不同中医证候雄激素性脱发患者的皮肤镜图像特点
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摘要
目的:探究皮肤镜在不同中医证候雄激素性脱发患者皮损中的皮肤镜图像特征及在中医辨证中的应用价值。方法:选取2017年3月至2018年2月北京中医药大学东直门医院确诊的且经中医辨证分别属肝肾不足证、血热风燥证及脾胃湿热证的雄激素性脱发患者120例,按证型分为3组,每组40例,每组拍摄120张皮肤镜图像,以毛周征、血管征、黄点征、蜂窝征为指标,观察3种证型患者图像的差异。结果:脾胃湿热组黄点征阳性率高于血热风燥组及肝肾不足组,差异有统计学意义(P <0. 05)。血热风燥组血管征阳性率高于肝肾不足组及脾胃湿热组,差异有统计学意义(P <0. 05),脾胃湿热组高于肝肾不足组,差异有统计学意义(P <0. 05)。肝肾不足组蜂窝征阳性率高于血热风燥组及脾胃湿热组,差异有统计学意义(P <0. 05)。肝肾不足组毛周征数量高于血热风燥组及脾胃湿热组,差异有统计学意义(P <0. 05)。3组患者毛周征数量与病程正相关(r=0. 369,P <0. 05)。脾胃湿热组及肝肾不足组患者毛周征数量与病程呈正相关(r=0. 410,P <0. 05; r=0. 549,P <0. 05)。结论:不同中医证候的雄激素性脱发患者的皮肤镜征象的阳性率及数量具有一定差异,皮肤镜可辅助应用于雄激素性脱发的中医辨证治疗。
Objective: To compare the differences of dermoscopic images of patients with androgenic alopecia in different traditional Chinese medicine (TCM) syndromes,and to explore the application value of dermatoscope in the skin syndrome differentiation of androgenetic alopecia. Methods: A total of 120 patients with androgenetic alopecia were divided into three groups,with 40 cases in each group. The three were liver and kidney deficiency group,blood heat group and dampness-heat of spleen and stomach group.Images were taken by dermatoscope with polarized light,and there were three images for every patient. Peripilar signs (PPS),yellow dots,blood vessels,and honeycomb signs were chosen as index to observe the differences in the three types of syndromes.Results: In the unit dermatoscope field of view,the results were shown as follows. Firstly,the rate of yellow dots positive was that index in dampness-heat of spleen and stomach group was higher than index in blood heat group (P < 0. 01) and kidney deficiency group (P < 0. 01). Secondly,the rate of blood vessels signs positive was that index in blood heat group was higher than index in liver and kidney deficiency group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0.01), and spleen and stomach group was higher than liver and kidney deficiency group (P < 0. 05). Thirdly,the rate of honeycomb signs was that index in liver and kidney deficiency group was higher than index in blood heat group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0. 01). Fourthly,the number of Peripilar signs was that index in liver and kidney deficiency group was higher than index in blood heat group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0. 01). Fifthly,the correlation analysis was that overall statistics of all patients showed positive correlation between the number of Peripilar signs and the course of disease (r = 0. 369,P < 0. 01). Grouping statistics showed that there was positive correlation between the number of Peripilar signs and the course of disease in dampness-heat of spleen and stomach group and liver and kidney deficiency group (r = 0. 410,P < 0. 01; r =0. 549,P < 0. 01). Conclusion: Different syndromes of androgen alopecia patient's dermoscopic images show certain differences between positive rate and quantity of dermoscopic signs. Dermatoscope could be used in the treatment of TCM syndrome differentiation of androgenic alopecia.
Objective: To compare the differences of dermoscopic images of patients with androgenic alopecia in different traditional Chinese medicine (TCM) syndromes,and to explore the application value of dermatoscope in the skin syndrome differentiation of androgenetic alopecia. Methods: A total of 120 patients with androgenetic alopecia were divided into three groups,with 40 cases in each group. The three were liver and kidney deficiency group,blood heat group and dampness-heat of spleen and stomach group.Images were taken by dermatoscope with polarized light,and there were three images for every patient. Peripilar signs (PPS),yellow dots,blood vessels,and honeycomb signs were chosen as index to observe the differences in the three types of syndromes.Results: In the unit dermatoscope field of view,the results were shown as follows. Firstly,the rate of yellow dots positive was that index in dampness-heat of spleen and stomach group was higher than index in blood heat group (P < 0. 01) and kidney deficiency group (P < 0. 01). Secondly,the rate of blood vessels signs positive was that index in blood heat group was higher than index in liver and kidney deficiency group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0.01), and spleen and stomach group was higher than liver and kidney deficiency group (P < 0. 05). Thirdly,the rate of honeycomb signs was that index in liver and kidney deficiency group was higher than index in blood heat group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0. 01). Fourthly,the number of Peripilar signs was that index in liver and kidney deficiency group was higher than index in blood heat group (P < 0. 01) and dampness-heat of spleen and stomach group (P < 0. 01). Fifthly,the correlation analysis was that overall statistics of all patients showed positive correlation between the number of Peripilar signs and the course of disease (r = 0. 369,P < 0. 01). Grouping statistics showed that there was positive correlation between the number of Peripilar signs and the course of disease in dampness-heat of spleen and stomach group and liver and kidney deficiency group (r = 0. 410,P < 0. 01; r =0. 549,P < 0. 01). Conclusion: Different syndromes of androgen alopecia patient's dermoscopic images show certain differences between positive rate and quantity of dermoscopic signs. Dermatoscope could be used in the treatment of TCM syndrome differentiation of androgenic alopecia.
