科技导报 >

2023 , Vol. 41 >Issue 20: 89 - 96

DOI: https://doi.org/10.3981/j.issn.1000-7857.2023.20.010

综述

儿童特发性中枢性性早熟的新型诊断及中西医治疗进展

  • 丁一诚 ,
  • 王海 ,
  • 包木龙 ,
  • 谷胜男
展开
  • 1. 黑龙江中医药大学研究生院，哈尔滨 150040
    2. 黑龙江中医药大学附属第一医院儿科，哈尔滨 150040
    3. 黑龙江中医药大学附属第二医院推拿科，哈尔滨 150001
丁一诚，博士研究生，研究方向为中医药调治小儿常见病，电子信箱：dingyicheng2022@126.com

收稿日期: 2022-12-03

  修回日期: 2023-03-29

  网络出版日期: 2023-11-06

基金资助

黑龙江中医药大学科研基金项目（2019XY05）

收起

Advances in new diagnosis and current treatment of idiopathic central precocious puberty with Western medicine and Traditional Chinese medicine

  • DING Yicheng ,
  • WANG Hai ,
  • BAO Mulong ,
  • GU Shengnan
Expand
  • 1. Graduate School, Heilongjiang University of Traditional Chinese Medicine, Harbin 150040, China
    2. Department of Pediatrics, the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin 150040, China
    3. Department of Massage, the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin 150001, China

Received date: 2022-12-03

  Revised date: 2023-03-29

  Online published: 2023-11-06

Fold

摘要

儿童健康是中国现阶段重点关注的问题。中国性早熟发病率为2%，是威胁儿童身心健康的重要疾病，特发性中枢性性早熟（ICPP）为最常见类型。综述了 ICPP 的临床研究现状、最新成果，及前沿趋势。最新《中枢性性早熟诊断与治疗专家共识（2022）》将中枢性性早熟的年龄界限由 8岁提至 7.5岁，基因诊断方法是辅助诊断 ICPP的新方法，建议对有性早熟家族史的患儿进行基因检测。GnRH 激动剂（GnRHa）是 ICPP 的金标准治疗方案，有利于抑制骨龄发育、增加患儿的最终成年身高，降低身体质量指数，改善脑功能等。ICPP的中医治疗是现阶段的研究热点，包括中药内治法，及耳穴贴压法、推拿法等外治法，中药治疗ICPP的疗效优于 GnRHa，安全性可能更佳。中医或中西医结合联合有望成为 ICPP 的有效治疗方案。

关键词： 儿童健康; 特发性中枢性性早熟; 基因诊断; GnRH激动剂; 中医治疗; 中西医结合

本文引用格式

丁一诚 , 王海 , 包木龙 , 谷胜男 . 儿童特发性中枢性性早熟的新型诊断及中西医治疗进展[J]. 科技导报, 2023 , 41(20) : 89 -96 . DOI: 10.3981/j.issn.1000-7857.2023.20.010

Abstract

Children's health is a key concern in China at present. The incidence rate of precocious puberty in China is 2%, which is an important disease threatening children's physical and mental health. Idiopathic central precocious puberty (ICPP) is the most common type. This article reviews the current clinical research status, latest achievements, and cutting-edge trends of ICPP. The latest“Expert Consensus on Diagnosis and Treatment of Central Sexual Precocity (2022)”up-dates the age limit of central sexual precocity from 8 to 7.5 years old. Gene diagnosis is a new method to assist in the diagnosis of ICPP, and the“2022 Consensus”suggests that children with the family history of precocious puberty should undergo gene testing. GnRH agonists (GnRHa) are the gold standard treatment regimen for ICPP, which are beneficial for inhibiting bone age development, increasing the final adult height of children, reducing body mass index, and improving brain function. The traditional Chinese medicine treatment of ICPP is currently a research hotspot, including traditional Chinese medicine internal treatment, as well as external treatment methods such as ear acupoint pressing and massage, it has a significant therapeutic effect on ICPP, with its efficacy superior to GnRHa, and its safety may be better. Traditional Chinese medicine or a combination of traditional Chinese and Western medicine is expected to become a cutting-edge treatment option for ICPP.

