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为探索雄激素拮抗剂氟他胺在先天性肾上腺皮质增生症(CAH)治疗中应用价值 ,对5例经传统糖皮质激素治疗后临床控制不良的CAH患儿 ,在原糖皮质激素治疗剂量不变或减少情况下 ,加用氟他胺7.5～10mg/(kg·d)治疗6个月左右 ,以观察该新方案治疗前后临床指标及内分泌激素变化。结果显示 :氟他胺联合治疗后 ,生长速率由(10.6±2.3)cm/y减至(5.9±1.3)cm/y(P<0.05) ;血睾酮水平明显下降 ,由5.5 ,39.2(M ,Q)nmol/L降至0.2 ,9.7nmol/L(P<0.05) ;血17 -羟孕酮、脱氢表雄酮、雄稀二酮及尿17 -酮类固醇水平也均有不同程度下降。研究表明氟他胺联合较低剂量糖皮质激素治疗 ,可使CAH患儿生长速率正常化 ,改善高雄激素血症。
In order to explore the application value of androgen antagonist flutamide in the treatment of congenital adrenal hyperplasia (CAH), five patients with clinically poor control of CAH after conventional glucocorticoid therapy were treated with the same dosage of original glucocorticoid Or reduce the case, plus flutamide 7.5 ~ 10mg / (kg · d) for about 6 months to observe the new regimen before and after treatment of clinical indicators and changes in endocrine hormones. The results showed that the growth rate decreased from (10.6 ± 2.3) cm / y to (5.9 ± 1.3) cm / y after flutamide treatment (P <0.05), and the serum testosterone level decreased significantly from 5.5, 39.2 Q) nmol / L decreased to 0.2 and 9.7 nmol / L, respectively (P <0.05). The levels of 17 - hydroxyprogesterone, DHEA, LDH and urinary 17 - keto steroid also declined to some extent. Studies have shown that the combination of flutamide and lower doses of glucocorticoid treatment can be normalized in children with CAH growth rate and improve hyperandrogenism.