女性型秃发患者的缺铁状况研究

发布时间：2018-01-01 23:37

本文关键词：女性型秃发患者的缺铁状况研究　出处：《复旦大学》2013年博士论文　论文类型：学位论文

【摘要】：背景女性型秃发是一种非常常见的疾病,且对女性患者的生活质量造成明显影响。部分研究表明秃发患者常见铁缺乏,包括斑秃、女性型秃发、休止期秃发等,也有部分研究质疑该观点。但是目前关于铁缺乏的定义仍不十分明确,包括哪种指标能准确反映体内铁储状态仍不明确,部分研究认为铁蛋白相对更能反映体内铁储状态。即便以铁蛋白作为体内铁储状态的指标,铁蛋白要低至何种程度才说明体内铁缺乏仍无明确定义。目的有研究认为女性型秃发与铁缺乏有关,也有研究质疑该观点。本研究的目的是研究铁缺乏在女性型秃发患者中的发病情况及相关影响因素。方法收集复旦大学附属华山医院皮肤科脱发专病门诊2011年7月至2013年03月间诊断为女性型秃发的429例女性病例组。收集通过社区随机抽取并符合条件的142例正常女性人群为对照组。对病例组和对照组分别进行血清铁蛋白、总铁结合力、未饱和转铁蛋白、血清铁、转铁蛋白饱和度值的比较。并分别以铁蛋白≤15μg/L、铁蛋白≤40μg/L、铁蛋白≤70μg/L作为铁缺乏的界限对病例组和对照组进行铁缺乏发生率的比较。并且区分未绝经人群与绝经人群了解病例组和对照组铁代谢各项参数及铁缺乏发生率是否有统计学差异。因为有研究认为铁缺乏和肥胖、胰岛素抵抗有关,故本研究对病例组进行身高、体重、腰围、臀围、空腹胰岛素和血糖的检测,从而比较病例组中铁缺乏人群和铁未缺乏人群的体重指数、腰臀比、胰岛素抵抗指数是否有显著性差异,以此排除肥胖、胰岛素抵抗的干扰因素。结果一.一般资料 1.1样本量：病例组429例,其中未绝经患者364例(84.8%),绝经患者65例(15.2%)；对照组142例,未绝经人数88例(62.0%),绝经人数54例(38.0%)。1.2年龄：病例组和对照组年龄分别为35.65岁(95%可信区间为18-60岁)和44.54岁(95%可信区间18-69岁)；未绝经人群病例组和对照组年龄分别为31.83岁(95%可信区间17-49岁)和35.09岁(95%可信区间为15-50岁)；绝经人群病例组和对照组年龄分别为57.02岁(95%可信区间为51-59岁)和59.94岁(95%可信区间为51-70岁)。不管是否区分未绝经人群与绝经人群,对照组年龄显著高于病例组(P0.001,P=0.006,P=0.004)。二.铁代谢参数 2.1铁蛋白：病例组和对照组铁蛋白分别为56.49μg/L(95%可信区间：5.62-216.04μg/L)和144.90μg/L(95%可信区间：8.73-596.31μg/L),未绝经人群中病例组和对照组铁蛋白分别为43.85μg/L(95%可信区间：5.53-140.14μg/L)和100.45(95%可信区间：5.93-363.21μg/L),绝经人群中病例组和对照组铁蛋白分别为127.32μg/L(95%可信区间：22.50-407.13gg/L)和217.34μg/L(95%可信区间：23.10-595.90μg/L),不管是否区分未绝经人群和绝经人群,对照组铁蛋白显著高于病例组(P0.001)。当铁蛋白≤15μg/L作为铁缺乏的界限时,病例组和对照组分别有74例(17.2%)和16例(11.3%)铁缺乏,未绝经人群中病例组和对照组分别有73例(20.1%)和16例(18.2%)铁缺乏,绝经人群中病例组和对照组分别有1例(1.5%)和0例(0%)铁缺乏。无论是否区分未绝经人群与绝经人群,病例组与对照组铁缺乏的发生率无统计学差异(P=0.09,P=0.692,P=0.362)。当铁蛋白≤40μg/L作为铁缺乏的界限,病例组和对照组分别有219例(52.1%)和40例(28.2%)铁缺乏,未绝经人群中病例组和对照组分别有214例(58.8%)和36例(40.9%)铁缺乏,绝经人群中病例组和对照组分别有5例(7.7%)和4例(7.4%)铁缺乏。若不区分绝经人群与未绝经人群,病例组铁缺乏的发生率显著高于对照组(P0.001)。在未绝经人群中,病例组铁缺乏的发生率显著高于对照组(P=0.002)。但在绝经人群中,病例组和对照组铁缺乏发生率无统计学差异(P=1)。当铁蛋白≤70gg/L作为铁缺乏的界限,病例组和对照组分别有325例(75.8%)和55例(38.7%)铁缺乏,未绝经人群中病例组和对照组分别有308例(84.6%)和47例(53.4%)铁缺乏,绝经人群中病例组和对照组分别有20例(30.8%)和8例(14.8%)铁缺乏。不管是否区分未绝经人群和绝经人群,病例组铁缺乏的发生率显著高于对照组(P0.001,P0.001,P=0.041)。 2.2总铁结合力：病例组和对照组总铁结合力分别为58.38μmol/L(95%可信区间：44.08-79.92μmol/L)和50.86μmol/L(95%可信区间：32.81-69.87μmol/L),未绝经人群病例组和对照组总铁结合力分别为58.84μmol/L(95%可信区间：44.12.92-81.36μmol/L)和52.78μmol/L(95%可信区间：35.03-69.84μmol/L),绝经人群病例组和对照组总铁结合力分别为55.78μmol/L(95%可信区间：42.33-67.27μmol/L)和47.71μmol/L(95%可信区间：31.62-70.91μmol/L),不管是否区分未绝经人群和绝经人群,病例组总铁结合力显著高于对照组(P0.001)。 