Key words： child health; idiopathic central precocious puberty; gene diagnosis; GnRH agonists; Traditional Chinese medicine treatment; integrated Traditional Chinese and Western Medicine

参考文献

[1] 石良艳, 熊丹妮, 黄丽娟, 等. 女性性早熟中国诊治共识解读[J]. 实用妇科内分泌电子杂志, 2021, 8(9): 1-6.
[2] 中华人民共和国卫生部 . 性早熟诊疗指南(试行〔) 卫办医政发(195)号〕[J]. 中国儿童保健杂志, 2021, 19(4): 390-392.
[3] 中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会 . 中枢性性早熟诊断与治疗专家共识（2022）[J]. 中华儿科杂志, 2023, 61(1): 16-22.
[4] Teilmann G, Pedersen C B, Jensen T K, et al. Prevalence and incidence of precocious pubertal development in Denmark: An epidemiologic study based on national registries[J]. Pediatrics, 2005, 116(6): 1323-1328.
[5] Colaco P. Precocious puberty[J]. Indian Journal of Pediatrics, 1997, 64(2): 165-175.
[6] 张婷, 曹松霞 . 特发性性早熟现代中西医治疗进展[J]. 中国医药导刊, 2020, 22(12): 857-860.
[7] Acar S, Ozkan B. Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: Preliminary results of a tertiary center study[J]. Journal of Pediatric Endocrinology & Metabolism: JPEM, 2022, 35(2): 249-251.
[8] Latronico A C, Brito V N, Carel J C. Causes, diagnosis, and treatment of central precocious puberty[J]. The lancet Diabetes & Endocrinology, 2016, 4(3): 265-274.
[9] Yang H, Luo S, Liang X, et al. The association between family impact and health-related quality of life of children with idiopathic central precocious puberty in Chongqing, China[J]. Health and Quality of Life Outcomes, 2021, 19(1): 171.
[10] 梁雁, 杜敏联, 罗小平. 中枢性性早熟诊断与治疗共识(2015)[J]. 中华儿科杂志, 2015, 53(6): 412-418.
[11] Chen M, Eugster E A. Central precocious puberty: Update on diagnosis and treatment[J]. Paediatric Drugs, 2015, 17(4): 273-281.
[12] Roelants M, Hauspie R, Hoppenbrouwers K. References for growth and pubertal development from birth to 21 years in Flanders, Belgium[J]. Annals of Human Biology, 2009, 36(6): 680-694.
[13] Biro F M, Greenspan L C, Galvez M P, et al. Onset of breast development in a longitudinal cohort[J]. Pediatrics, 2013, 132(6): 1019-1027.
[14] Kaplowitz P B, Oberfield S E. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: Implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society[J]. Pediatrics, 1999, 104: 936-941.
[15] Carretto F, Salinas-Vert I, Granada-Yvern M L, et al. The usefulness of the leuprolide stimulation test as a diagnostic method of idiopathic central precocious puberty in girls[J]. Hormone and Metabolic Research, 2014, 46(13): 959-963.
[16] Carel J C, Leger J. Clinical practice. Precocious puberty[J]. The New England Journal of Medicine, 2008, 358(22): 2366-2377.
[17] Carel J C, Eugster E A, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children[J]. Pediatrics, 2009, 123(4): e752-762.
[18] Cao R, Liu J, Fu P, et al. The diagnostic utility of the basal luteinizing hormone level and single 60-minute post GnRH agonist stimulation test for idiopathic central precocious puberty in girls[J]. Frontiers in Endocrinology, 2021, 12: 713880.
[19] Cheuiche A V, Da Silveira L G, De Paula L C P, et al. Diagnosis and management of precocious sexual maturation: An updated review[J]. European Journal of Pediat⁃rics, 2021, 180(10): 3073-3087.
