Correlation Between Syndrome Differentiation And Sex Hormone Level About Idiopathic Central Precocious Puberty

1 BackgroundIncidence of precocious puberty increases in recent years, which has become one of the most common endocrinopathy in pediatrics. It can cause short stature and psychological disorders. Idiopathic central precocious puberty occupies the highest ration in the disease, though etiology of which is not fully clear, it is believed to be caused by advanced activation of hypothalamus pituitary-gonadal axis. It is too expensive to treat it with western medicine and the influence to reproductive function still needs long-time observation. Traditional Chinese Medicine (TCM) has been used for thousands of years and is very cheap, which may be a suitable choice. But there are too many theories, different treating methods and differentiation of symptoms and signs. Until now there is no report about characters of syndrome patterns of ICPP. In the study, we will analyze characters of syndrome patterns of ICPP according to basic theories of TCM. It is thought from the point of TCM that normal growth and development and maturation of genitical gland mainly depend on sufficient kidney-OI and menstruation beginning on time. Advanced menstruation is the typical clinical manifestation of precocious puberty, which has relationship with kidney, liver and spleen. Its etiological factors include splenic asthenia and phlegm stasis, stagnation of QI due to depression of the liver, excessive fire moves uncontrollably due to deficiency of kidney-YIN, impairment of thoroughfare and conception vessel. When there is imbalance between YIN and YANG, there will be advanced menstruation that leads to precocious puberty. In that we proposed it to be divided into three types, i.e. type of asthenic yin causing excessive pyrexia, type of pathogenic fire derived from stagnation of liver-QI, and type of splenic asthenia and phlegm stasis. Until now differentiation of symptoms and signs in TCM is mainly based on principal syndrome, tongue demonstration and pulse tracings, which lacks objective index, and has little study about objective index such as symptom patterns of ICPP and sex hormone.2. ObjectiveFind out characters of each symptom pattern of ICPP to provide theoretic data for standard determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs in TCM. Find out relationship between each symptom pattern and biochemical indicators such as sex hormone, growth hormone gonadotropic hormone to provide practical objective index for differentiation treatment of symptoms and signs according to classification of syndrome.3. MethodsBased in retrospective study, 98 children who were diagnosed as ICPP in Guangzhong Hospital of Traditional Chinese Medicine (from January, 2002 to March, 2007) were recruited in the study. Principal syndrome, accompanied syndrome, tongue demonstration and pulse tracings were observed before being divided into four groups, i.e. type of asthenic yin causing excessive pyrexia,type of pathogenic fire derived from stagnation of liver-QI, type of splenic asthenia and phlegm stasis, and other type. In each group, age, course, clinical symptom, sign, weight index, GH, FSH, LH and E₂ in the blood and bone age were compared. SPSS10.0 was used as statistic software.4. Results(1) Symptom pattern of ICPP in TCM can be divided only as type of asthenic yin causing excessive pyrexia, type of pathogenic fire derived from stagnation of liver-QI and type of splenic asthenia and phlegm stasis; without other types; (2) Symptom pattern in TCM has correlation with age:age in the group of asthenic yin causing excessive pyrexia is older than that in the group of pathogenic fire derived from stagnation of liver-QI; (3) Symptom pattern in TCM has correlation with bone age: bone age is advanced in the group of splenic asthenia and phlegm stasis and pathogenic fire derived from stagnation of liver-QI than that in the group of pathogenic fire derived from stagnation of liver-QI, there is significant difference (P<0.05); (4) correlation of symptom pattern of ICPP girl in TCM and FSH, LH, E₂:FSH, LH and E₂ in each group is higher than in control group. Value of FSH, LH and E₂ in each group are different, those in group of asthenic yin causing excessive pyrexia holds the highest value, those in group of pathogenic fire derived from stagnation of liver-QI holds the lowest value and those in group of splenic asthenia and phlegm stasis lies between, there is significant difference (P＜0.01);(5) comparison of body mass index among different symptom pattern in TCM: body mass index in the group of splenic asthenia and phlegm stasis is higher than that in the other groups, there is significant difference (P＜0.01);(6) comparison of symptoms among different symptom pattern of ICPP girl in TCM: burning sensation of five centres in the group of asthenic yin causing excessive pyrexia is more than that in the other groups, there is significant difference (P＜0.01); painful swelling of breasts in the group of pathogenic fire derived from stagnation of liver-QI is more than that in the other groups, there is significant difference (P＜0.05). 5 conclusionsIt is thought that normal growth and development and maturation of genitical gland have relationship with kidney, liver and spleen, which mainly depend on sufficient kidney-OI, menstruation beginning on time and balance between entrails, YIN and YANG. ICPP has relationship with splenic asthenia and phlegm stasis, stagnation of QI due to depression of the liver, excessive fire moves uncontrollably due to deficiency of kidney-YIN, impairment of thoroughfare and conception vessel. When there is imbalance between YIN and YANG, there will be advanced menstruation that leads to precocious puberty. Symptom pattern of ICPP in TCM can be divided only as type of asthenic yin causing excessive pyrexia, type of pathogenic fire derived from stagnation of liver-QI and type of splenic asthenia and phlegm stasis. Type of asthenic yin causing excessive pyrexia is the most common type. Symptoms in splenic asthenia and phlegm stasis is the most serious, type of athogenic fire derived from stagnation of liver-QI has the lightest symptom. Girl in the group of athogenic fire derived from stagnation of liver-QI are the youngest ones, and the most common symptom is pain swelling of breasts; burning sensation of five centres is the most common symptom in the group of asthenic yin causing excessive pyrexia; children in the group of splenic asthenia and phlegm stasis are prone to be overweighed, and body mass index can be a standard for differentiation of symptoms and signs. FSH, LH and E² of ICPP girl increase significantly, but with different degree in different group, values in the group of asthenic yin causing excessive pyrexia are the highest. Symptom pattern of ICPP girl in TCM has relationship with hypothalamus-pituitary-gonadal axis, FSH, LH and E² can be a standard for differentiation of symptoms and signs.