曲普瑞林治疗特发性中枢性性早熟女童的疗效观察

目的 观察促性腺素释放激素类似物曲普瑞林(达菲林)治疗女童特发性中枢性性早熟(ICPP)的疗效.方法 采用曲普瑞林治疗12例ICPP女童18～24个月,观察其第二性征和生长速率变化,观察治疗前后B超(子宫、卵巢)、X线片骨龄、促性腺激素释放激素(LHRH)激发试验,用国际统一标准Greulich-Pyle图谱方法评估骨...     

促性腺激素释放激素类似物（曲普瑞林）治疗女童特发性中枢性性早熟23例疗效观察

目的观察促性腺激素释放激素类似物（曲普瑞林）治疗女童特发性中枢性性早熟（ICPP）的临床疗效。方法应用曲普瑞林治疗23例ICPP女童6个月,观察治疗前后第二性征、子宫、卵巢、骨龄（BA）、血清雌二醇（E2）、促性腺激素释放激素（GnRH）激发试验激素水平、预测成人终身高的变化及药物副反应。结果治疗后患儿乳房、子宫、卵巢体积均有缩小,E2、促黄体生成激素（LH）、卵泡刺激素（FSH）峰值均显著降低,骨龄成熟延迟,骨龄/实际生活年龄（BA/CA）值下降,预测成人终身高治疗前为（155.5±0.81）cm,治疗后为（157.0±0.81）cm,较治疗前有改善,差异具有统计学意义（P〈0.01）。结论曲普瑞林治疗ICPP能够抑制性腺轴及性腺发育,延缓BA成熟,最终对改善成人终身高有意义。     

女童性早熟200例性激素激发诊断试验临床分析

目的验证促性腺激素释放激素（GnRH）激发试验在性早熟鉴别诊断中的意义。方法 200例性早熟女童,其中真性性早熟78例,假性性早熟122例;所有患儿均行GnRH激发试验,检测血清促黄体生成素（LH）和促卵泡刺激素（FSH）含量,注射前加检血清E2含量。观察血清E2含量、LH和FSH的基础值和峰值。结果真性性早熟组LH、FSH峰值明显高于基础值,差异有统计学意义（P〈0.01）;假性性早熟组LH、FSH峰值与基础值比较差异无统计学意义（P〉0.05）。结论 GnRH激发试验在性早熟的鉴别诊断中有重要意义。     

高渗盐水激发试验和运动激发试验用于诊断儿童哮喘的对比观察

目的　研究高渗盐水激发试验及运动激发试验在哮喘儿童的临床应用,旨在寻求更适合哮喘儿童的气道反应性检测的方法。方法　收集中国医科大学附属 盛京医院2007年5月至2008年6月符合儿童支气管哮喘防治常规诊断　标准的哮喘缓解期患儿34例,年龄5～13岁,在规定时间内先后做气道高渗盐水激发试验和运 动激发试验。结果　同一哮喘患儿高渗盐水激发试验的敏感性显著高于运动激发试验（P < 0.01）。结论　高渗盐水激发试验的敏感性和特异性高于运动激发试 验,而且设备低廉,方法简单、易配合,安全,副反应少,尤其适用于在哮喘治疗期间动态观察儿童气道的反应性,对指导药物治疗有重要价值。     

哮喘儿童呼出气一氧化氮与肺功能、激发试验、哮喘控制测试评分相关性研究

目的 探讨哮喘儿童急性发作期和临床缓解期呼出气一氧化氮（FeNO）水平与肺功能（FEV1）、儿童哮喘控制测试（C-ACT）评分的相关性,临床缓解期哮喘儿童FeNO水平与运动激发试验的相关性.方法 哮喘儿童急性发作期135例（发作期组）,临床缓解期115例（缓解期组）,健康体检儿童140例（对照组）,均进行FeNO测定、FEV1检测和C-ACT评分,分析哮喘不同时期FeNO水平与FEV1、C-ACT是否存在相关性.同时临床缓解期哮喘儿童进行运动激发试验,分析缓解期FeNO水平与运动激发试验是否存在相关性.结果 （1）发作期组FeNO、FEV1与对照组比较差异有统计学意义（P＜0.000 1）;发作期组FeNO、FEV1与缓解期组比较差异有统计学意义（P＜0.000 1）;缓解期组FeNO与对照组比较差异有统计学意义（P＜0.000 1）,而FEV1与对照组比较差异无统计学意义（P＞0.05）.（2）发作期组FeNO与FEV1之间存在负相关（r=-0.181,P=0.035）,缓解期组及对照组的FeNO与FEV1之间无相关性.（3）缓解期组FeNO与运动激发试验之间存在正相关（r=0.230,P=0.013）.（4）发作期组、缓解期组FeNO与C-ACT评分之间存在负相关（r=-0.213,-0.209,P=0.013,0.025）.结论 哮喘儿童FeNO水平可用于评估哮喘病情的控制程度.运动激发试验是评估哮喘气道高反应的另一简易测定方法.     