引文
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[11]章星琪.皮肤镜在脱发疾病中的应用[J].临床皮肤科杂志,2014,43(8):505-508.
[12]王丽飞.214例脂溢性脱发患者发病因素及中医辨证的相关性研究[D].沈阳:辽宁中医药大学,2016.
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[15]陈亮,王玎,祁坤明,等.中医综合疗法治疗脂溢性脱发探析[J].亚太传统医药,2016,12(18):108-109.
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[17]陈修漾,陈达灿.不同证候的雄激素性脱发患者受损头皮的病理特征及雄激素受体表达的规律[J].广州中医药大学学报,2004,21(3):169-174.
[18]张宇明.男性雄激素性脱发的临床资料分析及毛发镜在其早期诊断与疗效评估中的应用探索[D].北京:北京中医药大学,2014.
[19]朱学骏,涂平,陈喜雪,等.皮肤病的组织病理学诊断[M].北京:北京大学医学出版社,2016:15,18-20.
[20]支炳伟.雄激素性脱发患者中医体质及其与毛周征关系的临床调查及相关因素分析[D].南京:南京中医药大学,2016.
[21]季绍良,成肇智.中医诊断学[M].北京:人民卫生出版社,2007:2.
[22]孙喜灵,姜伟炜,于东林,等.提高中医证候主观辨识准确性的关键问题[J].中医杂志,2016,57(3):181-184.
[23]郭蕾,韩俊莉,刘宁.论现代医学架构下中医证候临床疗效评价体系的瓶颈[J].中华中医药杂志,2017,32(8):3357-3360.
[24]尹仲衡.皮肤镜在雄激素性脱发中医皮损辨证的应用探究[D].北京:北京中医药大学,2016.
[2]中西医结合学会皮肤性病学专业委员会皮肤影像学亚专业委员会.毛发疾病皮肤镜诊断专家共识[J].中国麻风皮肤病杂志,2016,32(3):129-132.
[3]Inui S.Trichoscopy for common hair loss diseases:algorithmic method for diagnosis[J].J Dermatol,2011,38(1):71-75.
[4]Miteva M,Tosti A.Hair and scalp dermatoscopy[J].J Am Acad Dermatol,2012,67(5):1040-1048.
[5]李水凤,戚世玲,巩毓刚,等.男性雄激素性秃发患者的临床特征及治疗前后皮肤镜征象分析[J].临床皮肤科杂志,2013,42(12):727-730.
[6]庄娘桥,唐旭华,李俊珊,等.雄激素性脱发的皮肤镜下临床特征及疗效分析[J].中国医学创新,2017,14(12):108-110.
[7]瞿幸.中医皮肤性病学[M].北京:中国中医药出版社,2009:237.
[8]中华医学会皮肤性病学分会毛发学组.中国雄激素性秃发诊疗指南[J].临床皮肤科杂志,2014,43(3):182-186.
[9]夏金玉,邵丽,张斌,等.皮肤镜临床应用新进展[J].实用皮肤病学杂志,2015,8(4):280-283.
[10]郭海霞,王莹.皮肤镜在皮肤科的应用进展[J].中国中西医结合皮肤性病学杂志,2016,15(2):125-127.
[11]章星琪.皮肤镜在脱发疾病中的应用[J].临床皮肤科杂志,2014,43(8):505-508.
[12]王丽飞.214例脂溢性脱发患者发病因素及中医辨证的相关性研究[D].沈阳:辽宁中医药大学,2016.
[13]王珏云,冯蕙裳,侠晨辉,等.中西医治疗雄激素源性脱发研究进展[J].中国中医药现代远程教育,2015,13(13):156-158.
[14]马倩,王学岭.脂溢性脱发的中医研究概况[J].中医临床研究,2016,8(15):105-107.
[15]陈亮,王玎,祁坤明,等.中医综合疗法治疗脂溢性脱发探析[J].亚太传统医药,2016,12(18):108-109.
[16]马晓佳,王广,李丽琼.脂溢性脱发的中西医治疗进展[J].云南中医中药杂志,2009,30(6):70-72.
[17]陈修漾,陈达灿.不同证候的雄激素性脱发患者受损头皮的病理特征及雄激素受体表达的规律[J].广州中医药大学学报,2004,21(3):169-174.
[18]张宇明.男性雄激素性脱发的临床资料分析及毛发镜在其早期诊断与疗效评估中的应用探索[D].北京:北京中医药大学,2014.
[19]朱学骏,涂平,陈喜雪,等.皮肤病的组织病理学诊断[M].北京:北京大学医学出版社,2016:15,18-20.
[20]支炳伟.雄激素性脱发患者中医体质及其与毛周征关系的临床调查及相关因素分析[D].南京:南京中医药大学,2016.
[21]季绍良,成肇智.中医诊断学[M].北京:人民卫生出版社,2007:2.
[22]孙喜灵,姜伟炜,于东林,等.提高中医证候主观辨识准确性的关键问题[J].中医杂志,2016,57(3):181-184.
[23]郭蕾,韩俊莉,刘宁.论现代医学架构下中医证候临床疗效评价体系的瓶颈[J].中华中医药杂志,2017,32(8):3357-3360.
[24]尹仲衡.皮肤镜在雄激素性脱发中医皮损辨证的应用探究[D].北京:北京中医药大学,2016.