD were enrolled,among whom 39 had internal retention of damp-heat,24 had liver-kidney Yin deficiency,and 21 had deficiency of Qi and blood based on TCM syndrome differentiation,and 38 healthy individuals were enrolled as normal group.All subjects were assessed using Wechsler Adult Intelligence Scale(WAIS)and Raven's Standard Progressive Matrices(RSPM).Results Compared with the normal group,the patients with liver-kidney Yin deficiency had significantly lower performance intelligence quotient(PIQ)and full intelligence quotient(FIQ)(P<0.05),and those with deficiency of Qi and blood had significantly lower verbal intelligence quotient(VIQ),PIQ,and FIQ(P<0.05);there were no significant differences in VIQ,PIQ,and FIQ between the patients with internal retention of damp-heat and the normal group(P>0.05).Compared with those with internal retention of damp-heat,the patients with liver-kidney Yin deficiency had significantly lower VIQ and FIQ(P<0.05),and the patients with deficiency of Qi and blood had significantly lower VIQ,PIQ,and FIQ(P<0.05).The patients with deficiency of Qi and blood had significantly lower PIQ and FIQ than those with liver-kidney Yin deficiency(P<0.05).Compared with the normal group,the patients with deficiency of Qi and blood had significantly lower total RSPM score and scores of similar comparison,reasoning comparison,series relationship,and abstract reasoning(P<0.05),and there were no significant differences in these scores between the normal group and the patients with internal retention of damp-heat or liver-kidney Yin deficiency(P>0.05).There were no significant differences in all scores between the patients with internal retention of damp-heat and those with liver-kidney Yin deficiency(P>0.05);compared with those with internal retention of damp-heat,the patients with deficiency of Qi and blood had significantly lower total RSPM score and scores of similar comparison,reasoning comparison,series relationship,and abstract reasoning(P <0.05);compared with those with liver-kidney Yin deficiency,the patients with deficiency of Qi and blood had a significant reduction in the score of similar comparison(P<0.05).In the patients with the three TCM syndrome types of WD,FIQ and total RSPM score were negatively correlated with Goldstein score(P<0.05),and FIQ was negatively correlated with the course of disease(P<0.05).Conclusion WD patients with deficiency of Qi and blood have the highest degree of intellectual damage,followed by those with liver-kidney Yin deficiency,and no intellectual damage is observed in WD patients with internal retention of dampheat.The levels of crystalized intelligence and fluid intelligence are correlated with Goldstein score,and the level of crystalized intelligence is correlated with the course of disease.
引文
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[5]张静,陈怀珍,艾文龙,等.肝豆汤联合DMPS驱铜治疗对Wilson病湿热内蕴型认知功能障碍的影响[J].中国实验方剂学杂志,2018,24(15):210-215.
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[7]中华医学会神经病学分会帕金森病及运动障碍学组,中华医学会神经病学分会神经遗传病学组.肝豆状核变性的诊断与治疗指南[J].中华神经科杂志,2008,41(8):566-569.
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[10]龚耀先.修订韦氏成人智力量表手册[M].长沙:湖南地图出版社,1992:1-188.
[11]汪瀚,杨文明,鲍远程.从铜毒论治肝豆状核变性初探[J].安徽中医学院学报,2009,28(5):4-6.
[12]胡纪源,周志华,韩咏竹,等.肝豆状核变性患者中医证型与血尿酸、Goldstein分级的关系[J].中国中西医结合杂志,2015,35(11):1335-1339.
[13]叶群荣,胡纪源,王共强,等.Wilson病临床症状特征和中医证型分析[J].安徽中医药大学学报,2013,32(4):34-37.
[14]CARPENTER P A,JUST M A,SHELL P.What one intelligence test measures:A theoretical account of the processing in the Raven Progressive Matrices Test[J].Psychological Review,1990,97(3):404-431.
[15]彭君,莫雷,黄平,等.工作记忆训练提升幼儿流体智力表现[J].心理学报,2014,46(10):1498-1508.
[16]WICKETT J C,VERNON P A,LEE D H.Relationships between factors of intelligence and brain volume[J].Personality and Individual Differences,2000,29(6):1095-1122.
[17]MCDANIEL M A.Big-brained people are smarter:a meta-analysis of the relationship between in vivo brain volume and intelligence[J].Intelligence,2005,33(4):337-346.
[18]胡文彬,吴舒梅,杨金鹏,等.非脑型肝豆状核变性成人患者智商测定结果分析[J].安徽医学,2009,30(2):97-100.
[19]SCHEIBER I F,BR U°HA R,DUEK P.Pathogenesis of Wilson disease[J].Handbook of Clinical Neurology,2017,142(5):43-55.
[20]PEYROUX E,SANTAELLA N,BROUSSOLLE E,et al.Social cognition in Wilson's disease:a new phenotype?[J].PLoS ONE,2017,12(4):e0173467[2017-04-06].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383022.DOI:10.1371/journal.pone.0173467.
