滋阴泻火方对性早熟女童骨代谢影响的临床研究

Clinical study on the effect of Ziyin Xiehuo Formulation on bone metabolism in girls with precocious puberty

关键词:  滋阴泻火  性早熟  骨代谢  临床研究

Key words:  Ziyin Xiehuo Formulation  precocious puberty  bone metabolism  Clinical research

摘要:

[目的] 探讨滋阴泻火方对中枢性性早熟女童骨代谢的影响。[方法] 选取2018年10月—2020年1月就诊于南京中医药大学附属医院生长发育专科门诊，经GnRHa激发试验诊断为特发性中枢性性早熟（ICPP）女童80例，其中中药组45例，西药组35例，中药组予滋阴泻火方为基础治疗，西药组予促性腺激素释放激素类似物（GnRHa）治疗。另外选取同一时间段就诊的健康女童20例作为空白对照组。ICPP女童在治疗前、治疗6个月后分别检测骨代谢相关指标，包括骨龄（BA）、总Ⅰ型胶原氨基末端肽（tPINP）、胰岛素样生长因子-1（IGF-1）、Ⅰ型胶原羧基末端肽（β-CTX）、血清骨钙素（BGP），血清碱性磷酸酶（ALP）、血清25（OH）D₃等，并分析相关结果。[结果] ICPP女童BA/CA、BGP、tPINP、β-CTX、25（OH）D₃与空白对照组具有显著统计学差异（P<0.01），ICPP女童BGP、tPINP、β-CTX显著高于健康女童，而25（OH）D₃水平则显著低于健康女童。经过6个月短期的疗效评价发现中药组总有效率达80%，与西药组86%相比差异无统计学意义（P>0.05）。ICPP女童经过6个月干预后再次检测骨代谢指标，结果显示：西药组治疗前后tPINP、BGP、β-CTX均呈现下降趋势，差异具有统计学意义（P<0.05）；中药组治疗前后tPINP、BGP、β-CTX、IGF-1、25（OH）D₃差异具有统计学意义（P<0.05），tPINP、BGP、β-CTX呈现显著下降趋势，而IGF-1、25（OH）D₃有升高的趋势，ALP水平治疗前后差异无统计学意义（P>0.05）。[结论] 滋阴泻火类中药对于ICPP的治疗具有显著的临床疗效，同GnRHa类似，此类中药对机体骨代谢具有一定影响，可以降低骨转换速率，降低相关骨代谢生化标志物浓度，其中以抑制成骨细胞活动为主。

Abstract:

[Objective] To investigate the effect of Ziyin Xiehuo Formulation on bone metabolism in girls with central precocious puberty.[Methods] The 80 idiopathic central precocious puberty (ICPP) girls were selected by GnRHa stimulation test from October 2018 to January 2020 in our hospital. ICPP girls were divided into traditional Chinese medicine (TCM)group and Western medicine (WM) group,respectively in Ziyin Xiehuo Formulation and GnRHa (including triptorelin and leuprorelin) treatment. And 20 healthy girls in the same period were selected as the blank control group. Bone metabolism related indicators were detected,including bone age (BA),total collagen type Ⅰ amino-terminal peptide (tPINP),insulin-like growth factor 1 (IGF-1),collagen type Ⅰ carboxyl terminal peptide (beta CTX),serum osteocalcin (BGP),serum alkaline phosphatase (ALP) and serum 25(OH)D₃ before and 6 months after treatment,respectively.[Results] ICPP group has significant statistical difference (P<0.01) compared with blank control group in BA/CA,BGP,tPINP,25(OH)D₃ and beta CTX;ICPP girls' BGP,tPINP and beta CTX were significantly higher than healthy girl,however,25(OH)D₃ level was significantly lower than healthy girl. After 6 months of short-term efficacy evaluation,it was found that the total effective rate in the TCM group was up to 80%,with no statistically significant difference from 86% in the WM group (P>0.05). After 6 months intervention,the results showed that the tPINP,BGP and beta CTX all showed a trend of decline in WM group before and after treatment,statistically significant difference (P<0.05);before and after treatment of TCM group,the tPINP,BGP,beta CTX,IGF-1 and 25(OH)D₃ differences statistically significant (P<0.05),tPINP,BGP,beta CTX showed significant decline,and IGF-1,25(OH)D₃ has a tendency to rise,ALP level has no statistically significant difference(P>0.05).[Conclusion] Traditional Chinese medicine of Ziyin Xiehuo Formulation has a significant clinical effect on the treatment of ICPP. Similar to GnRHa,this kind of medicine has a certain effect on the bone metabolism of the body,which can reduce the bone conversion rate and the concentration of relevant biochemical markers of bone metabolism,mainly inhibiting the activity of osteoblasts.