自体富血小板血浆治疗雄激素性脱发的临床疗效:基于7例随机双盲、自身半头配对、安慰剂对照试验

Efficiency of autologous platelet-rich plasma for androgenic alopecia:a preliminary study

目的评估自体富血小板血浆(PRP)治疗雄激素性脱发(AGA)的有效性和安全性,测定PRP中生长因子浓度并初步探究其与疗效的相关性。方法纳入中山大学附属第三医院就诊的AGA受试者7例。抽取外周静脉血,使用regenlab自动化套装单次离心法制备PRP,随机分配受试者一侧秃发区域注射PRP,对侧注射生理盐水,共治疗3次,每次间隔1周,在治疗后1、2、3个月随访,进行大体照片及毛发皮肤镜图像采集并软件分析毛发变化,受试者自评以及医师临床评估。采用ELISA测定PRP与外周血中血小板衍生生长因子、转化生长因子-β和血管内皮生长因子的浓度,计算3种生长因子的富集系数,统计分析PRP中血小板与生长因子浓度的相关性,并比较治疗后有效和无效患者中生长因子浓度是否存在差异。结果治疗结束后,PRP侧毛发密度较治疗前和对照侧增加(P<0.05),毛发/毛囊比值较对照侧增加(P<0.05),毛发生长期/休止期比例较治疗前升高(P<0.05);医师评估与患者自评PRP侧治疗有效率均为42.86%。活化后PRP中PDGF、TGF-β和VEGF平均浓度分别为36.73、11.30和2.97 ng/mL,与外周血中3种生长因子比较,富集系数分别为2.14、1.90和2.30倍。PRP中血小板计数与VEGF、TGF-β浓度无明显相关性,PRP中血小板富集系数和PDGF、VEGF富集系数存在线性正相关(P<0.05)。治疗有效组PRP中的TGF-β和VEGF浓度高于治疗无效组(均P<0.05)。结论PRP可促进毛发增多,提高生长期毛发比例,安全性较高;治疗效果与PRP中含的TGF-β和VEGF浓度、个体单位血小板释放生长因子能力相关。

Objective To evaluate the efficacy and safety of autologous platelet-rich plasma(PRP)in the treatment of androgenetic alopecia and to investigate the correlation between concentrations of growth factors and efficacy.Methods Seven male patients with AGA were included in this prospective study.In each subject,one side of the alopecia area was randomly injected with PRP while the opposite side was injected with saline once every other week for 3 times,followed by follow-up at 1,2,and 3 months.Clinical pictures and dermoscopy images were taken for assessment of efficacy by patients and doctors.ELISA was used to measure the levels of PDGF,TGF-βand VEGF in PRP and peripheral blood.Relationship between efficacy and concentration of growth factors was also determined.Results After the treatment,both hair density hair/follicle ratio were increased on the PRP side compared with the placebo side(P<0.05).Anagen/telogen ratio on the PRP side was higher than that at baseline(P<0.05).The effective rate was 42.86%on the PRP side as assessed by the physician and the patients.The mean concentrations of PDGF,TGF-βand VEGF in PRP after activation were 36.73 ng/mL,11.30 ng/mL and 2.97 ng/mL,respectively,which enrichment coefficients were 2.14,1.9 and 2.3 times of that in peripheral blood,respectively.Platelet count in PRP was not significantly correlated with VEGF and TGF-βconcentrations.But platelet enrichment coefficient was positively and linearly correlated with PDGF and VEGF enrichment coefficients in PRP(P<0.05).Concentrations of TGF-βand VEGF in PRP were higher in the effective than in the ineffective group(P<0.05).Conclusions PRP can promote hair growth and increase the proportion of hair in the anagen phase.The efficacy of PRP is correlated with the concentrations of growth factors(TGF-β,VEGF)and the ability of platelets to release growth factors.