2.3未饱和转铁蛋白：病例组和对照组未饱和转铁蛋白分别为41.82pmol/L(95%可信区间：21.32-72.12pmol/L)和34.90pmol/L(95%可信区间：12.70-58.55pmol/L),未绝经人群中病例组和对照组未饱和转铁蛋白分别为42.67pmol/L(95%可信区间：21.61-72.84pmol,/L)和36.75pmol/L(95%可信区间：8.82-60.63pmol/L),绝经人群中病例组和对照组未饱和转铁蛋白分别为37.05pmol/L(95%可信区间：19.73-61.24pmol/L)和31.88pmol/L(95%可信区间：12.72-46.61pmol/L),不管是否区分未绝经人群和绝经人群,病例组未饱和转铁蛋白显著高于对照组(P0.001,P=0.001,P=0.002)。 2.4血清铁：病例组和对照组血清铁分别为16.51μmol/L(95%可信区间：5.62-29.76μmol/L)和15.96μmol/L(95%可信区间:4.82-30.19μmol/L),未绝经人群中病例组和对照组血清铁分别为16.12μmol/L(95%可信区间：5.51-29.74μmol,/L)和16.04μmol/L(95%可信区间：3.23-31.62μmol/L),绝经人群中病例组和对照组血清铁分别为16.73μmol/L(95%可信区间：6.12-36.83μmol/L)和15.83μmol/L(95%可信区间：6.61-28.47μmol/L),不管是否区分未绝经人群和绝经人群,病例组和对照组血清铁比较无统计学差异(P=0.326,P=0.796,P=0.154)。 2.5转铁蛋白饱和度：病例组和对照组转铁蛋白饱和度分别为29.49%(95%可信区间：8.01%-57.32%)和30.59%(95%可信区间：5.14%-66.32%),未绝经人群中病例组和对照组转铁蛋白饱和度分别为28.65%(95%可信区间：8.03%-57.17%)和29.81%(95%可信区间：5.12%-66.76%),绝经人群中病例组和对照组转铁蛋白饱和度分别为34.14%(95%可信区间：9.15%-65.31%)和31.88%(95%可信区间：19.14%-42.30%),不管是否区分未绝经人群和绝经人群,病例组和对照组转铁蛋白饱和度比较均无统计学差异(P=0.208, P=0.251, P=0.124)。三.铁代谢干扰因素 3.1体重指数：以铁蛋白≤40gg/L作为铁缺乏的界限值,病例组中铁缺乏人群和铁未缺乏人群体重指数分别为20.99(95%可信区间：17.22-26.73)和21.37(95%可信区间：17.58-27.77)；未绝经人群中,病例组中铁缺乏人群和铁未缺乏人群体重指数分别为20.93(95%可信区间：17.22-26.35)和21.29(95%可信区间：17.58-28.23)；绝经人群中,病例组中铁缺乏人群和铁未缺乏人群体重指数分别为23.47(95%可信区间：20.43-29.69)和21.57(95%可信区间：17.4-29.21)。不管是否区分未绝经人群和绝经人群,病例组中铁缺乏人群和铁未缺乏人群体重指数比较均无显著性差异(P=0.270,P=0.332,P=0.241)。 3.2腰臀比：以铁蛋白≤40gg/L作为铁缺乏的界限值,病例组中铁缺乏人群和铁未缺乏人群腰臀比分别为0.76(95%可信区间：0.67-0.89)和0.78(95%可信区间：0.69-0.93)；未绝经人群中,病例组中铁缺乏人群和铁未缺乏人群腰臀比分别为0.77(95%可信区间：0.67-0.88)和0.78(95%可信区间：0.69-0.90)；绝经人群中,病例组中铁缺乏人群和铁未缺乏人群腰臀比分别为0.78(95%可信区间：0.72-0.93)和0.79(95%可信区间：0.69-0.99)。不管是否区分未绝经人群和绝经人群,病例组中铁缺乏人群和铁未缺乏人群腰臀比比较均无显著性差异(P=0.082,P=0.201,P=0.341)。 3.3胰岛素抵抗指数：以铁蛋白≤40μg/L作为铁缺乏的界限值,病例组中铁缺乏人群和铁未缺乏人群胰岛素抵抗指数分别为1.66(95%可信区间：0.55-4.33)和1.86(95%可信区间：0.62-5.25)；未绝经人群中,病例组中铁缺乏人群和铁未缺乏人群胰岛素抵抗指数分别为1.66(95%可信区间：0.55-4.14)和1.85(95%可信区间：0.64-5.25)；绝经人群中,病例组中铁缺乏人群和铁未缺乏人群胰岛素抵抗指数分别为1.87(95%可信区间：0.66-5.35)和1.88(95%可信区间：0.59-6.22)。不管是否区分未绝经人群和绝经人群,病例组中铁缺乏人群和铁未缺乏人群胰岛素抵抗指数比较均无显著性差异(P=0.446, P=0.284, P=0.283)。结论本研究提示铁缺乏与女性型秃发存在一定的相关性,如能通过补铁进一步证实铁缺乏在女性型秃发发病中的作用,则为女性型秃发的治疗提供新的策略,具体分子机制有待进一步研究。我们建议铁蛋白≤40μg/L作为铁缺乏的界限值。本研究的特点在于进行了多参数的评估,且结果基本一致,排除了肥胖、胰岛素抵抗的干扰困素,结果可靠性高。
[Abstract]:background
