500例上海地区性早熟女童中医证型分布特点的多中心研究

A multicenter study on the distribution characteristics of traditional Chinese medicine syndrome types in 500 cases of precocious puberty girls in Shanghai

目的性早熟作为一种现代儿科疾病,发病率呈逐年上升趋势。本课题通过在上海不同区域的性早熟女童进行病例收集,运用中医证候评分的方法确定性早熟女童的中医证型,并观察性早熟女童的主要证候特征,为早期发现、诊断和治疗性早熟提供依据,为性早熟中医标准化诊治提供参考。方法采集2013年1月-2016年6月在上海6家医院儿科性早熟门诊就诊的性早熟女童500例病例的中医证候,对其临床症状按照中医临床症状轻重程度"无""轻""中""重"4个等级进行量化评分,分别记为0、2、4、6分,统计相应分值,依据其分值分析总结患儿的中医辨证分型特点。对病例进行中医辨证,分为阴虚火旺证、肝郁化火证、湿热内蕴证三大中医证型的构成比进行统计分析。结果三大证型中,阴虚火旺证的比例最高(315例,占63.0%),其次是湿热内蕴证(98例,占19.6%)及肝郁化火证(87例,占17.4%)。在中医证候方面,临床症状最常见的10项症状(频率>25.0%)依次为:怕热盗汗、手足心热、乳房胀痛、脉细数、烦躁易怒、大便干结、潮热、咽干口燥、多食肥甘、舌红少苔。结论阴虚火旺证是本次研究占最大比例的中医证型,湿热内蕴证和肝郁化火证的比例相近。研究性早熟女童的中医证型有助于观察性早熟女童的早期临床症状以及早期诊断,为辨证用药提供有力的线索和依据。

Objective The incidence of precocious puberty,one of the common diseases currently,increases year by year.By collecting the cases of girls with precocious puberty throughout Shanghai,we applied the TCM syndromes score sheet to determine the main syndromes of precocious puberty,and observed the main syndromes characteristics of precocious puberty to provide the evidence for early detection,diagnosis and treatment,and to provide reference for standardized diagnosis and treatment of precocious puberty in TCM.Methods e analyzed syndromes of 500 girls with precocious puberty from pediatric departments of 6 hospitals throughout Shanghai from January 2013 to June 2016.In accordance to the severity of clinical symptoms by TCM,we scored 0,2,4,6 to match with nil,light,middle,serious,and calculated the scores to summarize the characteristics of TCM Syndrome.There were three types of TCM syndromes,Yin deficiency and Fire prosperity(315 cases,occupied 63.0%),damp-heat smoldering(98 cases,19.6%)and liver constraint transforming into fire(87 cases,17.4%).For TCM syndromes,the top ten clinical syndromes(more than 25.0%by frequency)were fear of heat and night sweats,feverishness in palms and soles,swollen breasts,pulse breakdown,dysphoria,dry stool,tidal fever,the mouth swallows dry does,eating too much sweet and greasy food,red tongue with little coating.Conclusion The number of Yin deficiency and Fire prosperity is the largest,while the number of damp-heat smoldering is close to that of liver constraint transforming into fire.The research on the TCM syndrome of girls with precocious puberty is useful to not only observe the early clinical symptoms and early diagnosis,but also provide sounded clues and evidence for diagnosis and prescription.