氢化可的松治疗先天性肾上腺皮质增生症用药方式探讨  

Investigation on different treatment for congenital adrenal hyperplasia

作　　者：易琴[1] 田凤艳[1] 余肖[1] 魏虹[1] 梁雁[1] 罗小平[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院儿科,武汉430030

出　　处：《中国实用儿科杂志》2010年第10期771-773,共3页Chinese Journal of Practical Pediatrics

基　　金：国家"十一五"科技支撑计划项目(2006BAI05A07)

摘　　要：目的了解不同的用药方式对先天性肾上腺皮质增生症(CAH)患儿生长速率及骨龄进展的影响,为选择一种较好的用药方式提供依据。方法对2005—2009年在武汉同济医院儿科遗传代谢内分泌专科门诊就诊的18例CAH患儿(男9例,女9例)进行回顾性分析。根据氢化可的松用药方式不同分为A组(自2007年5月开始用药,用药方式为新方式,即每天用药3次,早8时和下午4时均服用全天总量的1/4,晚10时左右服用全天总量的1/2。)和B组(用药为2007年5月前用旧方式而2007年5月后改用新方式,旧方式即全天总量分2次或1次服用),B组又根据前后用药方式的改变分为B1组(旧方式组)和B2组(新方式组),分别比较A组和B1组、B1组和B2组年生长速率(GV)、身高年龄增长(ΔHA)、ΔHA与骨龄增长(ΔBA)间的关系(ΔHA/ΔBA)以及骨龄变化与实际年龄变化的比值(ΔBA/ΔCA)的差异。结果 A组和B1组、B2组和B1组相比,△BA/△CA的值均显著降低(P<0.05),ΔHA与ΔHA/ΔBA的值差异均无统计学意义(P>0.05)。A组和B1组的GV差异无统计学意义(P>0.05),但B2组和B1组相比,GV显著降低(P<0.05)。结论患儿以新方式用药在抑制骨龄进展和保持正常生长方面明显优于旧方式,新方式用药可增加患儿身高增长空间,提高患儿终身高。Objective To investigate the influences on growth velocity and bone age of two different treatments for con- genital adrenal hyperplasia and determine the optimal dose and frequency of hydrocortisone. Methods Clinical data of 18 patients （9 males, 9 females） with congenital adrenal hyperplasia, who were diagnosed and treated in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology from 2005 to 2009, was studied ret- rospectively. Before May 2007, all of the patients with congenital adrenal hyperplasia were treated with the old method; hydrocortisone dose was divided into two doses or one. Since May 2007, we have tried a new method, it was divided into three doses. At 8 a.m. and 4 p.m., the dose was both one fourth of the total dose, and at 10 p.m., the dose was the high- est, about one half. According to the different time of first visit, the patients were divided into group A （after May 2007） and group B （before May 2007 ）. In group B, according to the different treatment methods used, it was divided into group B1 （old method） and group B2 （new method）. Growth velocity （GV）, height age increased （ A HA）, the ratio of A HA/ A BA （bone age increased） and A BA/A CA （chronological age increased） were analyzed. Results The ratio of A BA/ A CA was reduced significantly after changing the frequency and time of taking hydrocortisone （P 〈 0.05 ）. The value of A HA and A HA/A BA both decreased in group A compared with group B1 and in group B2 compared with BI, but there were no significant differences between them （P 〉 0.05）. Gv had no significant difference between group A and group B 1, but it significantly decreased in group B2 compared with group B 1. Conclusion The new method of taking hydrocortisone can control the rapid progress of bone age better and does not lead to growth suppression.

关 键 词：先天性肾上腺皮质增生症 氢化可的松 身高年龄 骨龄 

分 类 号：R72[医药卫生—儿科]