皮肤镜在男性雄激素性脱发诊疗中的作用研究及男性雄激素性脱发临床特征分析

发布时间：2018-06-22 04:56

本文选题：雄激素性脱发 + 皮肤镜　；参考：《北京协和医学院》2017年硕士论文

【摘要】：雄激素性脱发(androgenetic alopecia,AGA)作为最常见的慢性脱发性疾病,在男性常表现为典型的男性型脱发,除了临床脱发表现,本病也会直接影响患者的心理和社会关系健康,科学的诊疗能够改善预后,提高生活质量。本研究第一部分利用皮肤镜测量毛发相关数据,通过统计学分析重点评估男性AGA患者皮肤镜测量结果与传统临床分级的一致性,研究皮肤镜在男性AGA诊疗中的作用。第二部分通过信息调查表对门诊男性AGA患者进行调查并对结果进行分析,进一步深化对男性AGA流行病学特点、临床表现、疾病相关因素、对患者的影响和治疗情况等方面的认识。第一部分皮肤镜在男性雄激素性脱发诊疗中的作用研究目的观察男性雄激素性脱发(AGA)皮肤镜特点,对患者与对照镜下数据进行研究,重点评估皮肤镜测量结果与传统临床分级的一致性,探索皮肤镜在男性AGA诊疗中的作用。方法根据Hamilton-Norwood分级(H-N分级)对187例男性AGA患者进行临床分级,利用皮肤镜分别测量男性AGA患者和对照组冠状区中央和枕骨区中央单位面积毛发的数量和直径等数据,并将测量数据进行分析和比较。结果男性AGA患者变细毛发比例在患者冠状区与枕骨区之间具有显著差异(P0.001)。在不同分级中,患者冠状区变细毛发比例之间的差异具有统计学意义(P0.001),枕骨区变细毛发比例之间的差异具有统计学意义(P0.01)。冠状区直径≤0.03mm的毛发比例、直径≤0.06mm的毛发比例与H-N分级具有正相关性(P0.001),冠状区和枕骨区1cm2毛发总数、枕骨区直径≤0.03mm和直径≤0.06mm的毛发比例与H-N分级无相关性(P0.05)。95.2%的患者冠状区直径≤0.06mm的毛发比例达到20%及以上,47.1%的患者冠状区直径≤0.03mm的毛发比例达到20%及以上。对照组变细毛发(直径≤0.03mm、直径≤0.06mm)比例在冠状区与枕骨区之间的差异均有统计学意义(P0.001)。患者与对照比较,变细毛发比例在冠状区之间和枕骨区之间的差异均有统计学意义(P0.001),患者与对照冠状区之间和枕骨区之间毛发密度的差异具有统计学意义(P0.05)。Ⅰ级患者变细毛发比例在冠状区和枕骨区与对照均有显著差异(P0.001)。结论男性AGA患者冠状区变细的毛发比例随着病情加重而增加,与AGA临床分级具有一致性。以20%毛发变细作为诊断标准,冠状区直径≤0.06mm的毛发比例较冠状区直径≤0.03mm敏感性更高。对照组变细毛发比例在冠状区和枕骨区即存在明显差异。男性AGA患者冠状区和枕骨区变细毛发比例、毛发密度与对照相应部位比较均有显著差异。皮肤镜测量数据在临床外观发生变化之前已有明显改变,皮肤镜检查有助于男性AGA病变的早期发现。第二部分:男性雄激素性脱发临床特征分析目的分析男性雄激素性脱发(AGA)的临床特征。方法制定信息调查表,由研究者对男性AGA患者进行调查,研究内容包括基本临床特征、流行病学特点、临床表现、疾病相关因素、对患者的影响和治疗情况等。结果156例男性AGA患者中,年龄最小18岁,最大48岁,20-29岁年龄段的就诊者占62%。参照H-N量表对患者进行分级,其中Ⅰ级19例,Ⅱ级71例,Ⅲ级34例,Ⅳ级17例,Ⅴ级11例,Ⅵ级4例,Ⅱ级占45%。本病最常累及冠状区,发际线形状最常表现为M型,21.2%的患者出现头顶部0型脱发区,16.7%的患者拉发试验阳性,76.3%的患者自觉发生脱发区发质改变,主要包括毛发变软、变细等,患者认为导致病情加重的因素主要是睡眠不佳和精神因素。发病年龄和分级与家族史无相关性(P0.05)。74例患者有治疗史,自觉治疗有效的仅26例,系统和局部联合治疗有效率最高,口服非那雄胺配合外用药物有效率达到73.3%。82.1%的患者认为治疗本病的支出不会成为经济上的负担,仅11.5%的患者表示不存在因本病引起的精神压力,55.8%的患者认为本病造成中重度精神压力。结论大部分男性AGA患者呈典型的男性型脱发外观,发病年龄和分级与家族史无相关性,患者认为口服非那雄胺配合米诺地尔溶液外用治疗效果最佳,本病能对患者造成心理健康方面的不良影响。
[Abstract]:Androgenetic alopecia (AGA), as the most common chronic alopecia, often appears as a typical male type alopecia in male. Besides the clinical alopecia, this disease will directly affect the mental and social relationship of the patient. Scientific diagnosis and treatment can improve the prognosis and improve the quality of life. The first part of this study is used in this study. Skin mirror measurement of hair related data, through statistical analysis to assess the consistency of the results of the skin mirror measurement of male AGA patients and the traditional clinical classification, study the role of the skin mirror in the diagnosis and treatment of male AGA. The second part through the information questionnaire to investigate and analyze the results of the male AGA patients in the outpatient department and further deepen the men AGA epidemiological characteristics, clinical manifestations, disease related factors, influence and treatment of patients. Part 1 the role of skin mirror in male androgenic alopecia diagnosis and treatment of male androgen alopecia (AGA), the characteristics of male androgen alopecia (AGA) skin mirror, study on the patient and the data under the mirror, and focus on the evaluation of the skin In accordance with the concordance of the microscopic examination and the traditional clinical classification, the role of the skin mirror in the diagnosis and treatment of male AGA was explored. Methods 187 male AGA patients were classified according to the Hamilton-Norwood classification (H-N grading), and the number of hair per unit area in the central and occipital region of the male AGA patients and the control group was measured by the skin mirror. The results were analyzed and compared. Results in male AGA patients, there was a significant difference between the coronal and occipital areas (P0.001) in the patients' coronary and occipital areas (P0.001). The difference between the proportion of the coronal finer hair in the patients was statistically significant (P0.001) and the difference between the occipital area and the proportion of the fine hair. The difference was statistically significant (P0.01). The hair proportion of the coronary diameter less than 0.03mm, the proportion of hair less than 0.06mm and the