Impact Of Nourishing Yin To Lessen Fire And Clear Stomach To Hormone Level In Serum In Girls With Idiopathic Central Precocious Puberty

Background:Precocious puberty is a kind of growth and developmental abnormality that is characterized as premature start of adolescence and secondary sexual character,among which idiopathic central precocious puberty(ICPP)is the most common one(92%of children with precocious puberty).Researches show it has impact on children' s physiology,mental health,lives and study;it can also effect the development of bone age and body height.In recent years, prevalence of precocious puberty increases steadily and it has become a common endocrine disease in children.80%-90%of endocrine disease in girls is ICPP, so ICPP in girls has become the focus in the study of precocious puberty.Until now its etiology is unclear,which is believed to be the result of activation of HPGA in advance.In western medicine,gonadotropin releasing hormone analogues(GnRHa)are the usual agent in treating ICPP of girls.GnRHa are expensive and its safety needs further appraisal because of its short application period in clinics,further more,it is report to inhibit secretion of GH and has negative impact to body height in recent years.It is thought from the point of TCM that normal growth and development and maturation of genital gland mainly depend on sufficient kidney-qi and menstruation beginning on time.If there are imbalance between kidney-yin and kidney-yang and menstruation is ahead of time,it will cause disease by bringing sexual maturity of children forward.It is regarded that the main etiology and pathogenesis of precocious puberty is:inefficiency of kidney-yin;pathogenic fire derived from stagnation of liver-QI;stagnation of phlegm caused by splenic asthenia;flowing down of pathogenic damp and etc.But in clinic inefficiency of kidney-yin and asthenic yin causing excessive pyrexia are the main symptoms of girls with ICPP.In clinic,we find that children with ICPP are always accompanied with symptoms of excessive gastric heat and hyperactivity of deficient fire such as polyphagia,easy to be hungry and acne in the face besides asthenic yin causing excessive pyrexia.During treatment of the disorder with traditional Chinese medicine(TCM),we found that TCM can not only decrease secondary sexual character of children patients,but also decrease serum level of sex hormone(FSH,LH,E₂)and has no impact to growth and development of the children during treating period.In the study, based on pathologic character of "yin frequently in deficiency,yang frequently in excess" and "liver frequently in excess,asthenic susceptibility of kidney" in children,we propose nourishing yin to lessen fire and clear stomach as therapeutical principle and prescribed Zaoshu Yifang to treat ICPP.We choose hormone(FSH,LH,E₂,GH)level in serum as the main index and ultrasound examination Of pelvic cavity,bone age,body weight,body height and clinical symptoms as parameters of curative effect.From the study, we hope to further investigate influence of TCM to functional activity of HPGA and somatotropic hormone-axle,hormone level in serum,growth and development.Objective:Appraisal clinical curative effect of Zaoshu Yifang to ICPP in scientific manner by observation of changes of sexual characteristics during adolescence, body weight,body height and bone age before and after the treatment; investigate impact of Zaoshu Yifang to hormone level of children patients by observation of changes of FSH,LH and E2 before and after the treatment;by observation of changes of GH level,study impact of Zaoshu Yifang to growth hormone of children patients,investigate interrelationship between somatotropic hormone-axle and gonadotropic hormone-axle and their role in pathogenesis of ICPP and further study the mechanism of action of Zaoshu Yifang.In the study,we try to study interrelationship between somatotropic hormone-axle and gonadotropic hormone-axle from changes of GH level and its relationship with changes of FSH,LH and E2,investigate pathogenesis of ICPP and mechanism of action of Zaoshu Yifang to ICPP from these fresh new point of view,verify advantages of nourishing yin to lessen fire and clear kidney in treating the disorder and drug safety and provide new therapeutic method in treating the disorder by TCM. Methods:50 girls diagnosed to be ICPP in outpatient pediatric clinic in Guangzhong Hospital of Chinese Medicine(from January,2006 to April,2008)were randomly divided into treatment group and control group with 25 girls in each group. Treatment group were treated with Zaoshu Yifang,twice per day;Control group were treated with