目的：观察长效促性腺激素类似物（GnRHa）治疗女童特发性中枢性性早熟（ICPP）的疗效和副作用。方法：对36例ICPP女童进行GnRHa治疗，观察治疗前后第二性征、子宫容积、卵巢容积、卵泡发育、骨龄与年龄比值（BA／CA）、体块指数（BMI...目的：观察长效促性腺激素类似物（GnRHa）治疗女童特发性中枢性性早熟（ICPP）的疗效和副作用。方法：对36例ICPP女童进行GnRHa治疗，观察治疗前后第二性征、子宫容积、卵巢容积、卵泡发育、骨龄与年龄比值（BA／CA）、体块指数（BMI）和生长速率的变化，采用Greulich-Pyle法评价骨龄，用Payley—Pinneau法预测成年预测身高（PAH），ELISA法测定血清抑制素A（INHa）和抑制素B（INH。），用化学发光法测定血清LH和FSH。结果：①治疗3～6个月乳房均有缩小，其中12例TannerⅡ期的女童治疗6个月乳房恢复到B1期；②治疗6个月子宫容积[（3．28±2．20）ml vs （1．27±0．69）m1]和卵巢容积[（3．62±1．94）ml vs（1．24±0．50）m1]均缩小，卵泡缩小甚至消失；血清INHA和INHB由治疗前Log（0．93±0．35）ng／L、Log（1．95±0．37）ng／L下降到Log（0．60±0.32）ng／L、Log（1．46±0．32）ng／L。③治疗1年，BA／CA由治疗前1．40±0．20下降到1．26±0．15；PAH由（149．12±4．04）cm升高到（152．84±3．72）cm，BMI治疗前后无明显变化（16．04±1．68us15．93±1．69）。结论：GnRHa治疗能有效抑制性腺轴及第二性征的发育，延缓骨龄的成熟，改善预测成人身高，短期应用未见明显副作用。展开更多
Background:Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle....Background:Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle. There are conflicting reports on a protective effect of pretreatment with a vitamin D analogue on cytotoxic drug-induced hair loss in rodents. Objectives:To investigate the process of cytotoxic hair loss and any protective effect on the hair of pretreatment with topical calcipotriol. Methods Breast cancer patients who were about to receive cycles of chemotherapy with cyclophosphamide 600 mg m-2, methotrexate 40 mg m-2 and 5-fluorouracil 600 mg m-2 were recruited and randomized to receive calcipotriol scalp solution 50 μg mL-1 or vehicle. The solution was applied twice daily from 4 days prior to chemotherapy and continued for 14 days in each treatment cycle. Shed, plucked and cut hairs were sampled. Absolute shed rates, the proportion of major hair types, the presence of proximal hair shaft changes, regrowth (using the new anagen hair count) and hair density were assessed. Results:Ten patients receiving calcipotriol and 14 receiving vehicle completed three treatment cycles and nine from both groups completed six cycles. There was no detectable effect of calcipotriol on the proportion of patients experiencing minimal hair loss from chemotherapy, shed rates, plucked telogen and fractured hair counts, the morphology of shed and plucked hair, hair regrowth or hair density. Combining results of the treatment groups, there was a large variation in the impact of chemotherapy on hair loss, from total loss in five patients to no obvious loss in five. Excluding the latter, during chemotherapy shed telogen hairs (mean 81%of shed hairs) predominated over fractured (12%) and anagen hairs (6%) (P=0.0002). The major pathological change was proximal hair shaft tapering, baseline mean 3%of shed hairs rising to 48%(P=0.0005) during treatment, and there was a consequent decrease in normal telogen hairs, baseline mean 98%of all telogen hairs falling to 55%(P=0.0005) during treatment. The pathological tapered telogen hairs had normal or small, sometimes diminutive, bulbs. Fracturing of hairs with diminutive bulbs produced typical ‘exclamation mark’hairs. Conclusions:The cardinal effects of cytotoxic drugs found in this study were tapering of the proximal hair shaft and premature entry of the follicle into telogen, conflicting with the conventional view that affected hair follicles continue in anagen. There was a resulting effluvium of a mixture of tapering telogen hairs and fractured hairs. As entry into telogen is an integral part of the process, cytotoxic hair loss may be regarded as a variant of the conventional ‘telogen effluvium’and we propose the term ‘atrophic telogen effluvium’. There was no obvious protective effect on the hair loss of prior treatment with topical calcipotriol.展开更多