H-N classification had positive correlation (P0.001), the total number of 1cm2 hair in the coronal and occipital region, the ratio of the occipital diameter less than 0.03mm and the diameter less than 0.06mm, and the coronal diameter of the patients with no correlation with H-N classification (P0.05).95.2%. The proportion of hair less than 0.06mm reached 20% and above, and the percentage of hair that was less than 0.03mm in the coronary area of 47.1% of the patients reached 20% and above. The proportion of fine hair (diameter less than 0.03mm, diameter < 0.06mm) in the control group was statistically significant between the coronal and occipital region (P0.001). The difference between the occipital and the occipital bone was statistically significant (P0.001). The difference of hair density between the patients and the control coronal area and occipital region was statistically significant (P0.05). The proportion of the fine hair in the patients with grade I was significantly different between the coronal and occipital areas (P0.001). Conclusion the percentage of the hair in the coronary area of the male AGA patients was thinner. As the condition worsened, it was consistent with the AGA clinical classification. With 20% hair thinning as a diagnostic criterion, the hair ratio of the coronal diameter less than 0.06mm was higher than that of the coronary zone diameter less than 0.03mm. The proportion of the fine hair in the control group was significantly different in the coronal and occipital region. The coronal and occipital region of male AGA patients changed fine hair. The incidence of hair density was significantly different from that of the corresponding part of the control. The skin mirror measurements had been significantly changed before the appearance of the clinical appearance, and the skin mirror examination was helpful to the early discovery of male AGA lesions. The second part: analysis of the clinical characteristics of male androgen alopecia to analyze the presence of male androgen alopecia (AGA). Methods the information questionnaire was made by the researchers to investigate the male AGA patients, including the basic clinical features, epidemiological characteristics, clinical manifestations, disease related factors, the influence and treatment of the patients. Results in 156 male AGA patients, the minimum age of age was 18, the maximum was 48 years, and the 20-29 year old age group accounted for the patients. 62%. was classified according to the H-N scale, including 19 cases of grade I, 71 cases of grade II, 34 cases of grade III, 17 cases of grade IV, 11 cases of grade V, 4 cases of grade VI, grade II in 45%., the most often involved in coronal area, the shape of the hairline most often manifested as M type, 21.2% patients appeared on top of head 0, 16.7% patients were positive, 76.3% of 76.3% patients consciously took off. Hair changes in the hair area, mainly including hair soft, thinning, and other factors, the patients think that the factors leading to the aggravation are not good sleep and mental factors. The age and classification of the disease and the family history of no correlation (P0.05).74 patients have a history of treatment, conscious treatment of only 26 cases of effective treatment, system and local combined treatment has the highest efficiency, oral administration of Finasteride The patients with the effective rate of foreign drugs reached 73.3%.82.1% that the expenditure on the treatment of the disease would not be an economic burden. Only 11.5% of the patients said that there was no mental stress caused by this disease. 55.8% of the patients considered the disease to cause moderate and severe mental stress. Conclusion most of the male AGA patients have a typical male type hair loss appearance. Age and classification are not related to family history. Patients think that oral administration of finasteride with Minoxidil Solution is the best treatment, and this disease can cause adverse effects on patients' mental health.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.71

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