滋阴泻火与益肾填精中药序贯治疗特发性真性性早熟女性患儿临床观察  

Nourishing Yin Purging Fire and Tonifying Shen Replenishing Essence Chinese Herbal Medicine Sequential Therapeutic Scheme for Idiopathic True Precocious Puberty Female Children Patients

作　　者：张亦群 蔡德培 

机构地区：[1]复旦大学附属儿科医院中西医结合科,上海201102

出　　处：《中国中西医结合杂志》2018年第1期33-37,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.30371820)

摘　　要：目的观察滋阴泻火与益肾填精中药对特发性真性性早熟女性患儿的青春发育进程及骨骼发育的影响。方法将54例特发性真性性早熟7~8岁女性患儿随机分为中药组(27例,滋阴泻火与益肾填精中药序贯治疗),西药组(27例,甲地孕酮治疗)。另收取家长不愿进行任何治疗,仅愿意定期检查的27例特发性真性性早熟7~8岁女性患儿为观察组。中药组治疗第1阶段(治疗至年龄10.5岁)服用滋阴泻火方,第2阶段(年龄10.5+~11.5岁)服用益肾填精方;西药组第1阶段服用甲地孕酮,第2阶段不服用药物。治疗前、治疗第1阶段及第2阶段,测定3组患儿的乳核单位、子宫卵巢容积、促性腺激素释放激素(GnRH)兴奋试验LH峰值、桡骨骨密度、血清骨钙素及计算骨龄差/年龄差,并进行最终身高预测。结果治疗第1阶段:中药组乳核单位、子宫容积、LH峰值下降,并低于同期的观察组(P<0.05,P<0.01);骨龄差/年龄差、骨密度、骨钙素下降,并低于同期西药组和观察组(P<0.05,P<0.01)。西药组乳核单位、子宫容积、LH峰值下降,并低于同期观察组(P<0.05,P<0.01);骨密度上升(P<0.05)。观察组乳核单位、子宫容积、卵巢容积、骨密度上升(P<0.05)。治疗第2阶段:中药组子宫容积增大,并高于同期西药组和观察组;乳核单位、卵巢容积、LH峰值上升,并高于同期西药组;骨龄差/年龄差、骨密度、骨钙素上升,但仍低于同期西药组和观察组(P<0.05,P<0.01);最终身高预测值增加,并高于同期西药组和观察组(P<0.01)。西药组乳核单位、子宫容积、卵巢容积、LH峰值低于同期观察组(P<0.05,P<0.01);骨龄差/年龄差、骨密度、血清骨钙素均无下降。观察组骨密度上升(P<0.05),最终身高的预测值下降(P<0.01)。结论滋阴泻火与益肾填精中药的序贯治疗方案能有效地调整性早熟儿童青春发育的进程,显著防止骨骺过早融合并改善最终身高。Objective To observe the effect of nourishing yin purging fire （NYPF） and tonifying Shen replenishing essence （TSRE） Chinese herbal medicine sequential therapeutic scheme on pubertal development and bone development of idiopathic true precocious puberty female children patients. Methods Totally 54 （7 -8 years old） female children with idiopathic true precocious puberty were ran- domly assigned to the Chinese medicine （CM） group （treated with NYPF and TSRE Chinese herbal medi- cine sequential therapeutic scheme） and the Western medicine （WM） group （treated with megestrol ace- tate）, 27 patients in each group. Besides, 27 （7 -8 years old） female children patients with idiopathic true precocious puberty were enrolled as an observational group, and they would not receive any treat- ment. Patients in the CM group took NYPF Recipe in the 1 st stage （starting treatment to 10.5 years old） and TSRE Recipe in the 2nd stage （10.5 -11.5 years old） respectively. Those in the WM group took megestrol acetate in the 1st stage and no drugs in the 2nd stage. Unit of mammillary nucleus, the volumes of uterus and ovary were detected in the 3 groups before treatment at the 1st stage and the 2nd stage of treatment. GnRH stimulating tests were performed. Luteinizing hormone （LH） bone mineral density of radius and serum osteocalcin were determined. The ratio of bone age difference/age difference was calculated. The final height of these girls could be predicted. Results After treated with the 1st phase, unit of mammillary nucleus, the volume of uterus, LH peak value decreased in the CM group, lower than those of the observational group at the same time period （P 〈0.05, P 〈0.01 ）. The ratio of bone age difference/age difference, bone mineral density （BMD）, serum osteocalcin decreased in the CM group, lower than those of the observational group and the WM group at the same time period （P 〈 0.05, P 〈0.01 ）. As for the WM group： After treated with the 1st phase, unit of mammi

关 键 词：特发性真性性早熟 中药序贯治疗 滋阴泻火 益肾填精 青春发育进程 骨骼发育 

分 类 号：R272[医药卫生—中医儿科学]