滋阴泻火中药及甲地孕酮治疗女性特发性性早熟的临床研究

目的探索适合国情的、不同于促性腺激素释放激素拟似剂(GnRHagonist)治疗特发性真性性早熟的有效方法.方法106例女性特发性性早熟患儿,其中51例采用滋阴泻火中药及甲地孕酮联合治疗(简称联合治疗),35例单纯使用甲地孕酮治疗,20例不用药物治疗作为对照.于治疗前后分别进行黄体生成素释放激素(LHRH)兴奋试验、子宫卵巢容积测定以及生长速率、X线骨龄的测算和最终身高的预测.结果经过平均2年8个月的治疗,联合治疗的患儿LHRH兴奋试验的LH峰值从(48.5±37.1)IU/L下降为(12.2±9.3)IU/L(P＜0.001),子宫卵巢回缩,第二性征消退;骨龄差/年龄差(△BA/△CA)值从1.35±0.64下降为0.65±0.36(P＜0.001),最终身高的预测值从(153.3±3.6)cm增加至(158.5±4.3)cm(P＜0.001).结论联合治疗的方法不仅可显著改善患儿的下丘脑-垂体-卵巢轴功能及内生殖器官的发育,而且可明显减慢骨骼生长,延缓骨骼成熟,从而可防止骨骺过早融合并改善最终身高.

Clinical Study on Treatment of Female Idiopathic Precocious Puberty with Combined Therapy of Chinese Medicine and Megestrol Acetate

OBJECTIVE: To find effective therapeutic approach for treating true idiopathic precocious puberty suitable to our national condition and different from gonadotrophin releasing hormone agonist. METHODS: One hundred and six girls with idiopathic precocious puberty were divided into 3 groups. The 51 girls in the combination therapy group were treated with megestrol acetate (MA) and Chinese medicine for nourishing Yin and removing Fire, the 35 girls in the MA treated group were treated with MA alone and the other 20 girls were given no treatment at all as control. Luteinizing hormone releasing hormone (LHRH) stimulating test was performed before and after treatment, and size of uterus and ovary, linear growth rate, X-ray bone age measurement and final height prediction were also observed simultaneously. RESULTS: After being treated with combination therapy for 2.7 years in average, in the combination therapy group, the luteinizing hormone peak value of LHRH stimulating test was reduced from 48.5 +/- 37.1 IU/L to 12.2 +/- 9.3 IU/L (P < 0.001), size of uterus and ovary decreased, secondary sexual characteristics regressed, the bone age difference/chronological age difference value (delta BA/delta CA) reduced from 1.35 +/- 0.64 to 0.65 +/- 0.36(P < 0.001), and predictive final height increased from 153.3 +/- 3.6 cm to 158.5 +/- 4.3 cm (P < 0.001). CONCLUSION: Combination therapy could not only modulate the function of hypothalamic-pituitary-ovarian axis and the development of internal genitalia, but also could slow down skeletal growth, delay skeletal maturation, and thereby prevent premature epiphyseal fusion and increase the final height of patients.