定点测距分级在男性雄激素性脱发中的适用性研究

定点测距分级在男性雄激素性脱发中的适用性研究

戚吉妮1 蒋宙男1 程含皛2 侯觉1 屠静怡1 周玥3 徐伟力4 赵钧5 周圳滔3 周易6 毛俊杰7 钱锡飞1 范崇祥1 张菊芳1,2 吕中法8

本文来源：《中华整形外科杂志》2023年2月第39卷第2期

DOI:10. 3760 / cma.j.cn114453-20220804-00239

作者单位：1浙江中医药大学第四临床医学院浙江大学医学院附属杭州市第一人民医院，杭州 310006； 2浙江大学医学院附属杭州市第一人民医院整形外科，杭州310006； 3解放军联勤保障部队第九○三医院烧伤整形科，杭州310013； 4浙江大学医学院附属杭州市第一人民医院城北院区整形外科，杭州310003； 5杭州市萧山区第一人民医院整形外科，杭州311200； 6杭州市第九人民医院医疗美容科，杭州310000； 7浙江中医药大学第一临床医学院，杭州310053； 8浙江大学医学院附属第二医院皮肤科，杭州310009

通信作者：张菊芳，Email: zhjuf@vip.sina.com；吕中法，Email: lzfskin@zju.edu.cn

引用本文

戚吉妮，蒋宙男，程含皛，等. 定点测距分级在男性雄激素性脱发中的适用性研究 [J] . 中华整形外科杂志, 2023, 39(2) : 125-133. DOI: 10.3760/cma.j.cn114453-20220804-00239.

【摘要】

目的探讨定点测距分级在评估男性雄激素性脱发严重程度中的适用性。

方法2019年 6至12月于杭州市第一人民医院脱发专科门诊根据定点测距分级及BASP（basic and specific）分级对诊断明确的中国男性雄激素性脱发患者进行评估。定点测距分级基于患者毛发的测量数据进行评级，通过测量前发际线定点至眉水平线的距离、发旋中心的最长脱发半径，评估患者额（F）、颞(M)、顶(V)部毛发退缩情况，将各区域脱发情况由轻到重评为0~3级，最终脱发分级表示为FnMnVn形式（如F1M2V0）。以F、M、V 中最高的脱发等级作为患者整体脱发分级。采用SPSS 25.0软件统计分析患者一般资料，采用Kappa检验评估定点测距分级与BASP分级结果间的一致性；通过3位脱发专科医生评级的重复率检验定点测距分级的重复性；3位脱发专科医生中2位及以上有相同评价的患者，将该评价结果视作标准结果，通过2位临时培训的普通医生的分级结果与标准结果的一致率检验定点测距分级的易用性。

结果共纳入150例男性患者，年龄（32.8±7.9）岁（19~58岁），其中24~35岁者99例，占66.00%，可以观察到患者发病年龄偏早。经定点测距分级评估，150例患者中轻度脱发的人数最多［65例（43.33%）］，其次为重度脱发［58例（38.67%）］，与BASP分级所得结果的一致性中等（κ=0.573，P＜0.001）。3位经验丰富的脱发专科医生通过定点测距分级对150例患者进行评估的结果显示，额、颞、顶部分级结果的重复率分别为98.00％（147/150）、 97.33%(146/150)和96.00%(144/150)，最终脱发分级的重复率为92.00％(138/150)，整体脱发分级的重复率为98.00％(147/150)。2名临时培训的普通医生的整体脱发分级结果与标准结果的一致率分别为95.92%(141/147)与96.60%(142/147)，且除其中1位普通医生在最终分级方面与标准结果的一致率为89.86%（124/138）外，其余结果一致率均高于90.00%。

结论定点测距分级是一种针对中国男性雄激素性脱发患者设计、基于客观测量数据的可重复性高、易于学习使用的分级方法。

【关键词】脱发；男性雄激素性脱发；脱发分级；脱发诊断；定点测距

基金项目：国家自然科学基金(81972959)；杭州市医学重点学科(0020200044)

A study on the applicability of the distance between facial marks classification of male androgenic alopecia

Qi Jini1, Jiang Zhounan1, Cheng Hanxiao2, Hou Jue1, Tu Jingyi1, Zhou Yue3, Xu Weili4, Zhao Jun5, Zhou Zhentao3, Zhou Yi6, Mao Junjie7, Qian Xifei1, Fan Chongxiang1, Zhang Jufang1,2, Lyu Zhongfa8