Zhibaidihuang Pill,6 pills per time,twice per day.Treating time is 6 months in both groups and without additional treatment.Clinical symptoms and signs,FSH,LH,E₂,GH,ultrasound examination of pelvic cavity, bone age,body weight,body height,liver function and renal function were compared before and after treatment.Results were showed as X±s.Group comparison:independent t test was used for homogeneity of variance and rank sum test was used for heterogeneity of variance.Comparison before and after treatment:paired t test was used for measurement data andχ² test was used for enumeration data.SPSS11.3 software was used for analysis.Results:1.Comparison of therapeutic effect:There is significant difference of total effective rate between two groups (88%in treatment group and 56%in control group,P＜0.05).2.Symptomatic relief time:There is significant difference of symptomatic relief time between two groups in the symptom such as dizziness,burning sensation of five centres, polyphagia,boutimia,prosopo-acne(P＜0.05).But,there is no significant difference of symptomatic relief time between two groups in the symptom such as hectic fever,night sweat(P＞0.05).3.Breasts diameter:There is significant difference in breasts diameter before and after treatment both in two groups(P＜0.05).But,there is no significant difference between two groups before treatment(P＞0.05),there is significant difference between two groupsafter treatment(P＜0.05).4.Volume of womb and ovaries:There is significant difference in volume of womb and ovaries before and after treatment in treatment group(P＜0.05).But,there is no significant difference in volume of womb and ovaries before and after treatment in control group(P＞0.05).There is no significant difference between two groups before treatment(P＞0.05).And,there is significant difference between two groups after treatment(P＜0.05)5.FSH level:There is significant difference in FSH level before and after treatment in treatment group(P＜0.05)But,there is no significant difference in FSH level before and after treatment in control group(P＞0.05)There is no significant difference between two groups before treatment(P＞0.05)But, there is significant difference between two groups after treatment(P＜0.05).6.LH level:There is significant difference in LH level before and after treatment in treatment group(P＜0.05).But,there is no significant difference in LH level before and after treatment in control group(P＞0.05).There is no significant difference between two groups before and after treatment(P＞0.05).7.E₂ level:There is significant difference in E₂ level before and after treatment both in two groups(P＜0.05).There is no significant difference between two groups before treatment(P＞0.05)But,there is significant difference between two groups after treatment(P＜0.05).8.GH level:There is significant difference in E₂ level before and after treatment both in two groups(P＞0.05).And there is no significant difference between two groups before and after treatment(P＞0.05).9.BA/CA(bone age/actual age):There is significant difference in BA/CA before and after treatment in treatment group(P＜0.05).But,there is no significant difference in BA/CA before and after treatment in control group(P＞0.05).There is no significant difference between two groups before treatment(P＞0.05),But,there is significant difference between two groups after treatment(P＜0.05).10.There is no significant difference of body height and body weight between two groups before and after treatment(P＞0.05).11.idverse effect of the drug:Total incidence of adverse effect is 8%in treatment group and 16%in control group,there is no significant difference between two groups, (P＞0.05).Conclusions:1.Zaoshu Yifang is better than Zhibaidihuang Pill in treating symptoms of deficiency of kidney-YIN and excessive stomach-fire such as dizziness,burning sensation of five centres,polyphagia,boulimia, prosopo-acne.2.Zaoshu Yifang can significantly diminish enlarged breasts,womb and ovaries,and its therapeutic effect is better than that of Zhibaidihuang Pill.3.Zaoshu Yifang not only can decrease the E₂ level in the body but also can decrease the FSH and LH level,which maybe is a proof that it can inhibit HPGi axle of ICPP sufferers.4.Zaoshu Yifang has no impact to GH while decreasing sex hormone level in children with ICPP.And growth rate of bone age in ICPP sufferers is lower than that in Zhibaidihuang Pill group.It is a proof that it has little inhibition effect to growth hormone axle,further more,advanced bone age in ICPP sufferers is slowed down,which will increase growth potential of the children.5.Zaoshu Yifang is a safe method in treating girls with ICPP.