MRI对子宫发育异常的诊断价值

子宫发育异常是不孕症及产科并发症的重要原因,其正确诊断和分型对临床治疗有非常重要的指导意义。近年来MRI发展迅速,新序列、新技术不断出现,对子宫可行多参数、多平面和多方位成像,加之MRI检查的无创、无辐射、软组织分辨率高等优势,已成为子宫最佳的检查方法之一。因此,MRI对子宫发育异常诊断和分型中的作用日益引起妇产科和影像科医师的重视。     

早孕期超声检查诊断胎儿畸形的临床价值

目的：探讨早孕期超声检查诊断胎儿畸形的临床价值。方法：选取我院2011年12月至2013年12月接收的行早孕期超声检查的1085例孕妇为研究对象,检查指标包括颈项透明带厚度、鼻骨长度、三尖瓣血流与静脉导管血流频谱,并观察胎儿心脏、胃泡、四肢与头颅结构,参照孕妇意愿决定是否终止异常妊娠;剩余孕妇均行中孕期超声检查,并对其最终的妊娠结局进行追踪。结果：纳入研究的行早孕期胎儿异常检查的检出率为6．6％（72例）;1045例孕妇行中孕期超声检查,胎儿异常检出率为5．3％（55例）。结论：早孕期行超声检查时,早发性、严重性异常胎儿的检出率较高,但不能取代中孕期超声检查。     

斜板试验诊断小儿血管迷走性晕厥的价值及饮水试验的防治效果

目的探讨小儿血管迷走性晕厥(VVS)的诊断及防治方法。 方法分析1999-10—2004-07上海交通大学附属儿童医院开展斜板试验(TT)(倾斜角度80°，试验时间持续30min)的状况，对不明原因晕厥组74例 及正常对照组54例进行前瞻性研究，对TT阳性组加做阳转阴试验，予以饮水试验，并随访。 结果基础TT在不明原因晕厥组中阳性41例，阳性率为55.4%,对照组为0(P<0.001)。阳性组表现血管抑制型21例,心脏抑制型7例，混合型13例； 28/41(68.3%)例患儿经饮水后阳转阴；随访38例TT阳性患儿，总有效率86.8%。 结论TT对诊断小儿血管迷走性晕厥有较高的敏感性(55.4%)和特异性(100%)。阳转阴试验为防治小儿血管迷走性晕厥提供了理论和实验依据，饮 水试验是一种简单有效可行的防治措施。     

运动平板试验对诊断冠心病的价值分析

目的:评估运动平板试验在冠心病诊断中的价值。方法:选择有症状疑诊冠心病的病例100例,行心电图、运动平板试验及冠脉造影检查,以冠脉造影结果为对比分析,计算运动平板试验对冠心病患者诊断的敏感性、特异性、阳性预测值、阴性预测值、准确性指标。结果:运动平板试验对冠心病诊断的敏感性为81.63%,特异性为72.54%,阳性预测值为74.07%,阴性预测值为80.43%,准确性为77.00%。结论;运动平板试验对协助临床诊断冠心病有较高的价值。     

舌下含服硝酸甘油倾斜试验诊断儿童血管迷走性晕厥的价值

目的 探讨舌下含服硝酸甘油倾斜试验(SNHUT)对儿童血管迷走性晕厥(VVS)的诊断价值。 方法 2001年3月至2005年5月在中南大学湘雅二医院儿童晕厥专科就诊或住院的不明原因晕厥(UPS)患儿143例，年龄4~18(12.10±3.03)岁，男58例，女85例。电动倾斜床直立倾斜70°行基础直立倾斜试验(BHUT)，并对其阴性者中的64例在同一角度直接给予舌下含服硝酸甘油片0.2mg，再次评价试验结果。用SPSS 11.0软件进行微机统计学处理。 结果 (1)BHUT阳性率29.4%(42/143)，其中女性占73.8%(31/42)；SNHUT 64例，阳性44例，阳性率为68.7%。SNHUT显著地提高了VVS的检出率。(2)出现阳性结果的时间：BHUT为(21.31±13.24)min，SNHUT为(5.41±4.23)min。(3)反应类型：BHUT及SNHUT阳性患儿共86例，血管抑制型83.7%(72/86)，女性占53.5%(46/86)；心脏抑制型7.0%(6/86)，均为女性；混合型9.3%(8/86)，女性占62.5%(5/8)。(4)副反应：舌下含服硝酸甘油64例，未见明显不耐受现象或其他副反应。 结论SNHUT能提高儿童VVS诊断阳性率，副反应小，使用方便，可在儿科临床推广。     