1The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; 2Department of Plastic Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;

3Department of Burn and Plastic Surgery, No. 903 Hospital of PLA Joint Logistic Support Force, Hangzhou 310013, China;

4Department of Plastic Surgery, Hangzhou First People’s Hospital Chengbei Branch, Zhejiang University School of Medicine, Hangzhou 310003, China; 5Department of Plastic Surgery, the First People’s Hospital of Xiaoshan District in Hangzhou, Hangzhou 311200, China;

6Department of Medical Cosmetology, Hangzhou Ninth People’s Hospital, Hangzhou 310000, China;

7the First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China;

8Department of Dermatology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China

Corresponding author: Zhang Jufang, Email: zhjuf@vip.sina.com; Lyu Zhongfa, Email: lzfskin@zju.edu.cn

【Abstract】

Objective To explore the applicability of the distance between facial marks classification in evaluating the severity of androgenic alopecia in men.

Methods From June to December 2019, the male Chinese with diagnosis of androgenic alopecia were evaluated in the specific clinic of alopecia of Hangzhou First People’s Hospital according to the distance between facial marks and BASP(basic and specific) classification. The classification based on the distance between facial marks measures the distance from the facial marks of the anterior hairline to the horizontal line of the eyebrow and the longest radius of hair loss in the hair rotation center, the hair recession of the patient’s forehead (F), temporal (M) and vertex (V) parts. The hair loss in each region is rated as 0-3 grade from light to heavy, and the final hair loss grading is expressed as FnMnVn, such as F1M2V0. The highest grade of hair loss in F, M and V is the overall grade of hair loss. SPSS 25.0 software was used to statistically analyze the general data of patients, and Kappa test was used to evaluate the consistency between the results of the distance classification and BASP classification. The repeatability of the distance classification was tested by the repetition rate of three hair loss specialists. When two or more specialists gave the same evaluation among the three hair loss specialists, the result was regarded as the standard result. The ease of use of the distance between facial marks classification was tested by the consistency rate between the grading results of two temporary trained general doctors and the standard results.

Results A total of 150 male patients, aged (32.8±7.9) years (19-58 years), were included, of which 99 patients were 24-35 years old, accounting for 66.00%. It can be observed that the onset age was earlier. As assessed in this classification, the patients who participated in the study were graded as mild in 65 cases(43.33%), severe in 58 cases(38.67%), and moderate, which was consistency with the results obtained by BASP classification (κ=0.573, P＜0.001). Three experienced alopecia specialists evaluated 150 patients through the distance between facial marks. The results showed that the repetition rates of frontal, temporal and parietal classification results were 98.00%(147/150), 97.33%(146/150) and 96.00%(144/150), respectively. The repetition rate of the final alopecia classification was 92.00%(138/150), and the repetition rate of the overall alopecia classification was 98.00%(147/150). The consistency rate between the overall alopecia classification results of two temporary trained general doctors and the standard results was 95.92%(141/147) and 96.60%(142/147), respectively, and the consistency rate of the other results was higher than 90.00% except for one general doctor who was 89.86%(124/138) in the final classification.

Conclusion The distance between facial marks classification is a comparatively accurate and easy-to-learn grading method designed for Chinese male androgenic hair loss patients based on objective measurement data.

【Key words】Alopecia; Male androgenic alopecia; Classification of alopecia; Diagnosis of alopecia; Distance between facial marks

Fund program: National Natural Science Foundation of China(81972959); Hangzhou Medical Key Discipline Fund Project (0020200044)

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Hangzhou First People’s Hospital, Zhejiang University School of Medicine(IIT-20220808-0125-01).

雄激素性脱发（androgenic alopecia，AGA）是一种最常见的脱发疾病，男性患者主要表现为前额发际后移和（或）顶部毛发稀疏，其发病情况与年龄、性别、种族有关［1-3］。AGA的分级在其诊断、治疗、疗效监测等方面有重要作用。目前中国常用的AGA分级为1975年由Norwood［4］在Hamilton分级［1］基础上完善的Norwood-Hamilton分级法，以及2007年由Lee等［5］提出的BASP(basic and specific)分级法。但目前这2种分级方法在临床使用过程中的重复性和一致性较低，脱发分级评估依赖评估者目测，缺乏客观指标。我们针对中国男性AGA患者设计了一种基于客观测量毛发数据的分级方法，称为定点测距分级［6］。本研究旨在评估定点测距分级方法的重复性、易用性及与BASP分级评估结果的一致性等情况。

