知柏地黄方加减颗粒对特发性性早熟女童骨密度、骨代谢指标和性激素、性腺体积的影响
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摘要
目的:探讨知柏地黄方加减颗粒对特发性性早熟女童骨密度、骨代谢指标和性激素、性腺体积的影响。方法:选取我院儿童生长发育门诊收治的150例女性患儿,按就诊顺序随机分为颗粒剂治疗组、传统丸剂治疗组和西药治疗组各50例,并选取同期来我院体检的同龄健康儿童20例为空白对照组。颗粒剂治疗组患儿给予口服知柏地黄方加减颗粒,传统丸剂治疗组给予口服知柏地黄丸,西药治疗组初期3个月每4周注射一次醋酸曲普瑞林(达必佳),第4个月起减量至60～80μg/kg,剂量按生长速率及性征发育情况调整,观察治疗12个月。比较治疗前、治疗6个月后患儿骨密度、骨碱性磷酸酶及血清骨钙素、血清性激素和性腺体积的变化情况。结果:治疗后,颗粒剂治疗组、传统丸剂治疗组、西药治疗组患儿血清性激素促卵泡生成素(FSH)、黄体生成素(LH)及雌二醇(E2)水平均降低(P均<0. 05);颗粒剂治疗组、传统丸剂治疗组、西药治疗组患儿治疗后子宫容积、卵泡直径均降低,卵巢容积均增大(P均<0. 05);颗粒剂治疗组治疗后骨密度均升高,骨碱性磷酸酶和骨钙素指标水平均下降,颗粒剂治疗组血清骨代谢指标治疗后均改善,与空白对照组的水平接近,且颗粒剂治疗组均优于传统丸剂治疗组和西药治疗组(P均<0. 05)。结论:知柏地黄方加减颗粒可有效改善性早熟女童骨密度及骨代谢指标的异常,抑制第二性征提前发育,降低过高的性激素水平。
Objective: To probe into the effects of Zhibai Dihuang Jiajian granules on bone mineral density,bone metabolism index,sex hormone and gonad volume in female children with idiopathic precocious puberty.Methods: Totally 150 female children admitted into children's growth and development clinic were extracted to be divided into the granule treatment group,the traditional pill treatment group and the western medicine treatment group according to the admission sequence,with 50 cases in each group,and 20 healthy children of the same age who were admitted to our hospital for physical examination during the same period were selected as the blank control group.Children in granule treatment group were given oral Zhibai Dihuang Jiajian granules,while the traditional pill treatment group received oral Zhibai Dihuang pills.In the western medicine treatment group,tripryline acetate( triptorelin) was injected once every 4 weeks for the first3 months,and the dose was reduced to 60-80 μg/kg from the fourth month,the dose was adjusted according to the growth rate and sexual development,and the treatment was observed for 12 months.Changes of bone mineral density,bone alkaline phosphatase,serum osteocalcin,serum sex hormone and gonadal volume in children were compared before and 6 months after treatment. Results: After treatment,the serum levels of follicle stimulating hormone( FSH),luteinizing hormone( LH) and estradiol( E2) decreased significantly in the granule treatment group,the traditional pill treatment group and the western medicine treatment group( P<0. 05).After treatment,the uterine volume and follicular diameter of the children in the granule treatment group,the traditional pill treatment group and the western medicine treatment group decreased significantly,while the ovarian volume increased( P < 0. 05). After treatment,the bone mineral density of bone metabolism in the granule treatment group increased significantly,and the levels of bone alkaline phosphatase and osteocalcin decreased significantly,the serum bone metabolism index of the granule treatment group was significantly improved after treatment,which was close to the level of the blank control group,the granule treatment group was significantly better than the traditional pill treatment group and the western medicine treatment group( P< 0. 05).Conclusion: Zhibai Dihuang Jiajian granules can effectively improve the abnormal bone mineral density,bone metabolism index in female children with idiopathic precocious puberty,inhibit the development of secondary sexual characteristics in advance,and reduce the high level of sex hormones.
