儿童性早熟及身高受损的中医治疗经验及思考  

Experience and reflection on traditional Chinese medicine treatment for precocious puberty in children and impaired height

作　　者：熊磊 贺喜盈 曹婷 XIONG Lei;HE Xiying;CAO Ting(Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,China)

机构地区：[1]云南中医药大学第一附属医院儿科,昆明650021

出　　处：《中国中西医结合儿科学》2024年第5期377-379,共3页Chinese Pediatrics of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金项目(82374523,82074421,82160924);国家中医药管理局高水平中医药重点学科建设项目(国中医药人教函[2023]85号);全国名老中医药专家传承工作室建设项目(国中医药人教函[2022]75号);岐黄学者-国家中医药领军人才支持计划(国中医药人教函[2022]6号);云南省科技厅重点研发计划项目(202103AC100005);云南省科技厅中医联合重大项目(2019FF002-001);云南省科技厅科技计划项目(202301AS070084);云南省院士专家工作站(202105AF150037);2023年度云南省研究生导师团队建设项目(云学位[2023]8号)。

摘　　要：性早熟临床表现为第二性征提前发育,可引起生长速率增快、骨骼成熟迅速、骨骺闭合过早等,如不及时干预易引起患儿成年后矮身材、增加内分泌疾病罹患风险。西医治疗本病首选促性腺激素释放激素拟似剂,通过调节下丘脑-垂体-性腺轴显著抑制性发育进程,但在患儿身高获益方面尚有争议。中医药疗法已被研究证实在改善患儿症状、调节性激素水平、延缓性腺发育和改善身高受损、增加成年终身高方面安全有效。熊磊教授认为本病核心病机为肾阴亏虚、相火妄动,治当滋阴培本,降火清源。同时,对伴见肝经郁热者,佐以疏肝泻火之法;对痰湿内蕴者,佐以健脾化痰之法;对中焦失和者,佐以健脾和胃之法。针对快速进展型患儿,可联合使用促性腺激素释放激素拟似剂;针对生长发育迟缓、身高受损患儿,应当考虑加用重组人生长激素,尽可能使其身高获益。The clinical manifestation of precocious puberty is the premature development of secondary sexual characteristics,which can cause increased growth rate,rapid skeletal maturation,premature epiphyseal closure,etc.If not treated in time,it may cause children to be short in adulthood and increase the risk of endocrine diseases.Gonadotrophin releasing hormone analogue is the first choice in the treatment of this disease in western medicine,which can significantly inhibit the sexual development process by regulating the hypothalamic-pituitary-gonadal axis,but there is still controversy in terms of benefits to children's height.Traditional Chinese medicine therapy has been proven to be safe and effective in improving children's symptoms,regulating sex hormone levels,delaying gonadal development,improving height impairment,and increasing adult height.Professor Xiong Lei believes that the core pathological mechanism of this disease is kidney-yin deficiency and hyperactivity of liver-yang fire.The treatment should be nourishing yin to strengthen the root,and lowering fire to clear sources.At the same time,for the patients with stagnated heat of liver channel,the method of dispersing stagnated liver qi and clearing fire is used;for those with internal retention of phlegm-dampness,the method of invigorating spleen to dissipate phlegm is used;for those with disharmony in the middle jiao,the method of invigorating spleen and harmonizing stomach is used.For children with rapid progression,gonadotrophin releasing hormone analogue can be used at the same time;for children with growth retardation and height impairment,recombinant human growth hormone should be considered to maximize their benefits to the height.

关 键 词：性早熟 乳房早发育 身高受损 知柏龟元汤 

分 类 号：R339.35[医药卫生—人体生理学]