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儿童性早熟及身高受损的中医治疗经验及思考

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性早熟临床表现为第二性征提前发育,可引起生长速率增快、骨骼成熟迅速、骨骺闭合过早等,如不及时干预易引起患儿成年后矮身材、增加内分泌疾病罹患风险.西医治疗本病首选促性腺激素释放激素拟似剂,通过调节下丘脑-垂体-性腺轴显著抑制性发育进程,但在患儿身高获益方面尚有争议.中医药疗法已被研究证实在改善患儿症状、调节性激素水平、延缓性腺发育和改善身高受损、增加成年终身高方面安全有效.熊磊教授认为本病核心病机为肾阴亏虚、相火妄动,治当滋阴培本,降火清源.同时,对伴见肝经郁热者,佐以疏肝泻火之法;对痰湿内蕴者,佐以健脾化痰之法;对中焦失和者,佐以健脾和胃之法.针对快速进展型患儿,可联合使用促性腺激素释放激素拟似剂;针对生长发育迟缓、身高受损患儿,应当考虑加用重组人生长激素,尽可能使其身高获益.
Experience and reflection on traditional Chinese medicine treatment for precocious puberty in children and impaired height
The clinical manifestation of precocious puberty is the premature development of secondary sexual characteristics,which can cause increased growth rate,rapid skeletal maturation,premature epiphyseal closure,etc.If not treated in time,it may cause children to be short in adulthood and increase the risk of endocrine diseases.Gonadotrophin releasing hormone analogue is the first choice in the treatment of this disease in western medicine,which can significantly inhibit the sexual development process by regulating the hypothalamic-pituitary-gonadal axis,but there is still controversy in terms of benefits to children's height.Traditional Chinese medicine therapy has been proven to be safe and effective in improving children's symptoms,regulating sex hormone levels,delaying gonadal development,improving height impairment,and increasing adult height.Professor Xiong Lei believes that the core pathological mechanism of this disease is kidney-yin deficiency and hyperactivity of liver-yang fire.The treatment should be nourishing yin to strengthen the root,and lowering fire to clear sources.At the same time,for the patients with stagnated heat of liver channel,the method of dispersing stagnated liver qi and clearing fire is used;for those with internal retention of phlegm-dampness,the method of invigorating spleen to dissipate phlegm is used;for those with disharmony in the middle jiao,the method of invigorating spleen and harmonizing stomach is used.For children with rapid progression,gonadotrophin releasing hormone analogue can be used at the same time;for children with growth retardation and height impairment,recombinant human growth hormone should be considered to maximize their benefits to the height.

Precocious pubertyPremature thelarcheImpaired heightZhibai Guiyuan decoction

熊磊、贺喜盈、曹婷

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650021 昆明,云南中医药大学第一附属医院儿科

性早熟 乳房早发育 身高受损 知柏龟元汤

2024

中国中西医结合儿科学
中国医师协会,辽宁省基础医学研究所,辽宁中医药大学附属医院

中国中西医结合儿科学

影响因子:1.03
ISSN:1674-3865
年,卷(期):2024.16(5)