雄激素性秃发患者游离睾酮及毛囊中雄激素受体mRNA表达的临床研究

Free androgen index and expression levels of androgen receptor mRNA in patients with androgenetic alopecia

目的:观察雄激素性秃发(AGA)患者游离睾酮及早发性患者雄激素受体(AR)信使RNA相对表达量的临床意义。方法:采用横断面研究该院脱发门诊258例AGA患者,其中男180例,女78例。按照发病年龄及性别分层,登记所有患者档案信息,包括身高、体重、基本型和特定型分级法(BASP)分型及家族史,测量双手除拇指之外的四指的指长,检测所有患者空腹血液的总睾酮及性激素结合球蛋白水平以及计算游离睾酮指数(FAI)。在早发组(发病年龄≤30岁)中随机获得71例(男47例及女24例)患者拔发标本,并检测毛发标本中AR mRNA的相对表达量。结果:①男性AGA患者FAI值明显高于女性,且早发组中男性FAI值明显高于迟发组;②无论是早发组还是迟发组,不同的家族史情况以及不同严重程度秃发患者FAI值比较,差异均无统计学意义(P>0.05);③早发组中,男性和女性身体质量指数(BMI)≥24者均较<24者的FAI值高(P<0.05);④早发组患者毛囊中AR mRNA表达量在不同性别、头皮不同部位及不同的家族史患者中差异无统计学意义(P>0.05),且与指长比、就诊时严重程度以及FAI值无相关性;⑤早发组患者毛囊中AR mRNA表达量与男性BMI值呈正相关(r=0.37, P<0.05),与女性BMI值无相关性。结论:男性早发性AGA患者的发病机制及临床表现均较为复杂,而BMI值与FAI及AR mRNA相对表达量均呈正相关(r1=0.21,r2=0.37;P<0.05)。男性患者BMI值越高,秃发发生的可能性越大。

Objective: To study the clinical significance of free androgen index (FAI) and the androgen receptor ( AR) in hair follicles in early onset androgenetic alopecia (AGA). Methods: A cross sectional study was carried out in 180 male and 78 female patients. The body height and weight, BASP classification, family history and finger lengths (except thumbs) were measured. Meanwhile, total testosterone(TT) and sex hormone binding globulin (SHBG) were also measured, and FAI was calculated. In early onset patients (age of onset ≤ 30 y), hairs in the anagen phase- were pulled from alopecia and occipital areas of 47 males and 24 females. The levels of AR mRNA were measured. Results: FAI was higher in males than in females. FAI in the males was higher in early onset than in late onset AGA. No differences in FAI were found in patients with different family history and severity. In early onset group, FAI in both males and females was higher in patients with body mass index (BMI)≥ 2 4 than BM I<24(P<0.05). AR mRNA levels did not varied significantly with gender, areas of scalp, family history, digit length ratio, severity and FAI. Levels of AR mRNA correlated positively with BMI in males(r=0.37, P<0.05), but not in females. Conclusions: In early onset male AGA, BMI is positively associated with both FAI (r=0.21, P<0.05)and the levels of AR mRNA(r=0.37, P<0.05). Higher BMI increases the risk of alopecia in males.