| Objective:To investigate the characteristics of bone metabolism in girls with precocious puberty and healthy children.To.investigate the effects of gonadotropin-releasing hormone analogues(GnRHa)on bone metabolism in girls with precocious puberty.Moreover,this paper analyzed the influence of Traditional Chinese Medicine(TCM)intervention on bone metabolism markers in girls with precocious puberty,discussed the influence of nourishing Yin and eliminating fire TCM on bone metabolism indicators,and expounded the possible mechanism of TCM in treating precocious puberty from the perspective of regulating bone metabolism.Methods:A prospective case-control study was conducted to collect 70 girls with idiopathic central precocious puberty(ICPP)who met the inclusion criteria,and another 20 healthy girls were selected as blank controls.ICPP girls will be divided into Traditional Chinese medicine and Western Medicine group,respectively in the Anti-precocious No.l prescription and GnRHa(including triptorelin and leuprorelin)treatment,the treatment course is in accordance with the guidelines for 1 to 2 years,but the observation period is 6 months.The syndrome of Traditional Chinese Medicine and Western Medicine group will be evaluated before and after treatment of 6 months.The overall curative effect and the main points and minor points will be compared.This is to evaluate the treatment of Anti-precocious No.l prescription on ICPP girls.In addition,the indicators of bone metabolism in ICPP girls and healthy girls were detected before treatment,including indicators of bone formation,bone resorption and bone metabolism regulations.The indexes of bone metabolism in the TCM group and the western medicine group were tested again after 6 months of treatment.Results:(1)Comparison of the overall efficacy of Chinese and western medicine:35 cases were treated in the TCM group based on the anti-precocious No.l prescription,of which 28 cases were effective and the effective rate was 80%,with no statistical difference compared with 86%in the western medicine group(P>0.05).Comparison of main scores:both groups showed a downward trend after treatment,but the western medicine group was better than the traditional Chinese medicine group in improving the main scores(P<0.05).Comparison of secondary scores:both groups showed a downward trend after treatment,and the secondary scores of the Chinese medicine group were better than that of the western medicine group(P<0.05).(2)Every single integral comparison:in improving clinical symptoms/signs/auxiliary inspection:comparison results between groups showed in improving the growth of breast and ovarian volume,western medicine group is superior to the traditional Chinese medicine group(P<0.05),while in the inhibition of bone age,improving follicle diameter size,improving vaginal discharge situation differences in the two groups has no statistical significance(P>0.05).The results of the intra-group comparison showed that the scores of symptoms/signs/auxiliary examination in both TCM group and western medicine group showed a decreasing trend before and after treatment,and both TCM group and western medicine group could improve the clinical symptoms,signs and related auxiliary examination results to varying degrees(all P<0.05).In terms of improving the scores of single syndromes of TCM,the TCM group had obvious efficacy in improving five upset fever,fear of hot flashes,night sweat,irritability,appetite for fat,chest distress and sigh,red face and red eyes,and dry stool(P<0.01),while there was no statistical difference in improving dry mouth and red tongue(P>0.05).Western medicine group in improving the five upset hot,afraid of fever heat,night sweats,irritability,like eating fat,on the stool stem node has obvious curative effect(P<0.01),sigh for the bosom is frowsty,bitter mouth pharynx dry,red eye red,the improvement of the tongue red no statistical difference(P>0.05),and compare the results between the other groups according to Chinese traditional medicine group in improving the night sweats,like eating fat,on the stool stem node is superior to western medicine group(P<0.05).(3)ICPP girl group compared with healthy controls serum osteocalcin(BGP),total collagen type I amino-terminal peptide(total tPINP),type I collagen carboxyl terminal peptide(beta CTX),25(OH)D3statistically significant(P<0.05),in which the BGP,total tPINP,beta CTX is significantly higher than healthy girl,and 25(OH)D3 is below healthy girls;however,there was no significant difference in insulin-like growth factor-1(IGF-1),alkaline phosphatase(ALP)and calcium phosphorus product(all P values were>0.05).(4)Western medicine group before and after treatment,25(OH)D3,calcium-phosphorus product difference has no statistical significance(P>0.05),and total tPINP,ALP,BGP,IGF-1,beta CTX level differences statistically significant(P<0.05),and total tPINP,BGP,ALP and beta CTX level are downturn,while the IGF-1 has a rising trend.Traditional Chinese medicine group before and after treatment,ALP,25(OH)D3,calcium-phosphorus product difference has no statistical significance(P>0.05),and total tPINP,BGP,IGF-1,beta CTX level differences statistically significant(P<0.05),and total tPINP,BGP,beta CTX level are downturn while the IGF-1 has a rising trend.Conclusions:(1)The anti-precocious No.1 prescription can obviously improve the clinical symptoms of Yin deficiency and fire flourishing in girls with precocious puberty.(2)Abnormal bone metabolism was found in girls with precocious puberty at an early stage.Compared with normal children,bone metabolism was hyperactive,bone conversion rate was significantly accelerated,bone absorption and bone formation were hyperactive,and bone formation was the main feature.(3)GnRHa treatment can slow down the progression of bone age,regulate bone metabolism,and significantly reduce the bone conversion rate.In particular,it has a significant inhibitory effect on excessive hyperactive osteoblast activity.(4)The anti-precocious No.1 prescription can affect related indexes of bone metabolism and has certain inhibitory effect on osteogenesis.The mechanism of its treatment of precocious puberty may be exerted by regulating bone metabolism. |
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