Objective: To probe into the effects of Zhibai Dihuang Jiajian granules on bone mineral density,bone metabolism index,sex hormone and gonad volume in female children with idiopathic precocious puberty.Methods: Totally 150 female children admitted into children's growth and development clinic were extracted to be divided into the granule treatment group,the traditional pill treatment group and the western medicine treatment group according to the admission sequence,with 50 cases in each group,and 20 healthy children of the same age who were admitted to our hospital for physical examination during the same period were selected as the blank control group.Children in granule treatment group were given oral Zhibai Dihuang Jiajian granules,while the traditional pill treatment group received oral Zhibai Dihuang pills.In the western medicine treatment group,tripryline acetate( triptorelin) was injected once every 4 weeks for the first3 months,and the dose was reduced to 60-80 μg/kg from the fourth month,the dose was adjusted according to the growth rate and sexual development,and the treatment was observed for 12 months.Changes of bone mineral density,bone alkaline phosphatase,serum osteocalcin,serum sex hormone and gonadal volume in children were compared before and 6 months after treatment. Results: After treatment,the serum levels of follicle stimulating hormone( FSH),luteinizing hormone( LH) and estradiol( E2) decreased significantly in the granule treatment group,the traditional pill treatment group and the western medicine treatment group( P<0. 05).After treatment,the uterine volume and follicular diameter of the children in the granule treatment group,the traditional pill treatment group and the western medicine treatment group decreased significantly,while the ovarian volume increased( P < 0. 05). After treatment,the bone mineral density of bone metabolism in the granule treatment group increased significantly,and the levels of bone alkaline phosphatase and osteocalcin decreased significantly,the serum bone metabolism index of the granule treatment group was significantly improved after treatment,which was close to the level of the blank control group,the granule treatment group was significantly better than the traditional pill treatment group and the western medicine treatment group( P< 0. 05).Conclusion: Zhibai Dihuang Jiajian granules can effectively improve the abnormal bone mineral density,bone metabolism index in female children with idiopathic precocious puberty,inhibit the development of secondary sexual characteristics in advance,and reduce the high level of sex hormones.
引文
[1]金献江,罗越,吴慧平,等.促性腺激素释放激素类似物对特发性中枢性性早熟女童体质指数及骨代谢标志物水平的影响[J].中国全科医学,2016,19(9):1049-1052.
[2]吴慧平,金献江,罗越,等.骨代谢标志物在特发性中枢性性早熟女童血清中的变化及意义[J].浙江医学,2015,37(16):1347-1349.
[3]谢理玲,杨玉,胡云,等.特发性中枢性性早熟女童干预治疗对体质量指数的影响[J].中华实用儿科临床杂志,2016,31(8):592-595.
[4]薛峥峰,冯娜,李元霞,等.血清维生素D水平对中枢性性早熟女童治疗效果的影响分析[J].中国性科学,2017,26(8):52-54.
[5]中华医学会儿科学分会内分泌遗传代谢学组.中枢性性早熟诊断与治疗共识(2015)[J].中华儿科杂志,2015,53(6):412-418.
[6]马融.中医儿科学(新四版)[M].北京:中国中医药出版社,2016:325-331.
[7]王玲,罗燕萍.从天癸论儿童中枢性性早熟[J].中医研究,2009,22(3):5-6.
[8]张庆梅,尚清,马彩云,等.滋肾疏肝泻火方对特发中枢性性早熟女童第二性征和生长发育的影响[J].南京中医药大学学报,2016,32(6):524-527.
[9]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察[J].中国性科学,2016,25(3):59-62.
[10]陈欣,刘宏雄,王艳,等.特发性性早熟女童乳腺高频超声显像特征分析[J].中国性科学,2017,26(7):43-46.
