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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 9
Sep.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(9): 2145-2150

Effect of dimercaptosuccinic acid combined with zinc sulfate versus D－penicillamine in treatment of children with Wilson’s disease

DOI: 10.3969/j.issn.1001-5256.2023.09.017
  • 1.

    The Second Medical School of Southern Medical University，Guangzhou 510000，China

  • 2.

    Department of Hepatology，The Fifth Medical Center of Chinese PLA General Hospital，Beijing 100000，China

  • 3.

    Department of Pediatrics，Minle Maternal and Child Health Hospital，Zhangye，Gansu 734000，China

Research funding:

Subject of Capital Characteristics (Z181100001718030);

Captial Medical Development Fund (2022－1－2182)

More Information
  • Corresponding author: WANG Fuchuan， wfc－20002000@163.com （ORCID： 0009－0008－2320－0220）; ZHANG Min， gcmw2001@163.com （ORCID： 0000－0003－2497－6748）
  • Received Date: 2022-12-04
  • Accepted Date: 2023-02-09
  • Published Date: 2023-09-19
    Abstract
  •   Objective  To investigate the effect of dimercaptosuccinic acid （DMSA） combined with zinc sulfate versus D－penicillamine （DPA） monotherapy in the treatment of children with Wilson’s Disease （WD）， and to provide a reference for clinical medication.  Methods  A total of 111 children with WD， aged 2－18 years， who were admitted to the Fifth Medical Center of Chinese PLA General Hospital from May 2018 to May 2021 were enrolled in this study and were randomly divided into DMSA+zinc sulfate treatment group （combination group with 52 children） and DPA monotherapy group （monotherapy group with 59 children）， and the two groups were compared in terms of liver function parameters and 24－hour urinary copper at baseline and 6 and 12 months of treatment. The Mann－Whitney U test was used for comparison of continuous data between two groups， and the Wilson rank sum test was used for comparison within each group； the chi－square test or the Fisher’s test was used for comparison of categorical data between two groups.  Results  At 12 months of treatment， the combination group had a significantly lower loss to follow－up rate due to adverse drug reactions than the monotherapy group ［3.85% （2/52） vs 20.34% （12/59）， χ2=6.821， P=0.009］. At 6 and 12 months of treatment， both the combination group and the monotherapy group had significant improvements in alanine aminotransferase and aspartate aminotransferase （all P<0.001）， while there were no significant differences between the two groups after treatment （all P>0.05）. Both groups had an increase in 24－hour urinary copper at 6 months of treatment and a reduction at 12 months of treatment， with a level of 123.00 （80.25－204.04） μg/24 h in the combination group and 239.50 （171.50－490.25） μg/24 h in the monotherapy group， and the monotherapy group had a significantly higher level of 24－hour urinary copper than the combination group （Z=－3.090， P=0.002）. For both groups at 12 months of treatment， there was a reduction in LSM in the children with a liver stiffness measurement （LSM） of ≥7.3 kPa； LSM was reduced by 1.8 （0.3－7.2） kPa in the 22 children in the combination group and was reduced by 2.2 （0.9－7.0） kPa in the 13 children in the monotherapy group； the children with a reduction in LSM accounted for 81.82% and 84.62%， respectively， in the two groups， with no significant difference between the two groups （χ2=0.127， P=0.721）.  Conclusion  In the treatment of WD， although DMSA combined with zinc sulfate has lower urinary copper excretion than DPA monotherapy， there is no significant difference in clinical efficacy between the two regimens， and DMSA combined with zinc sulfate has better safety than DPA monotherapy.

     

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