文摘目的：观察长效促性腺激素类似物（GnRHa）治疗女童特发性中枢性性早熟（ICPP）的疗效和副作用。方法：对36例ICPP女童进行GnRHa治疗，观察治疗前后第二性征、子宫容积、卵巢容积、卵泡发育、骨龄与年龄比值（BA／CA）、体块指数（BMI）和生长速率的变化，采用Greulich-Pyle法评价骨龄，用Payley—Pinneau法预测成年预测身高（PAH），ELISA法测定血清抑制素A（INHa）和抑制素B（INH。），用化学发光法测定血清LH和FSH。结果：①治疗3～6个月乳房均有缩小，其中12例TannerⅡ期的女童治疗6个月乳房恢复到B1期；②治疗6个月子宫容积[（3．28±2．20）ml vs （1．27±0．69）m1]和卵巢容积[（3．62±1．94）ml vs（1．24±0．50）m1]均缩小，卵泡缩小甚至消失；血清INHA和INHB由治疗前Log（0．93±0．35）ng／L、Log（1．95±0．37）ng／L下降到Log（0．60±0.32）ng／L、Log（1．46±0．32）ng／L。③治疗1年，BA／CA由治疗前1．40±0．20下降到1．26±0．15；PAH由（149．12±4．04）cm升高到（152．84±3．72）cm，BMI治疗前后无明显变化（16．04±1．68us15．93±1．69）。结论：GnRHa治疗能有效抑制性腺轴及第二性征的发育，延缓骨龄的成熟，改善预测成人身高，短期应用未见明显副作用。
文摘Background:Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle. There are conflicting reports on a protective effect of pretreatment with a vitamin D analogue on cytotoxic drug-induced hair loss in rodents. Objectives:To investigate the process of cytotoxic hair loss and any protective effect on the hair of pretreatment with topical calcipotriol. Methods Breast cancer patients who were about to receive cycles of chemotherapy with cyclophosphamide 600 mg m-2, methotrexate 40 mg m-2 and 5-fluorouracil 600 mg m-2 were recruited and randomized to receive calcipotriol scalp solution 50 μg mL-1 or vehicle. The solution was applied twice daily from 4 days prior to chemotherapy and continued for 14 days in each treatment cycle. Shed, plucked and cut hairs were sampled. Absolute shed rates, the proportion of major hair types, the presence of proximal hair shaft changes, regrowth (using the new anagen hair count) and hair density were assessed. Results:Ten patients receiving calcipotriol and 14 receiving vehicle completed three treatment cycles and nine from both groups completed six cycles. There was no detectable effect of calcipotriol on the proportion of patients experiencing minimal hair loss from chemotherapy, shed rates, plucked telogen and fractured hair counts, the morphology of shed and plucked hair, hair regrowth or hair density. Combining results of the treatment groups, there was a large variation in the impact of chemotherapy on hair loss, from total loss in five patients to no obvious loss in five. Excluding the latter, during chemotherapy shed telogen hairs (mean 81%of shed hairs) predominated over fractured (12%) and anagen hairs (6%) (P=0.0002). The major pathological change was proximal hair shaft tapering, baseline mean 3%of shed hairs rising to 48%(P=0.0005) during treatment, and there was a consequent decrease in normal telogen hairs, baseline mean 98%of all telogen hairs falling to 55%(P=0.0005) during treatment. The pathological tapered telogen hairs had normal or small, sometimes diminutive, bulbs. Fracturing of hairs with diminutive bulbs produced typical ‘exclamation mark’hairs. Conclusions:The cardinal effects of cytotoxic drugs found in this study were tapering of the proximal hair shaft and premature entry of the follicle into telogen, conflicting with the conventional view that affected hair follicles continue in anagen. There was a resulting effluvium of a mixture of tapering telogen hairs and fractured hairs. As entry into telogen is an integral part of the process, cytotoxic hair loss may be regarded as a variant of the conventional ‘telogen effluvium’and we propose the term ‘atrophic telogen effluvium’. There was no obvious protective effect on the hair loss of prior treatment with topical calcipotriol.
