中医辨证治疗女童乳房早发育临床研究
发布时间：2018-08-13 16:59
【摘要】：目的总结导师王绍洁教授治疗单纯乳房早发育的多年临床经验,结合北方沿海地区乳房早发育女童特点,在改善饮食结构及生活习惯的基础上,以中药滋阴降火、疏肝健脾、化痰散结法辨证治疗本病,观察评价本法的临床疗效并探究其作用机理,为改善患儿临床症状、体征,降低中枢性性早熟的转化率提供有效的治疗方法。方法90例符合要求的单纯乳房早发育女童均来自2014年3月至2015年3月期间大连市儿童医院门诊,年龄为3-7岁。采用随机数字表法将90例患儿分为观察组和对照组各45例。两组患儿年龄、身高、体重、乳房发育分期等一般资料比较,差异无统计学意义(P0.05),具有可比性。对照组以改善饮食结构及生活习惯进行干预。观察组在改善饮食结构及生活习惯的基础上,以知柏地黄丸为基础方加减化裁。具体用药:知母、黄柏、熟地、山药、茯苓、牡丹皮、瓦楞子、柴胡、白芍、太子参、炙甘草各3-6g,随证加减。中药煎汤,每日一剂,分早晚二次口服。疗程为3个月,治疗1-2个疗程,用药期间不予其他中西药物。两组患儿观察随访时间为6-12个月。治疗期间,乳房发育分期和中医证候表现每2周记录1次,身高、体重、乳腺超声每1个月记录1次,子宫、卵巢超声每3个月记录1次;疗程结束后,乳房发育分期、中医证候表现、身高、体重每3个月记录1次,超声影像学变化(乳腺、子宫、卵巢)每6个月记录1次。骨龄6个月记录1次。初诊时进行激素水平测定及促性腺激素释放激素激发试验,病情变化,3-6个月复查。同时,监测观察组患儿临床不良反应等情况。数据用IBM SPSS Statistics 19.0统计软件进行处理。结果1.90例患儿中阴虚火旺证所占比例最多,达41.1%(37例);肝郁化火与痰湿内蕴证,分别占32.2%和26.7%。2.随访结束后,观察组总有效率88.9%(治愈25例,好转15例),对照组总有效率68.9%(治愈10例,好转21例),观察组疗效优于对照组,差异有统计学意义(P0.05)。3.中医证候计量值比较:治疗前,两组患儿组间比较差异无统计学意义(P0.05)。治疗后,两组患儿组内比较,均较治疗前降低,差异有统计学意义(P0.01);组间比较,观察组较对照组降低明显,差异有统计学意义(P0.01)。4.观察组中枢性性早熟转化率2.2%(1例);对照组中枢性性早熟转化率13.3%(6例)。5.观察组患儿治疗后血常规、尿常规、便常规、心电图及肝、肾功能均未见明显异常。随访过程中,两组患儿均未出现明显不良反应。结论1.女童单纯乳房早发育以阴虚火旺证为主。2.总结导师王绍洁教授多年临床经验,主张结合北方沿海地区乳房早发育女童特点,在改善饮食结构及生活习惯的基础上,以中药滋阴降火、疏肝健脾、化痰散结法辨证治疗本病。3.本法辩证施治、综合治疗、防治结合,能够促进患儿乳房肿块消退,有效改善中医临床症状、体征,降低单纯乳房早发育患儿向中枢性性早熟的转化率,安全有效,值得推广。4.对于本法治疗女童乳房早发育的远期疗效有待于进一步研究。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R272
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R272
【参考文献】
相关期刊论文 前10条
1 张美琴;金晶;;自拟早熟一号汤治疗单纯性乳房早发育67例疗效观察[J];浙江中医杂志;2015年08期
2 杨玉;王荻兰;;207例0～2岁女童单纯乳房早发育相关危险因素分析[J];中国儿童保健杂志;2014年02期
3 褚艾妮;林静;;小儿推拿结合中药治疗幼女乳房早发育临床观察[J];吉林中医药;2013年09期
4 王应e，
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