Comparison of triptorelin acetate vs triptorelin pamoate in the treatment of Central precocious puberty (CPP): a retrospective study

Abstract

The aim of this study is to compare the clinical and biochemical outcomes of triptorelin acetate (TPA) versus triptorelin pamoate (TPP) treatment in girls with central precocious puberty. A total of 60 patients with idiopathic CPP were retrospectively recruited. Thirty girls were treated with triptorelin acetate 3.75?mg/month (TPA group) and thirty girls in a second group received triptorelin pamoate 3.75?mg/4?weeks (TPP group). Patient follow-up at 12 and 24?months included GnRH Test at 12?months and baseline LH at 24?months. Patients were monitored with pelvic ultrasound, X-Ray of the hand and wrist and anthropometric evaluations. A total of 60/60 girls showed a good response to both formulations. Significant reductions in basal and LH peaks, estradiol values, breast pubertal stage, progression of bone age and growth velocity rate after 12?months treatment were obtained in both groups, demonstrating the equivalence of the two formulations in regulating the hypothalamic–pituitary-gonadal (HPG) axis. Triptorelin pamoate provided a more effective and significant reduction in LH peak after 12?months in comparison with triptorelin acetate more effective in reducing ovarian volume and endometrial thickness. Both formulations were equivalent, even though the LH peak was significantly lower in girls treated with triptorelin pamoate     

青春早期SD雌性大鼠在阿霉素肾病模型过程中生长发育的变化

目的观察青春早期SD雌性大鼠在阿霉素肾病模型过程中生长发育的变化。方法选取4周龄SPF级雌性SD大鼠10只,随机分为观察组和对照组各5只。观察组大鼠经尾静脉注射阿霉素6.5mg/kg制备肾病模型,对照组大鼠经尾静脉注射等量生理盐水。观察阿霉素注射后1、2、3、4周SD大鼠体质量、子宫湿重、头尾长、胫骨长度变化及测定24h尿蛋白;透射电镜下观察足细胞超微结构变化;放射免疫法分析血清雌二醇(E_2)、促黄体生成素(LH)、促卵泡生成素(FSH)、胰岛素样生长因子1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)的变化。结果阿霉素注射后4周青春早期SD雌性大鼠尿蛋白显著高于对照组,差异有统计学意义(P0.05)。青春期雌性SD大鼠在阿霉素注射后足细胞足突融合逐渐加剧,在阿霉素注射后4周雌性SD大鼠肾小球足细胞足突出现广泛融合。观察组体质量在阿霉素注射后2、3、4周减轻逐渐加剧,与对照组比较差异有统计学意义(P0.05)。观察组头尾长在阿霉素注射后4周较对照组明显减少,差异有统计学意义(P0.05)。观察组胫骨长度和子宫湿重在阿霉素注射后2、3、4周后与对照组比较无明显减少,差异无统计学意义(P0.05)。观察组血清LH、FSH、E_2、IGF-1和IGFBP-3在阿霉素注射后2、3、4周与对照组比较无明显改变,差异无统计学意义(P0.05)。结论青春早期雌性SD大鼠在阿霉素肾病模型过程中未出现明显的生长发育迟滞,血清生长相关激素和性激素分泌未出现明显降低。     

Serum Makorin ring finger protein 3 values for predicting Central precocious puberty in girls

This study evaluated the serum level of MKRN3 and investigated its diagnostic usefulness in girls with central precocious puberty (CPP). In total, 41 girls with CPP and 35 age-matched normal control girls were enrolled. Serum values of MKRN3 were measured in both groups. Gonadotropin and estradiol concentrations were evaluated after 6 and 12?months of GnRH agonist (GnRHa) treatment in CPP patients. The MKRN3 concentrations were much lower in the patient group than in the control group (p?=?.005). Over 1 year of GnRHa treatment in patients, the gonadotropin concentrations were significantly decreased (p?<?.05), while the MKRN3 concentrations were unchanged (p?>?.05). MKRN3 levels were inversely correlated to standard deviation (SD) in height (r?=??0.46, p?=?.000), SD in weight (r?=??0.32, p?=?.005), Tanner stage (r?=??0.41, p?=?.000), and bone age (r?=??0.46, p?=?.000). Based on ROC analysis, the area under curve was 0.758 for MKRN3, with 82.9% sensitivity and 68.5% specificity. The measurement of serum MKRN3 level may provide some help for CPP prediction, but relatively various values need further validation     