[20] Kumar M, Mukhopadhyay S, Dutta D. Challenges and controversies in diagnosis and management of gonadotropin dependent precocious puberty: An Indian perspective[J]. Indian Journal of Endocrinology and Metabolism, 2015, 19(2): 228-235.
[21] Soriano-Guillen L, Argente J. Central precocious puberty, functional and tumor-related[J]. Best Practice & Research Clinical Endocrinology & Metabolism, 2019, 33(3): 101262.
[22] Ziereisen F, Guissard G, Damry N, et al. Sonographic imaging of the paediatric female pelvis[J]. European Radiology, 2005, 15(7): 1296-1309.
[23] De Vries L, Phillip M. Role of pelvic ultrasound in girls with precocious puberty[J]. Hormone Research in Paediatrics, 2011, 75(2): 148-152.
[24] Wen X, Wen D, Zhang H, et al. Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls[J]. Medicine, 2018, 97(10): e0092.
[25] Paesano P L, Colantoni C, Mora S, et al. Validation of an accurate and noninvasive tool to exclude female precocious puberty: Pelvic ultrasound with uterine artery pulsatility index[J]. American Journal of Roentgenology, 2019, 213(2): 451-457.
[26] Mogensen S S, Aksglaede L, Mouritsen A, et al. Pathological and incidental findings on brain MRI in a single-center study of 229 consecutive girls with early or precocious puberty[J]. PloS One, 2012, 7(1): e29829.
[27] Pedicelli S, Alessio P, Scire G, et al. Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years[J]. The Journal of Clinical Endocrinology and Metabolism, 2014, 99(12): 4455-4461.
[28] Khokhar A, Mojica A. Premature thelarche[J]. Pediatric Annals, 2018, 47(1): e12-e15.
[29] Rosenfield R L. Normal and premature adrenarche[J]. Endocrine Reviews, 2021, 42(6): 783-814.
[30] Leka-Emiri S, Chrousos G P, Kanaka-Gantenbein C. The mystery of puberty initiation: Genetics and epigenetics of idiopathic central precocious puberty (ICPP)[J]. Journal of Endocrinological Investigation, 2017, 40(8): 789-802.
[31] Zhang J, Gao R, Jiang Y, et al. Novel serological biomarker models composed of bone turnover markers, vitamin D, and estradiol and their auxiliary diagnostic value in girls with idiopathic central precocious puberty[J]. Bone, 2022, 154: 116221.
[32] Lee H S, Kim K H, Hwang J S. Association study of DLK1 in girls with idiopathic central precocious puberty[J]. Journal of Pediatric Endocrinology & Metabolism, 2020, 33(8): 1 045-1049.
[33] Dong G, Zhang J, Yang Z, et al. The Association of gut microbiota with idiopathic central precocious puberty in girls[J]. Frontiers in Endocrinology, 2019, 10: 941.
[34] Maione L, Bouvattier C, Kaiser U B. Central precocious puberty: Recent advances in understanding the aetiology and in the clinical approach[J]. Clinical Endocrinol(Oxf), 2021, 95(4): 542-555.
[35] Liu M, Fan L, Gong C X. A novel heterozygous MKRN3 nonsense mutation in a Chinese girl with idiopathic central precocious puberty: A case report[J]. Medicine, 2020, 99(38): e22295.
[36] De Sanctis V, Soliman A T, Di Maio S, et al. Long-term effects and significant Adverse Drug Reactions (ADRs) associated with the use of Gonadotropin-Releasing Hormone analogs (GnRHa) for central precocious puberty: A brief review of literature[J]. Acta bio-medica: Atenei Parmensis, 2019, 90(3): 345-359.
