柔肝健脾法治疗脾虚肝旺型性早熟患儿的回顾性分析

doi:10.20274/j.cnki.issn.1674-3865.2025.03.004

摘要/Abstract

摘要：

目的探讨柔肝健脾法对脾虚肝旺型性早熟患儿的临床疗效，并探讨其治疗机制。方法选择2023年10月至2024年5月在复旦大学附属儿科医院中医科就诊的脾虚肝旺型中枢性性早熟患儿62例为研究对象，其中女孩38例，男孩24例。62例患儿均采用柔肝健脾法治疗，口服四物汤合白术膏加减6个月。通过分析患儿治疗前后的身高生长速度、骨龄-年龄比值变化、性激素水平及生长因子水平的变化情况，评估柔肝健脾法的疗效。结果（1）柔肝健脾治疗后患儿骨龄-年龄比值较治疗前明显减小（减少6%～9%），生长速度较治疗前明显增加，差异均有统计学意义（P<0.05）。（2）患儿治疗前后子宫、卵巢、卵泡、睾丸没有明显增大，差异无统计学意义（P>0.05）。（3）治疗后女孩雌二醇、男孩睾酮水平较治疗前下降，女孩促卵泡激素（FSH）水平较治疗前升高，差异均有统计学意义（P<0.05）；男孩、女孩促黄体生成素（LH）、泌乳素（PRL）水平治疗前后均没有明显变化，男孩FSH水平治疗前后没有明显变化，差异无统计学意义（P>0.05）。（4）患儿治疗后血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平较治疗前明显升高，差异有统计学意义（P<0.05）。结论柔肝健脾法既能够有效降低患儿性激素水平，抑制患儿的骨龄快速进展，又能够提高患儿生长因子水平，增加患儿生长速度。

关键词: 中枢性性早熟, 柔肝健脾, 骨龄, 身高, 儿童

Abstract:

Objective To explore the clinical efficacy and the treatment mechanism of liver?softening and spleen?strengthening therapy for children with precocious puberty of spleen?deficiency and liver?hyperactivity type. Method A total of 62 children with central precocious puberty of spleen?deficiency and liver?hyperactivity type were selected as research subjects, who visited Children’s Hospital of Fudan University from October 2023 to May 2024, including 38 girls and 24 boys. The 62 pediatric patients were treated with liver?softening and spleen?strengthening therapy, orally taking Siwu decoction combined with Baizhu Ointment with modification for 6 months. The efficacy of liver?softening and spleen?strengthening therapy was evaluated by analyzing growth rate of body height, changes in bone age?chronological age(BA-CA) ratio, level of sex hormone and changes in growth factor level before and after treatment. Result (1) After treatment with liver?softening and spleen?strengthening therapy, the BA-CA ratio significantly reduced compared with before treatment（reducing by 6%–9%), and the growth rate increased significantly compared with before treatment (P<0.05). (2) There was no significant enlargement in uterine, ovary, follicle or testicle after treatment (P>0.05). (3) After treatment estradiol level in girls and testosterone level in boys were lower than before treatment, while FSH in girls was higher than before treatment (all P<0.05); LH and PRL levels in boys and girls and FSH level in boys had no obvious changes before and after treatment (P>0.05). (4) After treatment, serum IGF-1 and IGFBP-3 levels increased significantly compared with before treatment (P<0.05). Conclusion The liver?softening and spleen?strengthening therapy can not only reduce the level of sex hormones effectively and inhibit the rapid progress of bone age, but also increase the levels of growth factors and the growth rate of the child patients.

Key words: Central precocious puberty, Softening the liver and strengthening the spleen, Bone age, Body height, Child

中图分类号:

R585

刘俊朝, 刘娇娇, 徐虹. 柔肝健脾法治疗脾虚肝旺型性早熟患儿的回顾性分析[J]. 中国中西医结合儿科学, 2025, 17(3): 208-212.

Junchao LIU, Jiaojiao LIU, Hong XU. Retrospective analysis of liver⁃softening and spleen⁃strengthening therapy for children with precocious puberty of spleen⁃deficiency and liver⁃hyperactivity type[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(3): 208-212.

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性别	n	骨龄-年龄比值
性别	n	治疗前	治疗后	t值	P值
女孩	38	1.23±0.02	1.13±0.02	4.03	<0.05
男孩	24	1.17±0.02	1.10±0.02	2.60	<0.05
性别	n	生长速度（cm/年）
性别	n	治疗前	治疗后	t值	P值
女孩	38	6.95±0.32	8.81±0.44	3.34	<0.05
男孩	24	6.86±0.67	12.65±1.05	3.96	<0.05

项目	女孩（n=38）			男孩（n=24）
项目	子宫体积（mL）	卵巢体积（mL）	卵泡大小（mm）	睾丸体积（mL）
治疗前	3.05±0.26	2.48±0.99	4.29±0.13	4.23±0.41
治疗后	2.84±0.17	2.71±0.15	4.28±0.16	4.24±0.44
t值	0.62	1.30	0.07	0.02
P值	>0.05	>0.05	>0.05	>0.05

性别	n	LH（IU/L）				PRL（IU/L）
性别	n	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
女孩	38	1.78±0.25	2.15±0.41	0.81	>0.05	220.40±16.53	194.60±20.58	0.84	>0.05
男孩	24	2.10±0.21	2.02±0.11	0.38	>0.05	172.20±18.53	161.30±12.44	0.46	>0.05
性别	n	FSH（IU/L）				雌二醇/睾酮（pmol/L）
性别	n	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
女孩	38	4.06±0.25	5.35±0.49	2.45	<0.05	121.50±9.87	89.74±10.01	2.14	<0.05
男孩	24	3.67±0.32	3.94±0.29	0.63	>0.05	5.33±0.57	3.31±0.59	2.34	<0.05

性别	n	IGF-1				IGFBP-3
性别	n	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
女孩	38	189.70±7.88	273.60±23.58	4.19	<0.05	5.03±0.09	6.50±0.26	6.27	<0.05
男孩	24	265.80±18.09	329.80±19.48	2.35	<0.05	5.56±0.19	6.43±0.26	2.68	<0.05