[21]PARIS I,PEREZ-PASTENE C,COUVE E,et al.Copper dopamine complex induces mitochondrial autophagy preceding caspase-independent apoptotic cell death[J].J Biol Chem,2009,284(20):13306-13315.
[22]焦先婷,刘晓青,黄丽素,等.铜诱导原代皮层神经元凋亡的信号传导通路研究[J].中华神经医学杂志,2009,8(9):893-897.
[23]徐陈陈,董健健,王训,等.基于Cer通路探讨肝豆汤对Wilson病模型高铜诱导海马神经元细胞损伤的保护作用[J].中国实验方剂学杂志,2019,25(7):56-60.
[2]SINHA S,CHRISTOPHER R,ARUNODAYA G R,et al.Is low serum tocopherol in Wilson's disease a significant symptom?[J].Journal of the Neurological Sciences,2005,228(2):121-123.
[3]SENIOW J,BAK T,GAJDA J,et al.Cognitive functioning in neurologically symptomatic and a symptomatic forms of Wilson disease[J].Movement Disorders,2002,17(5):1077-1083.
[4]李波,王共强,韩咏竹,等.脑型Wilson病患者智力水平及智力结构的研究[J].安徽医学,2014,35(4):420-422.
[5]张静,陈怀珍,艾文龙,等.肝豆汤联合DMPS驱铜治疗对Wilson病湿热内蕴型认知功能障碍的影响[J].中国实验方剂学杂志,2018,24(15):210-215.
[6]韩辉,方向,吴丽敏,等.化痰祛瘀法治疗肝豆状核变性认知功能障碍21例[J].安徽中医药大学学报,2014,33(1):21-23.
[7]中华医学会神经病学分会帕金森病及运动障碍学组,中华医学会神经病学分会神经遗传病学组.肝豆状核变性的诊断与治疗指南[J].中华神经科杂志,2008,41(8):566-569.
[8]洪铭范,胡纪原,胡文彬,等.肝豆状核变性的中医辨证分型[J].安徽中医学院学报,1998,17(1):10-11.
[9]杨任民.肝豆状核变性[M].北京:人民卫生出版社,2015:70-73.
[10]龚耀先.修订韦氏成人智力量表手册[M].长沙:湖南地图出版社,1992:1-188.
[11]汪瀚,杨文明,鲍远程.从铜毒论治肝豆状核变性初探[J].安徽中医学院学报,2009,28(5):4-6.
[12]胡纪源,周志华,韩咏竹,等.肝豆状核变性患者中医证型与血尿酸、Goldstein分级的关系[J].中国中西医结合杂志,2015,35(11):1335-1339.
[13]叶群荣,胡纪源,王共强,等.Wilson病临床症状特征和中医证型分析[J].安徽中医药大学学报,2013,32(4):34-37.
[14]CARPENTER P A,JUST M A,SHELL P.What one intelligence test measures:A theoretical account of the processing in the Raven Progressive Matrices Test[J].Psychological Review,1990,97(3):404-431.
[15]彭君,莫雷,黄平,等.工作记忆训练提升幼儿流体智力表现[J].心理学报,2014,46(10):1498-1508.
[16]WICKETT J C,VERNON P A,LEE D H.Relationships between factors of intelligence and brain volume[J].Personality and Individual Differences,2000,29(6):1095-1122.
[17]MCDANIEL M A.Big-brained people are smarter:a meta-analysis of the relationship between in vivo brain volume and intelligence[J].Intelligence,2005,33(4):337-346.
[18]胡文彬,吴舒梅,杨金鹏,等.非脑型肝豆状核变性成人患者智商测定结果分析[J].安徽医学,2009,30(2):97-100.
[19]SCHEIBER I F,BR U°HA R,DUEK P.Pathogenesis of Wilson disease[J].Handbook of Clinical Neurology,2017,142(5):43-55.
[20]PEYROUX E,SANTAELLA N,BROUSSOLLE E,et al.Social cognition in Wilson's disease:a new phenotype?[J].PLoS ONE,2017,12(4):e0173467[2017-04-06].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383022.DOI:10.1371/journal.pone.0173467.
[21]PARIS I,PEREZ-PASTENE C,COUVE E,et al.Copper dopamine complex induces mitochondrial autophagy preceding caspase-independent apoptotic cell death[J].J Biol Chem,2009,284(20):13306-13315.
[22]焦先婷,刘晓青,黄丽素,等.铜诱导原代皮层神经元凋亡的信号传导通路研究[J].中华神经医学杂志,2009,8(9):893-897.
[23]徐陈陈,董健健,王训,等.基于Cer通路探讨肝豆汤对Wilson病模型高铜诱导海马神经元细胞损伤的保护作用[J].中国实验方剂学杂志,2019,25(7):56-60.