Female pattern baldness is a very common disease, and caused significant impact on women's quality of life of patients. Some studies show that the lack of iron, including common alopecia patients with alopecia areata, female pattern baldness, telogen alopecia, there are some studies questioned the view. But at present a definition of iron deficiency is still not very clear, including what kind of index can accurately reflect the state of body iron stores are still not clear, part of the research that ferritin could reflect the relative iron storage state. Even in the iron in iron storage protein as the index, to the extent to which low ferritin only that iron deficiency is still no clear definition.
objective
Studies have suggested that female alopecia is related to iron deficiency. There are also studies that question this view. The purpose of this study is to investigate the incidence and related factors of iron deficiency in female patients with alopecia.
Method
From the Department of Dermatology of Huashan Hospital Affiliated to Fudan University alopecia clinic from July 2011 to 2013 03 months was diagnosed in 429 cases of female patients were female pattern baldness. Collected 142 cases of normal women were selected by the community and meet the conditions for the control group. The case group and control group respectively, serum ferritin, total iron binding capacity, unsaturated transferrin comparison of serum iron, transferrin saturation, value. And the ferritin is less than or equal to 15 mu g/L, ferritin is less than or equal to 40 mu g/L, ferritin is less than or equal to 70 g/L as the threshold of iron deficiency in the case group and control group were compared. The incidence of iron deficiency and does not distinguish between menopause and menopause patients and understand the control group of iron metabolism parameters and the incidence of iron deficiency is statistically significant. Because studies have shown that iron deficiency and obesity, insulin resistance, so the study of case group were higher, Body weight, waist circumference, hip circumference, fasting insulin and blood glucose were detected. The body mass index, waist hip ratio and insulin resistance index of iron deficiency group and iron deficient population in case group were compared, so as to exclude the interference factors of obesity and insulin resistance.