[37] Newton C L, Riekert C, Millar R P. Gonadotropin-releasing hormone analog therapeutics[J]. Minerva Ginecologica, 2018, 70(5): 497-515.
[38] Aguirre R S, Eugster E A. Central precocious puberty: From genetics to treatment[J]. Best Practice & Research Clinical Endocrinology & Metabolism, 2018, 32(4): 343-354.
[39] Badaru A, Wilson D M, Bachrach L K, et al. Sequential comparisons of one-month and three-month depot leuprolide regimens in central precocious puberty[J]. The Journal of Clinical Endocrinology and Metabolism, 2006, 91(5): 1862-1867.
[40] Luo X, Liang Y, Hou L, et al. Long-term efficacy and safety of gonadotropin-releasing hormone analog treatment in children with idiopathic central precocious puberty: A systematic review and meta-analysis[J]. Clinical Endocrinology, 2021, 94(5): 786-796.
[41] Vuralli D, Alikasifoglu A, Iyigun I, et al. Treatment with depot leuprolide acetate in girls with idiopathic precocious puberty: What parameter should be used in deciding on the initial dose?[J]. Journal of Clinical Research in Pediatric Endocrinology, 2020, 12(1): 37-44.
[42] Vuralli D, Ozon Z A, Gonc E N, et al. Long-term effects of GnRH agonist treatment on body mass index in girls with idiopathic central precocious puberty[J]. Journal of Pediatric Endocrinology & Metabolism: JPEM, 2020, 33(1): 99-105.
[43] Cho A Y, Ko S Y, Lee J H, et al. Effects of gonadotropin-releasing hormone agonist treatment on final adult height in boys with idiopathic central precocious puberty[J]. Annals of Pediatric Endocrinology & Metabolism, 2021, 26(4): 259-265.
[44] Chen T, Yu W, Xie X, et al. Influence of gonadotropin hormone releasing hormone agonists on interhemispheric functional connectivity in  girls with idiopathic central precocious puberty[J]. Frontiers in Neurology, 2020, 11: 17.
[45] 宋连成, 张桂菊 . 特发性性早熟的中西医研究进展[J]. 中国医药导报, 2020, 17(17): 1673-7210.
[46] 陆玉廷, 肖琦, 陈锴. 自拟滋阴泻火方治疗女童性早熟临床体会[J]. 中医儿科杂志, 2019, 15(6): 77-79.
[47] 黄田田. 九味楮实方治疗女童中枢性性早熟（阴虚火旺证）的临床研究[D]. 武汉: 湖北中医药大学, 2020.
[48] 陈松鹤, 林恩余, 陈烨. 调肝法治疗早期儿童特发性性早熟临证体会[J]. 中医药临床杂志, 2019, 31(2): 281-283.
[49] 汤瑶瑶, 叶进 . 叶进从肝论治女童性早熟经验[J]. 浙江中医药大学学报, 2017, 41(9): 765-767.
[50] 任娟 . 中药抗早 2 号方治疗痰湿壅滞型中枢性性早熟女童临床疗效观察[D]. 南京: 南京中医药大学, 2019.
[51] 任娟, 叶进 . 叶进基于脾肾互赞理论辨治性早熟经验[J]. 山东中医杂志, 2019, 38(10): 970-973.
[52] 赵鋆 . 耳穴压丸联合早熟方治疗女童性早熟临床研究[J]. 世界中医药, 2018, 13(1): 190-194.
[53] 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, 33(9): 943-944.
[54] 李伟元, 邓丽莎, 莫珊, 等 . 耳穴贴压法配合滋阴降火中药对真性性早熟女童生长的影响[J]. 中华中医药学刊, 2007(10): 2118-2119.
[55] 仇艳, 乌海华 . 知柏地黄汤联合醋酸亮丙瑞林微球治疗女童特发性性早熟阴虚火旺证52例临床观察[J]. 中医儿科杂志, 2020, 16(4): 56-59.
[56] 沈玉祥 . 知柏地黄丸加减辅助治疗女童特发性性早熟44例临床观察[J]. 中医儿科杂志, 2018, 14(2): 64-67.
[57] 刘瑜 . 柴胡疏肝散加减辅助治疗女童中枢性性早熟肝郁化火型 26 例临床观察[J]. 中医儿科杂志, 2019, 15(2): 52-55.
[58] Lee Y B, Lee J A, Lee H L. Herbal medicine for idiopathic central precocious puberty: A systematic review and meta-analysis[J]. Journal of Alternative and Complementary Medicine, 2020, 26(11): 976-999.
Options
文章导航

/

〈 〉

联系我们

  • 地址：北京市海淀区学院南路86号科技导报社　邮编：100081
  • 电话：010-62138113　传真：010-62138113
  • E-mail：kjdbbjb@cast.org.cn

    • 访问统计

      总访问量
      今日访问
      在线人数
    科技导报官方微信公众号
    京ICP备14028469号-1　
    版权所有 © 《科技导报》编辑部