Biophysical parameters of early puberty in girls

OBJECTIVE: The appearance of breast development in girls characterizes an early period of puberty. Ultrasonographic examinations of the uterus and ovaries make possible the estimation of first pubertal changes in sexual organs. DESIGN: The aim of this work was to study the clinical and ultrasonographical features of early puberty in girls. MATERIAL AND METHODS: 33 healthy girls were observed quarterly in the course of prepuberty. Body mass, height, body mass index (BMI), quantity of adipose tissue were investigated. Stage of puberty was established according to Tanner. The uterus and ovaries were studied ultrasonographically, and the volume of the uterine body, length of the cervix and ovarian volume and size of ovarian follicles were scrutinised. RESULTS: Statistical differences were observed in weight, height, quantity of adipose tissue and the volume of body and that of the uterus, in length of the cervix between prepuberty and early puberty periods. Luminastity of mucus in the cervical canal in half of girls in the breast stage M1 was obtained. CONCLUSION: Ultrasonographic investigations of internal sexual organs with estimation of clinical sexual features are helpful in examination of early stage of puberty.     

曲普瑞林治疗子宫肌瘤的临床疗效及安全性研究

目的 观察曲普瑞林治疗子宫肌瘤的临床疗效及安全性。方法 采用多中心的前瞻性随机对照临床研究,于2002年12月—2004年3月,将确诊的125例子宫肌瘤患者随机分为研究组,63例,接受臀部肌内注射曲普瑞林3．75mg治疗;和对照组,62例,接受前臂皮下注射亮丙瑞林3．75mg治疗。两组均为每28d注射药物1次,共治疗3个月。观察月经情况、子宫与子宫肌瘤体积以及血清雌二醇水平等变化。结果 125例均完成治疗。两组治疗前子宫及最大子宫肌瘤体积比较,差异均无统计学意义(P＞0．05)。但两组治疗后子宫及最大子宫肌瘤体积较治疗前均明显缩小,两组组内治疗前后比较,差异均有统计学意义(P＜0．01)。研究组和对照组治疗后子宫体积较治疗前分别平均缩小51％(中位数,下同)和49％,最大子宫肌瘤体积分别平均缩小50％,和48％,两组间比较,差异均无统计学意义(P＞0．05)。研究组和对照组治疗后血清雌二醇达到去势水平(＜183pmol／L)的比例均为94％(59／63,58／62)。研究组和对照组治疗3个月时的闭经率分别为97％(61／63)和95％(59／62)。患者治疗后痛经、非经期下腹痛和压迫症状等均迅速缓解,两组比较,差异均无统计学意义(P＞0．05)。两组药物副反应总的发生率均为71％(45／63,44／62);主要副反应为注射药物后2周左右发生阴道出血及低雌激素症状;研究组和对照组分别有9例和6例因症状明显给予替勃龙1．25～2．50mg／d口服治疗。结论 曲普瑞林治疗子宫肌瘤3个月的临床疗效确切,无严重副反应。     

中国城市儿童性早熟现状的调查研究

目的对国内城市儿童性早熟现状进行调查,为制定有效的预防策略,并推动儿童性早熟的临床规范化和个性化治疗提供理论依据。方法 2014年3月至12月在全国范围内开展"中国城市儿童性早熟现状调研"活动。调研共收集来自全国10余省市的2 687份问卷,其中1 714份问卷纳入统计分析。结果调查人群大多分布在全国10个主要省市,包括北京、上海、重庆、江苏、湖北等;调查患儿以女童为主,其男女比例约1∶16。诊断为中枢性性早熟的患者占75.79%(1 299/1 714);调查中初次诊断为中枢性性早熟患者占88.91%(1 524/1 714)。调查患者的骨龄为(10.00±1.77)岁,高于实际年龄(8.29±1.60)岁,差异有统计学意义(P0.001);初次诊断为CPP的患者的骨龄为(10.11±1.70)岁,高于实际年龄(8.35±1.57)岁,差异均有统计学意义(P0.001)。结论国内城市儿童性早熟就诊患者的年龄偏大,为防止患者就诊时已错过最佳的干预和治疗时机,应引起对疾病筛查的高度重视,做到早发现、早诊断和早治疗。     