Result
I. General Information
1.1 sample size:
There were 429 cases in the case group, including 364 cases of non menopausal women (84.8%), 65 cases (15.2%) of menopausal women, 142 cases of control group, 88 cases (62%) of menopause, 54 cases (38%) of menopause,.1.2 age:
The case group and the control group were 35.65 years of age (95% confidence interval 18-60 years) and 44.54 (95% confidence interval 18-69 years); no cases of menopause group and control group were 31.83 years of age (95% confidence interval 17-49 years) and 35.09 (95% confidence interval for 15-50 years of menopause cases); group and control group were 57.02 years of age (95% confidence interval 51-59 years) and 59.94 (95% Ci, 51-70 years). No matter whether to distinguish between premenopausal and postmenopausal population groups, the control group was significantly higher than that of age group (P0.001, P=0.006, P=0.004).
Two. Iron metabolic parameters
2.1 ferritin:
The case group and the control group of ferritin were 56.49 g/L (95% CI: 5.62-216.04 g/L) and 144.90 g/L (95% CI: 8.73-596.31 g/L), no cases of menopause in control group and ferritin were 43.85 g/L (95% confidence interval: 5.53-140.14 g/L (95% and 100.45) confidence interval: 5.93-363.21 g/L), menopause in case group and control group ferritin were 127.32 g/L (95% CI: 22.50-407.13gg/L) and 217.34 g/L (95% CI: 23.10-595.90 g/L), regardless of whether the distinction between premenopausal and the vast population by population group was significantly higher than that of control group cases of ferritin (P0.001).
When ferritin is less than or equal to 15 mu g/L as the threshold of iron deficiency, the case group and the control group were 74 cases (17.2%) and 16 (11.3%) cases of iron deficiency, not menopause in case group and control group were 73 cases (20.1%) and 16 (18.2%) cases of iron deficiency, in cases of menopause and the control group were 1 cases (1.5%) and 0 cases (0%). No matter whether iron deficiency does not distinguish between menopause and menopause group, the case group and the control group the incidence of iron deficiency had no significant difference (P=0.09, P=0.692, P=0.362).
When ferritin is less than or equal to 40 mu g/L as the threshold of iron deficiency, the case group and the control group were 219 cases (52.1%) and 40 (28.2%) cases of iron deficiency, not menopause in case group and control group were 214 cases (58.8%) and 36 (40.9%) cases of iron deficiency, cases of menopause in and the control group were 5 cases (7.7%) and 4 cases (7.4%) of iron deficiency. If do not distinguish between menopause and premenopausal population, incidence of iron deficiency in case group was significantly higher than the control group (P0.001). In premenopausal group, the incidence of iron deficiency in case group was significantly higher than the control group (P=0.002). But in the case of menopause, iron deficiency group and the control group there was no significant difference (P=1).
When ferritin is less than or equal to 70gg/L as the limits of iron deficiency, the case group and the control group were 325 cases (75.8%) and 55 (38.7%) cases of iron deficiency, not menopause in case group and control group were 308 cases (84.6%) and 47 (53.4%) cases of iron deficiency, menopause in cases and controls group there were 20 cases (30.8%) and 8 cases (14.8%). No matter whether iron deficiency does not distinguish between menopause and menopause population, incidence of iron deficiency in case group was significantly higher than the control group (P0.001, P0.001, P=0.041).
2.2 total iron junctions:
The case group and the control group in the total iron binding capacity were 58.38 mol/L (95% CI: 44.08-79.92 mol/L) and 50.86 mol/L (95% CI: 32.81-69.87 mol/L), not menopause patients and the control group total iron binding capacity were 58.84 mol/L (95% confidence interval: 44.12.92-81.36 and mol/L) 52.78 mol/L (95% CI: 35.03-69.84 mol/L), menopause patients group and control group total iron binding capacity were 55.78 mol/L (95% CI: 42.33-67.27 mol/L) and 47.71 mol/L (95% CI: 31.62-70.91 mol/L), regardless of whether the distinction between premenopausal and postmenopausal population groups, the case group the total iron binding capacity was significantly higher than the control group (P0.001).
2.3 unsaturated transferrin:
The case group and the control group without transferrin saturation were 41.82pmol/L (95% CI: 21.32-72.12pmol/L) and 34.90pmol/L (95% CI: 12.70-58.55pmol/L), among premenopausal patients and the control group without transferrin saturation were 42.67pmol/L (95% CI: 21.61-72.84pmol, /L) and 36.75pmol/L (95% CI: 8.82-60.63pmol/L), menopause in the case group and the control group without transferrin saturation were 37.05pmol/L (95% CI: 19.73-61.24pmol/L) and 31.88pmol/L (95% CI: 12.72-46.61pmol/L), regardless of whether the distinction between premenopausal and postmenopausal population groups, the case group of unsaturated transferrin was significantly higher than the control group (P0.001, P=0.001, P=0.002).
