柴胡疏肝散加减辅助治疗女童中枢性性早熟肝郁化火型26例临床观察

Clinical observation on modified Chaihu Shugan San (柴胡疏肝散) in adjuvant treatment of 26 cases of central precocious puberty in girls with liver depression transforming into fire type

目的观察柴胡疏肝散加减联合促性腺激素释放激素类似物(GnRHa)治疗女童中枢性性早熟肝郁化火型的临床疗效。方法选取2013年10月至2015年11月我院儿科收治的52例中枢性性早熟肝郁化火型女童作为研究对象,随机分为对照组和治疗组,各26例。对照组予GnRHa达菲林治疗,治疗组在对照组治疗方法的基础上联合柴胡疏肝散加减治疗,治疗3月后,比较2组治疗前后血清雌二醇(E_2)、黄体生成素(LH)和卵泡刺激素(FSH)水平,子宫容积,卵巢容积,临床疗效以及不良反应的发生情况。结果治疗后2组E_2、LH和FSH水平均明显下降,与同组治疗前比较,差异均有统计学意义(P<0.01),且治疗组下降更显著(P<0.05)。2组治疗后子宫容积、卵巢容积均较治疗前缩小,但经统计学分析,差异无统计学意义(P>0.05)。对照组总有效率为76.92%,治疗组为96.15%,2组比较,差异有统计学意义(P<0.05)。治疗过程中对照组有2例出现恶心呕吐,经相应处理后均好转,其余均未出现明显不良反应。结论柴胡疏肝散加减联合GnRHa能够显著改善中枢性性早熟肝郁化火型女童的激素水平,避免第二性征过早出现,效果优于单一GnRHa治疗,值得临床推广应用。

Objective To observe the clinical efficacy of modified Chaihu Shugan San(柴胡疏肝散) combined with gonadotrophin releasing hormone analog(GnRHa) in the treatment of central precocious puberty in girls with liver depression transforming into fire type.Methods Fifty-two girls of central precocious puberty with liver depression transforming into fire type admitted to the department of pediatrics in our hospital from October 2013 to November 2015 were chosen as study subjects and they were randomly divided into control group and treatment group,with 26 cases in each.The control group was treated with GnRHa diphereline,and the treatment group was combined with modified Chaihu Shugan San on the basis of the treatment of control group. After treatment for 3 months,the levels of serum estradiol(E2),luteinizing hormone(LH),follicle-stimulating hormone(FSH),the volumes of uterus and ovary,clinical efficacy and the incidence of adverse reactions of the 2 groups before and after treatment were compared.Results After treatment,the E2,LH and FSH levels of the two groups both significantly decreased, the difference was statistically significant compared with the same group before treatment(P<0.01),moreover,the decrease was more significant in the treatment group(P<0.05).After treatment,the volumes of uterus and ovary significantly reduced than those before treatment,but by statistics analysis, the difference was not statistically significant(P>0.05).The total effective rate of the control group was 76.92%,that of the treatment group was 96.15%,the difference was statistically significant between the two groups(P<0.05).Two cases of nausea and vomiting occurred in the control group during the course of treatment,both of them improved after corresponding treatment,and no obvious adverse reactions occurred in the rest.Conclusion Modified Chaihu Shugan San combined with GnRHa in the treatment of central precocious puberty in girls with liver depression transforming into fire type can significantly improve the hormone levels,and avoid premature appearance of secondary sexual characteristics of the girl patients.The effect is superior to that of the treatment of using GnRHa alone,which is worthy of clinical promotion and application.