2~10岁性早熟女童骨密度检测分析

目的探讨性早熟对2~10岁女童骨密度的影响。 方法选择2003 01—2006 01在湖南省儿童医院内分泌专科就诊的2~10岁性早熟(明确诊断、并排除影响骨代谢性疾病)女童237例，根据真、假性性早熟(CPP、PPP)分为2组，各组再按年龄组分层，采用单光子骨矿物质密度测定仪测量左手桡骨中远1/3处桡、尺骨密度(BMD)，并与同龄健康女童进行对比和分析。 结果CPP、PPP和健康组BMD均随年龄增长而增加，3组各年龄桡骨BMD均高于尺骨；CPP桡、尺骨BMD均相对较高，8~10岁组中CPP较对照组约高6.4%~8.6%；3组桡、尺骨BMD均在8~10岁增长加速，特别是尺骨(P<0.05)，分别较6~7岁组增长20.4%、17.8%和14.3%；以CPP组增幅最大，明显高于健康组，与健康组(6~7岁)增长比较差异有显著性(桡骨P<0.05、尺骨P<0.001)。PPP组则与健康女童差异不显著。 结论健康女童骨矿化自9岁起开始青春期加速，CPP女童青春期尺骨生长加速的年龄提早，BMD相应增加，而PPP不像CPP那样明显影响女童的正常骨骼发育。     

Inhibin B as a screening tool for early detection and treatment monitoring of central precocious puberty

Abstract

Anti-Müllerian hormone (AMH) and inhibin B are considered possible biomarkers of central precocious puberty (CPP). The aim of this study was to evaluate serum levels of AMH and inhibin B, to investigate their regulatory patterns, and to study their clinical significance in girls with CPP. In total, 48 girls with CPP and 35 age-matched prepubertal control girls were enrolled in the study. AMH and inhibin B levels were determined in the CPP and control groups. In the patient group, AMH and inhibin B levels were evaluated during 1?year of gonadotropin releasing hormone analog (GnRHa) treatment. The mean inhibin B level in the CPP group was significantly higher than that in the control. AMH levels were not different between the two groups. After GnRHa treatment. AMH and inhibin B levels decreased significantly. Based on the ROC analysis, the cutoff value for inhibin B to determine CPP was 19.59?pg/mL, with 83.3% sensitivity and 82.9% specificity, and the area under the curve was 0. 852. Inhibin B was useful for determining CPP and the therapeutic effects of GnRHa treatment in girls with CPP. AMH interacted, in part, with the hypothalamo-pituitary gonadal axis, but its clinical implications in CPP should be further investigated.     

The usefulness of circulating levels of leptin,kisspeptin, and neurokinin B in obese girls with precocious puberty

This study investigated the relationships of circulating leptin, kisspeptin, and neurokinin B (NKB) levels with precocious puberty (PP) in overweight/obese girls and evaluated the usefulness of these markers in the initiation of puberty. One hundred and twenty-eight girls aged 7.0–8.9?years with PP (group A, normal-weight; group B, overweight/obese) and 30 age-matched normal controls (NC) were enrolled. Serum levels of leptin, kisspeptin, and NKB were measured by commercial kits. Serum leptin levels were higher in group A (4.21?ng/mL) and B (5.64?ng/mL) compared to the NC (2.35?ng/mL, p?p?=?.018). Serum NKB levels were not different among the three groups. The predictive value of leptin (AUC =0.791) was lower than that of IGF-1 (AUC =0.917, p?=?.009), although both were significant markers for PP in the regression analysis. BMI z-score (AUC =0.806) was a predictive factor of PP. In conclusion, a higher level of leptin, IGF-1, and fatness in overweight/obese girls with PP compared to the NC confirms their roles in the regulation of puberty. Further research is needed if the effects of kisspeptin and NKB on puberty are limited at the levels of neurons or target tissue.     

两种短效曲普瑞林降调节方案诱发排卵效果比较

目的:比较两种剂量短效曲普瑞林降调节方案促排卵的效果。方法:将接受超促排卵降调节长方案的178例患者分为两组,A组86例,从前一月经周期的第21天始,每天皮下注射短效曲普瑞林0.1mg 10~21天降调节后,减量至0.05mg/d直至注射HCG日;B组92例,从前一月经周期第21天始隔日1次皮下注射短效曲普瑞林0.1mg 10~21天降调节后减量至0.05mg/d直至注射HCG日,比较两组的获卵率、优质胚胎、胚胎冷冻率、着床率、妊娠率、继续妊娠率、激素水平等。结果:A组获卵率、优质胚胎数、优质胚胎率、冻胚率较B组高(P<0.01);着床率、临床妊娠率、继续妊娠率A组较B组有增高趋势。结论:月经周期第21天始,皮下注射短效曲普瑞林0.1mg/d降调节效果最好。