早发雄激素性秃发患者雄激素水平与中医体质分布的相关性研究

Study on the correlation between androgen level and TCM constitution in patients with early-onset androgenetic alopecia

目的 探讨早发雄激素性秃发(AGA)患者雄激素水平与中医体质分布的相关性。方法选取2020年11月-2021年4月就诊于中日友好医院毛发中心的早发AGA患者,收集临床基线资料,检测其血清睾酮(T)、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)水平,填写中医体质调查问卷,进行中医体质辨识。对有效完成中医体质问卷及血清检测的患者,先以患者主要体质进行分组,再以患者兼夹体质进行分类。使用方差分析、非参数检验及多因素线性回归分析研究雄激素水平与中医体质的相关性。结果 共收集220例早发AGA患者,有效完成中医体质问卷和血清检测的患者195例。195例患者的主要体质中,前4位为湿热质(25.64%)、平和质(21.03%)、气郁质(16.41%)、阳虚质(11.28%);兼夹体质总频次310次,前4位为湿热质(22.58%)、气郁质(16.77%)、平和质(13.23%)、阳虚质(12.26%)。主要体质分组中,阳虚质患者血清SHBG水平高于湿热质患者(P<0.05);痰湿质、气郁质及阳虚质患者的血清DHEAS水平均低于湿热质患者(P<0.05,P<0.01),阴虚质及湿热质患者血清DHEAS水平均高于平和质患者(P<0.01),气郁质及阳虚质患者血清DHEAS水平均低于阴虚质患者(P<0.05,P<0.01)。兼夹体质分组中,多因素线性回归分析显示,血清T水平与男性、阳虚质呈正相关;血清SHBG水平与男性、体质量指数、脱发程度、湿热质呈负相关;血清DHEAS水平与男性、体质量指数、湿热质呈正相关,与年龄、平和质、痰湿质呈负相关。结论 早发AGA患者血清T、SHBG、DHEAS水平与中医体质分布存在一定相关性,而雄激素在很多系统性疾病中起着关键性作用,中医体质学研究可以为解释其中的相关性提供新的思路。本研究提示应关注早发AGA患者不同体质的调养、血清雄激素等内分泌激素的综合干预,以及后续合并其他系统性疾病的可能。

Objective We aimed to explore the correlation between androgen level and TCM constitution in patients with early-onset androgenetic alopecia(AGA).Methods Early-onset AGA patients who visited the Hair Medical Center of the China-Japan Friendship Hospital between November 2020 and April 2021 were selected.The clinical baseline data were collected,and the serum levels of testosterone(T),sex hormone binding globulin(SHBG),and dehydroepiandrosterone sulfate(DHEAS)were determined.The TCM constitution questionnaire was filled out,and TCM constitution identification was carried out.The patients who have effectively completed the TCM constitution questionnaire and serum test were divided into groups,first according to the main constitution,and then according to the composite constitution with the binary classification.The analysis of variance,nonparametric test,and multivariate linear regression analysis were used to analyze the correlation between androgen level and TCM constitution.Results 220 patients with early-onset AGA were enrolled.Among them,195 patients completed the questionnaire and underwent serum test.Among 195 patients in the main constitution,the top four were damp heat constitution(25.64%),balanced constitution(21.03%),qi stagnation constitution(16.41%)and yang deficiency constitution(11.28%).The total frequency of the composite constitution is 310 times,and the top four are damp heat constitution(22.58%),qi stagnation constitution(16.77%),balanced constitution(13.23%)and yang deficiency constitution(12.26%).In the main constitution grouping method,the serum SHBG level of patients with yang deficiency constitution was higher than that of patients with damp heat constitution(P<0.05).The serum DHEAS level of patients with phlegm dampness constitution,qi stagnation constitution and yang deficiency constitution were lower than those with damp heat constitution(P<0.05,P<0.01).The serum DHEAS level of patients with yin deficiency constitution and damp heat constitution were higher than those with balanced constitution(P<0.01).The serum DHEAS level of patients with qi stagnation constitution and yang deficiency constitution were lower than those with yin deficiency constitution(P<0.05,P<0.01).In the composite constitution grouping method,multivariate linear regression analysis showed that T was positively correlated with male and yang deficiency constitution.SHBG was negatively correlated with male,BMI,degree of AGA,and damp heat constitution;DHEAS was positively correlated with male,BMI,and damp heat constitution and negatively correlated with age,balanced constitution and phlegm dampness constitution.Conclusion The serum levels of T,SHBG,and DHEAS in patients with early-onset AGA are related to the TCM constitution.Androgen plays a key role in many systemic diseases,and the study of TCM constitution can provide a new way to explain the correlation.This study suggests that we should pay attention to the recuperation of patients with different TCM constitutions,the comprehensive intervention of serum androgens and other endocrine hormones,and the possibility of subsequent complications of other systemic diseases with early-onset AGA.