促性腺激素释放激素激动剂联合滋阴疏肝方加减治疗女童特发性中枢性性早熟的疗效观察

Efficacy of Gonadotropin Releasing Hormone Agonist in Combination with Modified Nourishing Yin and Dispersing Stagnated Liver Qi Formula in the Treatment of Idiopathic Central Precocious Puberty in Girls

目的:探究在促性腺激素释放激素激动剂(GnRH-a)治疗基础上加用滋阴疏肝方加减治疗女童特发性中枢性性早熟(ICPP)的疗效。方法:选取某院2020年1月~2022年2月生长发育门诊收治的106例患儿为研究对象,采用随机数字表法分为观察组与对照组,每组53例。对照组采用GnRH-a治疗,观察组在对照组治疗基础上加用滋阴疏肝方加减。观察两组治疗前后黄体生成素(LH)、促卵泡激素(FSH)、LH/FSH、雌二醇(E_(2))、胰岛素样生长因子-1(IGF-1);计算骨龄指数、预测成年身高及身高标准差分值;检测子宫、卵巢容积及直径>4mm的卵泡数量;观察两组临床疗效和不良反应发生率。结果:治疗前,两组LH、E_(2)、FSH、IGF-1、LH/FSH水平比较均无统计学差异(P>0.05);治疗后,LH、E_(2)、FSH、IGF-1、LH/FSH水平均降低,且观察组低于对照组(P<0.05)。治疗前,两组骨龄指数、预测成年身高、身高标准差分值比较均无统计学差异(P>0.05);治疗后,两组骨龄指数、身高标准差分值绝对值水平均降低,且观察组低于对照组,而两组预测成年身高均有所提高,且观察组高于对照组(P<0.05)。治疗前,两组子宫、卵巢容积及直径>4mm的卵泡数量比较均无统计学差异(P>0.05);治疗后,两组子宫、卵巢容积及直径>4mm的卵泡数量均降低,且观察组低于对照组(P<0.05)。观察组治疗总有效率(96.23%)高于对照组(81.13%,χ^(2)=6.014,P=0.014)。观察组不良反应发生率(3.78%)略低于对照组(7.56%),但无统计学差异(χ^(2)=0.706,P=0.401)。结论:GnRH-a联合滋阴疏肝方加减能有效改善ICPP患儿的临床症状,有助于缓解青春期的提前到来、恢复性激素水平。

Objective:To evaluate the efficacy of gonadotropin releasing hormone agonist(GnRH-a)with modified nourishing yin and dispersing stagnated liver qi formula in the treatment of idiopathic central precocious puberty in girls.Methods:A total of 106 children patients admitted to the Department of Growth and Development in a hospital during January 2020 to February 2022 were selected and randomly assigned into observation group and control group with 53 patients in each group.The control group was treated with GnRH-a,and the observation group was treated with modified nourishing yin and dispersing stagnated liver qi formula in addition to GnRH-a.Luteinizing hormone(LH),follicle-stimulating hormone(FSH),LH/FSH,estradiol(E_(2))and insulin-like growth factor-1(IGF-1)were observed before and after treatment for both groups.Bone age index,predicted adult height and standard deviation of height were calculated.Uterine and ovarian volumes and the number of follicles(>4 mm)were determined.The clinical efficacy and incidence of adverse reactions were observed for both groups.Results:Before treatment,there was no statistically significant difference in the levels of LH,E_(2),FSH,IGF-1 and LH/FSH between the two groups(P>0.05).After treatment,the levels of LH,E_(2),FSH,IGF-1 and LH/FSH were decreased,and lower in the observation group than in the control group(P<0.05).Before treatment,there was no statistically significant difference in bone age index,predicted adult height and standard deviation of height between the two groups(P>0.05).After treatment,the bone age index and standard deviation of height in both groups were decreased with lower values in the observation group than in the control group,while the predicted adult height in both groups was increased,and higher in the observation group than the control group(P<0.05).Before treatment,there was no statistically significant difference in the uterine and ovarian volumes and the number of follicles between the two groups(P>0.05).After treatment,the uterine and ovarian volumes and the number of follicles were decreased in both groups,and lower in the observation group than in the control group(P<0.05).The total response rate in the observation group(96.24%)was higher than that in the control group(81.20%,χ^(2)=6.014,P=0.014).The incidence rate of adverse reactions in the observation group(3.78%)was slightly lower than that in the control group(7.56%),without statistically significant difference(χ^(2)=0.706,P=0.401).Conclusion:GnRH-a combined with modified nourishing yin and dispersing stagnated liver qi formula can effectively improve the clinical symptoms,delay puberty,restore gonadal hormone levels in children with ICPP.