2.4 serum iron:
The case group and the control group of serum iron were 16.51 mol/L (95% CI: 5.62-29.76 mol/L) and 15.96 mol/L (95% CI: 4.82-30.19 mol/L), no cases of menopause in control group and serum iron were 16.12 mol/L (95% confidence interval: 5.51-29.74 mol, /L) and 16.04 mol/L (95% CI: 3.23-31.62 mol/L), menopause in case group and control group respectively, serum iron was 16.73 mol/L (95% CI: 6.12-36.83 mol/L) and 15.83 mol/L (95% CI: 6.61-28.47 mol/L), regardless of whether the distinction between premenopausal and postmenopausal population groups, cases and controls there was no significant difference in serum iron (P=0.326, P=0.796, P=0.154).
2.5 transferrin saturation:
The case group and the control group were 29.49% transferrin saturation (95% CI: 8.01%-57.32%) and 30.59% (95% CI: 5.14%-66.32%), no cases of menopause in control group and transferrin saturation were 28.65% (95% CI: 8.03%-57.17%) and 29.81% (95% CI: 5.12%-66.76%), menopause in case group and the control group were 34.14% transferrin saturation (95% CI: 9.15%-65.31%) and 31.88% (95% CI: 19.14%-42.30%), regardless of whether the distinction between premenopausal and postmenopausal population groups, the case group and the control group transferrin saturation were no statistically significant difference (P=0.208, P=0.251, P=0.124).
Three. Interference factors of iron metabolism
3.1 body mass index (BMI):
In order to ferritin than 40gg/L as the limits of iron deficiency, iron deficiency and iron were not the lack of crowd crowd weight index were 20.99 (95% CI: 17.22-26.73) and 21.37 (95% CI: 17.58-27.77); premenopausal population, cases of iron deficiency and iron deficient population population without weight index were 20.93 (95% CI: 17.22-26.35) and 21.29 (95% CI: 17.58-28.23); menopause in cases of iron deficiency and iron deficient population population without weight index were 23.47 (95% CI: 20.43-29.69) and 21.57 (95% CI: 17.4-29.21). No matter whether to distinguish between premenopausal and postmenopausal population groups, cases group of iron deficiency and iron deficient population population without BMI had no significant difference (P=0.270, P=0.332, P=0.241).
3.2 waist to hip ratio:
In order to ferritin than 40gg/L as the limits of iron deficiency, iron deficiency and iron were not lack of people crowd the waist to hip ratio was 0.76 (95% CI: 0.67-0.89) and 0.78 (95% CI: 0.69-0.93); premenopausal population, cases of iron deficiency and iron deficient population population without waist to hip ratio respectively. 0.77 (95% CI: 0.67-0.88) and 0.78 (95% CI: 0.69-0.90); menopause in cases of iron deficiency and iron deficient population population without waist to hip ratio was 0.78 (95% CI: 0.72-0.93) and 0.79 (95% confidence interval: 0.69-0.99). No matter whether to distinguish between premenopausal and population menopause, cases of iron deficiency and iron deficient population population not WHR had no significant difference (P=0.082, P=0.201, P=0.341).
3.3 insulin resistance index:
In the Fe protein is less than or equal to 40 mu g/L as the boundary value of iron deficiency, iron deficiency and iron were not crowd people lacking insulin resistance index were 1.66 (95% CI: 0.55-4.33) and 1.86 (95% CI: 0.62-5.25); premenopausal population, cases of iron deficiency and iron deficiency group without insulin the resistance index was 1.66 (95% CI: 0.55-4.14) and 1.85 (95% CI: 0.64-5.25); menopause in cases of iron deficiency and iron deficient population population without insulin resistance index were 1.87 (95% CI: 0.66-5.35) and 1.88 (95% CI: 0.59-6.22). No matter whether to distinguish between premenopausal the crowd and the menopause, cases of iron deficiency and iron deficient population population without insulin resistance index had no significant difference (P=0.446, P=0.284, P=0.283).
conclusion
This study suggests that iron deficiency in women with alopecia type has certain relevance, such as through iron supplementation in the pathogenesis of female pattern baldness further confirmed the role of iron deficiency, then provide a new strategy for the treatment of female pattern baldness, needs further research. We suggest that the molecular mechanism of ferritin is less than or equal to 40 g/L as the threshold of iron deficiency value. The characteristics of this study is to evaluate the parameters, and the results are basically the same, excluding obesity, insulin resistance and interference factors, the reliability is high.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R758.71

【共引文献】