【摘要】：目的總結(jié)導(dǎo)師王紹潔教授治療單純?nèi)榉吭绨l(fā)育的多年臨床經(jīng)驗(yàn),結(jié)合北方沿海地區(qū)乳房早發(fā)育女童特點(diǎn),在改善飲食結(jié)構(gòu)及生活習(xí)慣的基礎(chǔ)上,以中藥滋陰降火、疏肝健脾、化痰散結(jié)法辨證治療本病,觀察評(píng)價(jià)本法的臨床療效并探究其作用機(jī)理,為改善患兒臨床癥狀、體征,降低中樞性性早熟的轉(zhuǎn)化率提供有效的治療方法。方法90例符合要求的單純?nèi)榉吭绨l(fā)育女童均來(lái)自2014年3月至2015年3月期間大連市兒童醫(yī)院門診,年齡為3-7歲。采用隨機(jī)數(shù)字表法將90例患兒分為觀察組和對(duì)照組各45例。兩組患兒年齡、身高、體重、乳房發(fā)育分期等一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。對(duì)照組以改善飲食結(jié)構(gòu)及生活習(xí)慣進(jìn)行干預(yù)。觀察組在改善飲食結(jié)構(gòu)及生活習(xí)慣的基礎(chǔ)上,以知柏地黃丸為基礎(chǔ)方加減化裁。具體用藥:知母、黃柏、熟地、山藥、茯苓、牡丹皮、瓦楞子、柴胡、白芍、太子參、炙甘草各3-6g,隨證加減。中藥煎湯,每日一劑,分早晚二次口服。療程為3個(gè)月,治療1-2個(gè)療程,用藥期間不予其他中西藥物。兩組患兒觀察隨訪時(shí)間為6-12個(gè)月。治療期間,乳房發(fā)育分期和中醫(yī)證候表現(xiàn)每2周記錄1次,身高、體重、乳腺超聲每1個(gè)月記錄1次,子宮、卵巢超聲每3個(gè)月記錄1次;療程結(jié)束后,乳房發(fā)育分期、中醫(yī)證候表現(xiàn)、身高、體重每3個(gè)月記錄1次,超聲影像學(xué)變化(乳腺、子宮、卵巢)每6個(gè)月記錄1次。骨齡6個(gè)月記錄1次。初診時(shí)進(jìn)行激素水平測(cè)定及促性腺激素釋放激素激發(fā)試驗(yàn),病情變化,3-6個(gè)月復(fù)查。同時(shí),監(jiān)測(cè)觀察組患兒臨床不良反應(yīng)等情況。數(shù)據(jù)用IBM SPSS Statistics 19.0統(tǒng)計(jì)軟件進(jìn)行處理。結(jié)果1.90例患兒中陰虛火旺證所占比例最多,達(dá)41.1%(37例);肝郁化火與痰濕內(nèi)蘊(yùn)證,分別占32.2%和26.7%。2.隨訪結(jié)束后,觀察組總有效率88.9%(治愈25例,好轉(zhuǎn)15例),對(duì)照組總有效率68.9%(治愈10例,好轉(zhuǎn)21例),觀察組療效優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.中醫(yī)證候計(jì)量值比較:治療前,兩組患兒組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,兩組患兒組內(nèi)比較,均較治療前降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01);組間比較,觀察組較對(duì)照組降低明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。4.觀察組中樞性性早熟轉(zhuǎn)化率2.2%(1例);對(duì)照組中樞性性早熟轉(zhuǎn)化率13.3%(6例)。5.觀察組患兒治療后血常規(guī)、尿常規(guī)、便常規(guī)、心電圖及肝、腎功能均未見明顯異常。隨訪過(guò)程中,兩組患兒均未出現(xiàn)明顯不良反應(yīng)。結(jié)論1.女童單純?nèi)榉吭绨l(fā)育以陰虛火旺證為主。2.總結(jié)導(dǎo)師王紹潔教授多年臨床經(jīng)驗(yàn),主張結(jié)合北方沿海地區(qū)乳房早發(fā)育女童特點(diǎn),在改善飲食結(jié)構(gòu)及生活習(xí)慣的基礎(chǔ)上,以中藥滋陰降火、疏肝健脾、化痰散結(jié)法辨證治療本病。3.本法辯證施治、綜合治療、防治結(jié)合,能夠促進(jìn)患兒乳房腫塊消退,有效改善中醫(yī)臨床癥狀、體征,降低單純?nèi)榉吭绨l(fā)育患兒向中樞性性早熟的轉(zhuǎn)化率,安全有效,值得推廣。4.對(duì)于本法治療女童乳房早發(fā)育的遠(yuǎn)期療效有待于進(jìn)一步研究。
[Abstract]:Objective To summarize the clinical experience of Professor Wang Shaojie in the treatment of simple early breast development and to observe and evaluate the clinical efficacy of this method on the basis of improving the dietary structure and living habits of girls with early breast development in northern coastal areas. Methods 90 cases of girls with simple premature breast development were all from the outpatient department of Dalian Children's Hospital from March 2014 to March 2015. The age ranged from 3 to 7 years. There was no significant difference between the two groups in age, height, weight, breast development stage and other general data (P 0.05). The control group was intervened to improve dietary structure and living habits. The observation group was added or subtracted on the basis of improving dietary structure and living habits. Specific medication: Zhimu, Huangbai, Shudi, Yam, Poria cocos, Peony peel, Corrugated seed, Bupleurum, Paeonia lactiflora, Radix Pseudostellariae, Radix Glycyrrhizae, each 3-6 g, with the card add or subtract. Chinese medicine decoction, one dose a day, two oral sooner or later. The course of treatment is 3 months, treatment of 1-2 courses, no other Chinese and Western medicines. During the treatment period, breast development stages and TCM syndromes were recorded once every two weeks, height, weight, breast ultrasound every month, uterus, ovary ultrasound every three months, breast development stages, TCM syndromes, height, weight every three months, ultrasound imaging changes (breast, uterus, ovary) every six months. At the beginning of diagnosis, hormone levels and gonadotropin-releasing hormone provocative test, changes of the disease, 3-6 months follow-up. Meanwhile, the clinical adverse reactions of the observation group were monitored. The data were processed by IBM SPSS Statistics 19.0 statistical software. Results 1.90 cases of children with Yin deficiency and fire hyperactivity syndrome accounted for 1.90 cases. After the follow-up, the total effective rate of observation group was 88.9% (cure 25 cases, improve 15 cases), the total effective rate of control group was 68.9% (cure 10 cases, improve 21 cases), the curative effect of observation group was better than that of control group, the difference was statistically significant (P 0.05). Before treatment, there was no significant difference between the two groups (P 0.05). After treatment, the difference between the two groups was statistically significant (P 0.01). Compared with the control group, the observation group decreased significantly (P 0.01). 4. The conversion rate of precocious puberty was 13.3%(6 cases). 5. There were no obvious abnormalities in blood routine, urine routine, stool routine, electrocardiogram, liver and kidney function in the observation group. Combining the characteristics of girls with early breast development in the northern coastal areas, and on the basis of improving dietary structure and living habits, we should treat the disease by differentiation of symptoms and signs of traditional Chinese medicine, such as nourishing yin and reducing fire, soothing liver and strengthening spleen, resolving phlegm and dispersing knots. It is safe and effective to reduce the conversion rate from simple premature breast development to central precocious puberty. 4. The long-term efficacy of this method in the treatment of girls with premature breast development needs further study.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R272

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本文編號(hào)：2181612