不同中医证候雄激素性脱发患者的皮肤镜图像特点

Exploration of Dermoscopic Images Characteristic of Patients with Androgenic Alopecia in Different Traditional Chinese Medicine Syndromes

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.