对处于青春发育不同阶段的57例女性特发性真性性早熟患儿进行了下丘脑-垂体-卵巢轴功能及子宫卵巢容积的测定，并将各项指标与性早熟的程度做相关分析，结果表明：（1）性早熟的程度与患儿的病程长短、骨骼生长加速的程度、子宫卵巢容积大小以及下丘脑-垂体-卵巢轴功能亢进的程度密切相关，而与起病年龄无关；（2）特发性性早熟患儿的下丘脑-垂体-卵巢轴提前发动，功能亢进。其GnRH兴奋试验的反应曲线具有特征性的改变；（3）特发性性早熟患儿与正常青春发育相比，其内生殖器官的发育较不成熟，体积相对较小。

目的：观察滋阴泻火中药改善性早熟儿童骨骼发育的作用并探讨其作用机理。方法：女性特发性性早熟患儿，50例采用滋阴泻火中药与甲地孕酮联合治疗，32例单纯采用甲地孕酮治疗，疗程为一年。对照组25例不用药物治疗。于治疗前后分别进行生长速率和X线骨龄的测算、桡骨骨密度和血清骨钙素水平的测定以及最终身高的预测。结果：对照组于1年后骨龄差/年龄差（△BA/△CA）值从1.39±0.24上升为1.54±0.20(P<0.01)，最终身高预测值从154.2±5.3cm下降至149.4±4.8cm(P<0.01).单纯使用甲地孕酮治疗，对患儿骨龄提前及最终身高预测值下降的这种趋势无明显的影响。联合治疗的患儿生长速率减慢，△BA/△CA值从1.36±0.19下降为0.65±0.16(P<0.001)。骨密度从0.585±0.052g/cm2（P<0.05），血清骨钙素从16.85±3.16μg/L下降为10.06±3.37μg/L（P<0.001）。最终身高的预测值从153.6±3.8cm增加至158.8±4.4cm(P<0.001)。结论：滋阴泻火中药可明显减慢性早熟儿童的骨骼生长，延缓其骨骼成熟，从而防止骨骺过早融合并改善最终身高。滋阴泻火中药对成骨细胞过度亢进的功能活动有明显的抑制作用，这可能是其改善性早熟儿童骨骼发育的主要作用环节及作用机理之一。

Objective: To find effective therapeutic approach f。r treating true idi。pathic precocious pubertv suitable to OU F national condilion and different from gonadotrophin releasing hormone aIlalogue Metbs: Onc hundred and SIX gifts with idiopathic precocious puberty were divided into 3 groups The 51 girls in the TCM WM group were treated with Chinese herbal medicine combined with megestr. l acctatc(MA), 35 girls in the MA group treated with megestrol acetate alone, and 20 girls were taken 8s control group and given n. trea LIncnt at all Luteinizing hormone releasing hormone (LHRH) sticau]ating test were performed before and after treat ment, and the size ol the uterus and ovary, linear growth rate, X-ray bone age measurement and final heighy prediction were also observed simultaneously Results：Aher t reared with TCM WM for 27 years in average, the luteinizing hormone (LH) peak value of LHRH stimulating test was reduced front 48.5±5.2 IU/L FO 12 2±1.3IU/L, size of uterus and Ovary decreased, secondary sexual characteristics rezressed, the bone age difterence/chronoIogical age difference value (ABA/ACA) reduced from 1.35±0.09 to 0.65+0.05 and predictive final height increased front 153.3±0.5cm to 158.5+0.6cm. Conclusion: TCM-WM therapy could not only modulate the function of hypothalamic-pltuitary-ovarian axis and the development of internal, genhalia. but also cluld decelerate skeletal growth, delay skeletal maturation, and thereby prevent premature epiphyseal fusion and increase the final height of patiehts.

In recent ten-odd years the pathogenetic regularity of female idiopathic precocious puberty was researched in our hospital, in terms of the function of hypothalamic-pituitary-gonadal axis and the status of skeletal development as indicators. The regime of the therapy with a predominance of Chinese herbal medicine (CHM) was formulated, according to recognition for the regularity of differential diagnosis with method of traditional Chinese medicine (TCM). It has been clinically verified that the regime could successfully modulate the course of pubertal development and optimize skeletal development in children with precocious puberty. The mechanism of effectiveness of the drugs has been further researched focusing of the neuroendocrine regulation and gene expression with modern medical technique.

目的：探讨滋肾阴泻相火中药对下丘脑促性腺激素释放激素（GnRH）的合成、分泌及其调节机制的影响。方法：青春期大白鼠喂饲滋肾阴泻相火中药后，采用内侧基底下丘脑区的脑片孵育法，测定KCl刺激后孵育液中GnRH的含量，观察其下丘脑GnRH的紧张性分泌中心（弓状核及腹内侧核）GnRH合成水平的变化；采用免疫组化及计算机图象处理技术，测定其下丘脑视前区GnRH阳性物质的积分光密度值，观察其下丘脑GnRH的周期性分泌中心（视前内侧核）GnRH含量的变化；采用下丘脑的内侧视前区的推挽灌流技术，以放射免疫法测定序列的灌流液中GnRH的含量，观察其下丘脑视前内侧核GnRH脉冲释放频率及幅度的变化；以高效液相色谱-荧光检测法，测定灌流液中门冬氨酸、谷氨酸及γ氨基丁酸的含量，并以放射免疫法测定灌流液中β-内啡肽的含量，观察其下丘脑GnRH的周期性分泌中心（内侧视前区）兴奋性、抑制性氨基酸递质及β-内啡肽释放量的变化。结果：滋肾阴泻相火中药可使内侧基底下丘脑区（弓状核、腹内侧核）及下丘脑视前区（视前内侧核）的GnRH含量显著减少，并可使下丘脑视前内侧核GnRH脉冲释放的频率及幅度明显降低。滋肾阴泻相火中药还可使下丘脑内侧视前区门冬氨酸和谷氨酸的释放明显减少，而使r氨基丁酸和β-内啡肽的释放明显增加。结论：滋肾阴泻相火中药可通过抑制中枢兴奋性氨基酸递质的释放及促进中枢抑制性氨基酸递质和β-内啡肽的释放，使下丘脑GnRH神经元的功能活动显著降低，从而使下丘脑GnRH的紧张性分泌中心和周期性分泌中心GnRH的合成及分泌明显减少，这可能是滋肾阴泻相火中药能有效地治疗特发性真性性早熟的主要作用机理之一。