基于PI3K/Akt/mTOR信号通路、性激素、骨代谢探究知柏地黄丸联合治疗女性特发性性早熟的效果及机制  

Effect and Mechanism of Combined Treatment with Zhibai Dihuang Pills on Idiopathic Precocious Puberty Based on PI3K/Akt/mTOR Signaling Pathway,Sex Hormones,and Bone Metabolism

作　　者：陆影[1] 龙海旭 LU Ying;LONG Haixu(Department of Pediatrics,the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410005,China)

机构地区：[1]湖南中医药大学第二附属医院儿科,长沙410005

出　　处：《临床误诊误治》2024年第6期82-88,共7页Clinical Misdiagnosis & Mistherapy

基　　金：湖南省中医药管理局中医药科研项目(B2023148)。

摘　　要：目的探讨联合知柏地黄丸对女性特发性性早熟(CPP)患儿性激素、骨代谢及PI3K/Akt/mTOR信号通路的影响。方法选取2022年1月—2022年12月收治的60例CPP患儿,随机数字表法分为西药组、联合组2组,均30例。西药组给予注射用曲普瑞林治疗,联合组在西药组基础上联合知柏地黄丸治疗。比较2组临床疗效、安全性,以及治疗前后子宫体积、卵巢体积、卵泡直径、性激素水平[促黄体生成素(LH)、LH/促卵泡激素(FSH)、雌二醇(E_(2))]、骨代谢指标[骨钙素、骨碱性磷酸酶(BALP)、Ⅰ型前胶原氨基端肽(PⅠNP)、骨密度、β-胶原降解产物(β-CTX)]、PI3K/Akt/mTOR信号通路相关蛋白表达。结果联合组总有效率96.67%(29/30)高于西药组70.00%(21/30)(P<0.05)。联合组治疗后子宫体积、卵巢体积、卵泡直径均低于西药组(P<0.05);联合组治疗后血清LH、LH/FSH、E_(2)、骨钙素、BALP、PⅠNP水平低于西药组,骨密度高于西药组(P<0.05)。2组治疗后血清β-CTX水平比较无显著差异(P>0.05)。联合组治疗后PI3K、Akt、mTOR蛋白表达水平低于西药组(P<0.05)。联合组不良反应总发生率与西药组比较无显著差异(P>0.05)。结论注射用曲普瑞林联合知柏地黄丸能降低CPP患儿性激素水平,改善骨代谢相关因子的表达,抑制PI3K/Akt/mTOR信号通路活性,从而改善患儿症状。研究结果表明该方案临床疗效确切,且具有一定安全性。Objective To investigate the effects of combined treatment with Zhibai Dihuang pills on sex hormone,bone metabolism and PI3K/Akt/mTOR signaling pathway in children with idiopathic central precocious puberty(CPP).Methods Sixty patients with CPP treated from January 2022 to December 2022 were selected and divided into Western medicine group(n=30)and combination group(n=30)by random number table method.The Western medicine group was treated with Triprerelin injection,and the combination group was treated with Zhibai Dihuang pills on the basis of the Western medicine group.The clinical efficacy and safety of the two groups were compared.Uterine volume,ovarian volume,follicle diameter,sex hormone levels[luteinising hormone(LH),LH/follicle-stimulating hormone(FSH),estradiol(E_(2))],bone metabolism indicators[osteocalcin,bone alkaline phosphatase(BALP),procollagenⅠN-terminal propeptide(PⅠNP),bone mineral density,β-collagen degradation products(β-CTX)],and expression of I3K/Akt/mTOR signaling pathway related proteins before and after treatment were compared.Results The total effective rate of combination group was 96.67%(29/30),which was higher than that of Western medicine group[70.00%(21/30)](P<0.05).After treatment,uterine volume,ovarian volume and follicle diameter in combination group were lower than those in Western medicine group(P<0.05).After treatment,serum levels of LH,LH/FSH,E_(2) osteocalcin,BALP and PⅠNP in combination group were lower than those in Western medicine group,while bone mineral density was higher than that in Western medicine group(P<0.05).There was no significant difference in serumβ-CTX between the two groups after treatment(P>0.05).The protein expression levels of PI3K,Akt and mTOR in combination group after treatment were lower than those in Western medicine group(P<0.05).The total incidence of adverse reactions in combination group was not significantly different from that in Western medicine group(P>0.05).Conclusion Triprerelin injection combined with Zhibai Dihuang pills can redu

关 键 词：特发性性早熟 知柏地黄丸 曲普瑞林 PI3K/Akt/mTOR信号通路 雌二醇 黄体生成激素 骨钙素 骨密度 

分 类 号：R725.8[医药卫生—儿科]