儿童性早熟长期GnRHa治疗问题的哲学思辨

Philosophical Thinking on Long-term GnRHa Treatment of Children with Precocious Puberty

关于儿童长期使用促性腺激素释放激素类似物(GnRHa)治疗性早熟改善终身高及身高获益的报道不一,但长期使用GnRHa,对处于身体发育快速的儿童是否将会带来一些新的问题,这是需要辩证看待及解决的问题。一方面,对于儿童性早熟,预防重于治疗,需要早期诊断、早期干预,重视人体自然力在疾病中的作用。另一方面,性早熟的治疗方案需兼顾安全、有效、经济、合理的原则。第三方面,长期治疗的过程中应考虑到药物不良反应的耐受性、患儿身高的满意度、依从性、生活质量、性发育与同龄人发育需求以及家庭经济情况等因素,运用循证医学、药物经济学等方法保护儿童身体健康。

There are different reports about the long-term use of Gonadotropin releasing hormone analogue(GnRHa)to treat children's precocious puberty and improve their adult height or gain height benefits.However,the long-term use of GnRHa will bring some new problems to the children,who are in the rapid physical development.Therefore,it is a problem needed to be solved dialectically.On the one hand,for children with precocious puberty,prevention is more important than treatment.Early diagnosis and intervention are needed,and the role of human body's natural force of recovery from the disease is valued.On the other hand,the treatment of precocious puberty should take into account the principles of safety,effectiveness,economy and rationality.Third,in the process of long-term treatment,we should take into account the tolerance of adverse drug reactions,the height satisfaction of children,compliance,quality of life,sexual development and the development needs of peers,as well as family economic conditions and other factors,and use evidence-based medicine,pharmacoeconomics and other methods to protect children's health.