[11]曾碧荷,经纬,郭玉秀,等.促性腺激素释放激素类似物停药后特发性中枢性性早熟女童月经来潮年龄及其相关因素分析[J/OL].中华临床医师杂志:电子版,2016,10(18):2710-2714.
[12]卢蓉,马科,徐珍珍,等.中枢性性早熟女童血清中维生素D的临床检测意义分析[J].中国性科学,2017,26(4):84-86.
[13]张莉,刘俊莉,杨柳,等.促性腺激素释放激素类似物联合生长激素治疗中枢性性早熟女童疗效观察[J].中国性科学,2017,26(8):54-57.
[14]曾可,杨东新,潘明沃,等.不同剂量知柏地黄方药穴位贴剂对TannerⅡⅢ期性早熟女童的疗效比较[J].山西医药杂志,2017,46(19):2333-2335.
[15]顾淑萍,陈美元.曲普瑞林联合知柏地黄丸对女性特发性性早熟第二性征、骨龄及骨密度的影响[J].现代中西医结合杂志,2013,22(26):2883-2885.
[16]李嫔,蔡德培,黄玉娟.性早熟女童骨骼发育异常的规律及滋阴泻火中药治疗的作用[J].中国中西医结合杂志,2004,24(11):979-982.
[2]吴慧平,金献江,罗越,等.骨代谢标志物在特发性中枢性性早熟女童血清中的变化及意义[J].浙江医学,2015,37(16):1347-1349.
[3]谢理玲,杨玉,胡云,等.特发性中枢性性早熟女童干预治疗对体质量指数的影响[J].中华实用儿科临床杂志,2016,31(8):592-595.
[4]薛峥峰,冯娜,李元霞,等.血清维生素D水平对中枢性性早熟女童治疗效果的影响分析[J].中国性科学,2017,26(8):52-54.
[5]中华医学会儿科学分会内分泌遗传代谢学组.中枢性性早熟诊断与治疗共识(2015)[J].中华儿科杂志,2015,53(6):412-418.
[6]马融.中医儿科学(新四版)[M].北京:中国中医药出版社,2016:325-331.
[7]王玲,罗燕萍.从天癸论儿童中枢性性早熟[J].中医研究,2009,22(3):5-6.
[8]张庆梅,尚清,马彩云,等.滋肾疏肝泻火方对特发中枢性性早熟女童第二性征和生长发育的影响[J].南京中医药大学学报,2016,32(6):524-527.
[9]汪培欢,施弦.曲普瑞林对特发性中枢性性早熟女童治疗作用的自身前后对照观察[J].中国性科学,2016,25(3):59-62.
[10]陈欣,刘宏雄,王艳,等.特发性性早熟女童乳腺高频超声显像特征分析[J].中国性科学,2017,26(7):43-46.
[11]曾碧荷,经纬,郭玉秀,等.促性腺激素释放激素类似物停药后特发性中枢性性早熟女童月经来潮年龄及其相关因素分析[J/OL].中华临床医师杂志:电子版,2016,10(18):2710-2714.
[12]卢蓉,马科,徐珍珍,等.中枢性性早熟女童血清中维生素D的临床检测意义分析[J].中国性科学,2017,26(4):84-86.
[13]张莉,刘俊莉,杨柳,等.促性腺激素释放激素类似物联合生长激素治疗中枢性性早熟女童疗效观察[J].中国性科学,2017,26(8):54-57.
[14]曾可,杨东新,潘明沃,等.不同剂量知柏地黄方药穴位贴剂对TannerⅡⅢ期性早熟女童的疗效比较[J].山西医药杂志,2017,46(19):2333-2335.
[15]顾淑萍,陈美元.曲普瑞林联合知柏地黄丸对女性特发性性早熟第二性征、骨龄及骨密度的影响[J].现代中西医结合杂志,2013,22(26):2883-2885.
[16]李嫔,蔡德培,黄玉娟.性早熟女童骨骼发育异常的规律及滋阴泻火中药治疗的作用[J].中国中西医结合杂志,2004,24(11):979-982.