本文選題：雄激素性脫發(fā) + 皮膚鏡��； 參考：《北京協(xié)和醫(yī)學院》2017年碩士論文

【摘要】：雄激素性脫發(fā)(androgenetic alopecia,AGA)作為最常見的慢性脫發(fā)性疾病,在男性常表現為典型的男性型脫發(fā),除了臨床脫發(fā)表現,本病也會直接影響患者的心理和社會關系健康,科學的診療能夠改善預后,提高生活質量。本研究第一部分利用皮膚鏡測量毛發(fā)相關數據,通過統(tǒng)計學分析重點評估男性AGA患者皮膚鏡測量結果與傳統(tǒng)臨床分級的一致性,研究皮膚鏡在男性AGA診療中的作用。第二部分通過信息調查表對門診男性AGA患者進行調查并對結果進行分析,進一步深化對男性AGA流行病學特點、臨床表現、疾病相關因素、對患者的影響和治療情況等方面的認識。第一部分皮膚鏡在男性雄激素性脫發(fā)診療中的作用研究目的觀察男性雄激素性脫發(fā)(AGA)皮膚鏡特點,對患者與對照鏡下數據進行研究,重點評估皮膚鏡測量結果與傳統(tǒng)臨床分級的一致性,探索皮膚鏡在男性AGA診療中的作用。方法根據Hamilton-Norwood分級(H-N分級)對187例男性AGA患者進行臨床分級,利用皮膚鏡分別測量男性AGA患者和對照組冠狀區(qū)中央和枕骨區(qū)中央單位面積毛發(fā)的數量和直徑等數據,并將測量數據進行分析和比較。結果男性AGA患者變細毛發(fā)比例在患者冠狀區(qū)與枕骨區(qū)之間具有顯著差異(P0.001)。在不同分級中,患者冠狀區(qū)變細毛發(fā)比例之間的差異具有統(tǒng)計學意義(P0.001),枕骨區(qū)變細毛發(fā)比例之間的差異具有統(tǒng)計學意義(P0.01)。冠狀區(qū)直徑≤0.03mm的毛發(fā)比例、直徑≤0.06mm的毛發(fā)比例與H-N分級具有正相關性(P0.001),冠狀區(qū)和枕骨區(qū)1cm2毛發(fā)總數、枕骨區(qū)直徑≤0.03mm和直徑≤0.06mm的毛發(fā)比例與H-N分級無相關性(P0.05)。95.2%的患者冠狀區(qū)直徑≤0.06mm的毛發(fā)比例達到20%及以上,47.1%的患者冠狀區(qū)直徑≤0.03mm的毛發(fā)比例達到20%及以上。對照組變細毛發(fā)(直徑≤0.03mm、直徑≤0.06mm)比例在冠狀區(qū)與枕骨區(qū)之間的差異均有統(tǒng)計學意義(P0.001)�；颊吲c對照比較,變細毛發(fā)比例在冠狀區(qū)之間和枕骨區(qū)之間的差異均有統(tǒng)計學意義(P0.001),患者與對照冠狀區(qū)之間和枕骨區(qū)之間毛發(fā)密度的差異具有統(tǒng)計學意義(P0.05)。Ⅰ級患者變細毛發(fā)比例在冠狀區(qū)和枕骨區(qū)與對照均有顯著差異(P0.001)。結論男性AGA患者冠狀區(qū)變細的毛發(fā)比例隨著病情加重而增加,與AGA臨床分級具有一致性。以20%毛發(fā)變細作為診斷標準,冠狀區(qū)直徑≤0.06mm的毛發(fā)比例較冠狀區(qū)直徑≤0.03mm敏感性更高。對照組變細毛發(fā)比例在冠狀區(qū)和枕骨區(qū)即存在明顯差異。男性AGA患者冠狀區(qū)和枕骨區(qū)變細毛發(fā)比例、毛發(fā)密度與對照相應部位比較均有顯著差異。皮膚鏡測量數據在臨床外觀發(fā)生變化之前已有明顯改變,皮膚鏡檢查有助于男性AGA病變的早期發(fā)現。第二部分:男性雄激素性脫發(fā)臨床特征分析目的分析男性雄激素性脫發(fā)(AGA)的臨床特征。方法制定信息調查表,由研究者對男性AGA患者進行調查,研究內容包括基本臨床特征、流行病學特點、臨床表現、疾病相關因素、對患者的影響和治療情況等。結果156例男性AGA患者中,年齡最小18歲,最大48歲,20-29歲年齡段的就診者占62%。參照H-N量表對患者進行分級,其中Ⅰ級19例,Ⅱ級71例,Ⅲ級34例,Ⅳ級17例,Ⅴ級11例,Ⅵ級4例,Ⅱ級占45%。本病最常累及冠狀區(qū),發(fā)際線形狀最常表現為M型,21.2%的患者出現頭頂部0型脫發(fā)區(qū),16.7%的患者拉發(fā)試驗陽性,76.3%的患者自覺發(fā)生脫發(fā)區(qū)發(fā)質改變,主要包括毛發(fā)變軟、變細等,患者認為導致病情加重的因素主要是睡眠不佳和精神因素。發(fā)病年齡和分級與家族史無相關性(P0.05)。74例患者有治療史,自覺治療有效的僅26例,系統(tǒng)和局部聯合治療有效率最高,口服非那雄胺配合外用藥物有效率達到73.3%。82.1%的患者認為治療本病的支出不會成為經濟上的負擔,僅11.5%的患者表示不存在因本病引起的精神壓力,55.8%的患者認為本病造成中重度精神壓力。結論大部分男性AGA患者呈典型的男性型脫發(fā)外觀,發(fā)病年齡和分級與家族史無相關性,患者認為口服非那雄胺配合米諾地爾溶液外用治療效果最佳,本病能對患者造成心理健康方面的不良影響。
[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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R758.71

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