资料与方法

一、资料选择

收集2019年6至12月浙江中医药大学第四临床医学院（浙江大学医学院附属杭州市第一人民医院）脱发专科门诊诊断明确的中国男性AGA患者资料进行回顾性分析。纳入标准：（1）患者均符合2019年修订的《中国人雄激素性脱发诊疗指南》［7］中AGA诊断标准；（2）男性患者。排除标准：（1）伴有其他毛发疾病；（2）入组前6个月内接受过毛发生长治疗；（3）有任何影响毛发生长的状况（如高烧、严重的精神压力、代谢紊乱或抗癌治疗）。

本研究经浙江中医药大学第四临床医学院（浙江大学医学院附属杭州市第一人民医院）伦理委员会批准（IIT-20220808-0125-01），患者均知情同意。

二、方法

（一）检查及拍照

由脱发专科医生仔细检查每位患者情况，并分别根据定点测距分级及BASP分级进行评估，保留完整病例资料后以8张标准视图顺序拍摄数码照片，拍摄角度包括：正面平前额发际线0°、正面低头45°、左转和右转头部45°、左转和右转头部90°、背面平后发际线0°、头部后仰45°各1张（图1）。若患者前额毛发较长，拍摄照片时需使用发箍显露发际线。

（二）定点测距分级方法

定点测距分级是基于中国男性毛发测量数据设计的针对中国男性AGA患者的脱发分级方法。通过定点测量前额、颞部及顶点区域（发旋处）的毛发数据，对患者脱发情况进行综合评估，分别以字母F、M、V描述前额、颞部及发旋处的发际线退缩情况。根据脱发严重程度，将各处划分为4个等级（0~3 级），0级表示无明显脱发，1级表示轻度脱发，2级表示中度脱发，3级表示重度脱发，最终分级记为FnMnVn形式，如F1M2V0，将F、M、V中最高的脱发等级记为患者的整体脱发分级。若患者的脱发模式无法通过定点测距分级进行评估，可添加文字具体描述补充。定点测距分级的具体步骤如下（图2）。

步骤1：标记眉间中点A，过眉间中点做水平线，与左右侧外眦垂线交于眉尾附近，分别记为点Bl（左）、Br（右）；当存在发旋处脱发时，标记发旋中心点V及环形脱发轮廓线上距离发旋中心的最远点C，其中脱发轮廓线为脱发区与非脱发区交界点的连线，表现为完全脱发区的边界或肉眼下毛发较非脱发区明显变稀疏、可观察到头皮的范围边界。

步骤2：标记前额发际线脱发轮廓线上前缘中点F及与双侧外眦垂线交点Ml（左）和Mr（右）（额角区域）。

步骤3：记录AF长度a；测量BlMl长度b1、BrMr长度b2，b1、b2中较大值记录为b；若存在发旋脱发，记录CV长度c。

步骤4：评定定点测距分级等级。评估时，长度a、b、c的正常参考值分别为7、9和0 cm［8-9］，将测量的距离a、b、c与正常参考值进行比较，无明显退缩记为0级，参考BASP分级前中后1/3的脱发分类方法［5,10］，将前发际线每退缩4 cm为一级，即退缩0~4 cm记为1级，退缩>4~8 cm记为2级，退缩＞8 cm 记为3级；发旋区则每退缩5 cm为一级，即退缩0~5 cm记为1级，退缩>5~10 cm记为2级，退缩＞10 cm 记为3级，分别得出额、颞处发际线及发旋区退缩严重程度的分级，具体的分级界值见表1。男性AGA患者定点测距分级系统示意图见图3。

（三）BASP分级及其与定点测距分级结果一致性的比较

由脱发专科医生通过测量发际线数据、检查头皮的临床数码照片等，使用BASP分级对前述进行定点测距分级的相同一批患者的脱发情况进行评估（表2）。BASP分级将L、M0、C0定义为无明显脱发，M1、C1、F1、V1定义为轻度脱发，M2、C2、F2、V2定义为中度脱发，M3、C3、F3、V3及所有的U型脱发定义为重度脱发，将基本类型（BA）与特定类型（SP）中最高的脱发等级记为患者的整体脱发分级。