首页 中华整形外科杂志 2024年40卷01期 2023中国临床实践指南：雄激素性脱发诊断与治疗
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ENGLISH ABSTRACT
2023中国临床实践指南：雄激素性脱发诊断与治疗
中华医学会整形外科学分会中国雄激素性脱发诊断与治疗指南制订工作组 
整形美容专业国家级医疗质量控制中心
中国整形美容协会毛发医学分会
中国女医师协会整形美容专业委员会
作者及单位信息
·
DOI： 10.3760/cma.j.cn114453-20231029-00156
Chinese guideline for the diagnosis and treatment of androgenetic alopecia (2023)
The Working Group of Chinese Guideline for the Diagnosis and Treatment of Androgenetic Alopecia, Chinese Medical Association of Plastic Surgery;
National Medical Quality Control Center for Plastic Surgery;
Society of Hair Medicine, Chinese Association of Plastics and Aesthetics;
Plastic & Aesthetic Surgery Committee, China Medical Women’s Association
Zhang Jufang
Wu Wenyu
Niu Dong
Long Xiao
Authors Info & Affiliations
The Working Group of Chinese Guideline for the Diagnosis and Treatment of Androgenetic Alopecia, Chinese Medical Association of Plastic Surgery;
National Medical Quality Control Center for Plastic Surgery;
Society of Hair Medicine, Chinese Association of Plastics and Aesthetics;
Plastic & Aesthetic Surgery Committee, China Medical Women’s Association
Zhang Jufang
Department of Medical Cosmetology, Hangzhou First People’s Hospital, Westlake University, Hangzhou 310006, China
Wu Wenyu
Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China
Niu Dong
Animal Science College and Animal Medicine College, Zhejiang A&F University, Hangzhou 311300, China
Long Xiao
Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
·
DOI： 10.3760/cma.j.cn114453-20231029-00156
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摘要
雄激素性脱发发病率逐年增高并呈现低龄化的趋势，困扰着众多患者。对于雄激素性脱发的治疗，近年来出现了很多新方式和思路，因此雄激素性脱发的治疗策略需要随之更新；另外，随着近年来毛发行业的发展，大量的从业者涌入雄激素性脱发诊治的相关岗位，因此需要经过证实的指南来进行指引。指南制订工作组遴选了有关临床问题，经过证据检索、专家论证，形成了相关推荐意见，以期能够进一步规范雄激素性脱发的治疗决策。
脱发;雄激素性脱发;整形外科;指南
ABSTRACT
The incidence rate of androgenetic alopecia is increasing year by year and presents a trend of younger age, which puzzles many patients. In recent years, there have been many new treatment methods and ideas for androgenetic alopecia, so the treatment strategies for androgenetic alopecia need to be updated accordingly. In addition, with the development of the hair industry in recent years, a large number of practitioners have flocked to positions related to the diagnosis and treatment of androgenetic alopecia, so proven guidelines are needed for guidance. The guide writing team selected relevant clinical issues, gave recommendations based on a thorough literature review of the latest reports and expert’s evaluation, in the hope of providing a treatment algorithm for androgenetic alopecia.
Alopecia;Androgenetic alopecia;Plastic surgery;Guideline
Zhang Jufang, Department of Medical Cosmetology, Hangzhou First People’s Hospital, Westlake University, Hangzhou 310006, China, Email:
mocdef.aabnis.pivfujhz;
Wu Wenyu, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China, Email:
nc.defgrabo.nahsauhuynewuw;
Niu Dong, Animal Science College and Animal Medicine College, Zhejiang A&F University, Hangzhou 311300, China, Email:
nc.defudabe.ufazuind;
Long Xiao, Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China, Email:
mocdef.6ab21oaixgnolcmup
The authors have no financial interest to declare in relation to the content of this article.
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引用本文
中华医学会整形外科学分会中国雄激素性脱发诊断与治疗指南制订工作组,整形美容专业国家级医疗质量控制中心,中国整形美容协会毛发医学分会,等. 2023中国临床实践指南：雄激素性脱发诊断与治疗[J]. 中华整形外科杂志,2024,40(01)：1-20.
DOI:10.3760/cma.j.cn114453-20231029-00156PERMISSIONS
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雄激素性脱发(androgenetic alopecia，AGA)是一种多基因遗传疾病，是非瘢痕性秃发最常见的原因。AGA的特点是毛囊进行性微小化，导致终毛转变为毳毛。AGA通常呈模式分布，男性主要表现为前额发际线后移和(或)头顶部毛发进行性变细和减少，女性主要表现为头顶部头发的弥漫性稀疏、纤细；也有少部分男性患者呈现女性型AGA的经典脱发模式，同时也有少量女性AGA患者呈现非经典脱发模式或男性型脱发模式。在临床中可以根据患者毛发进行性微小化的病史、特殊的脱发模式和家族史来诊断AGA。
AGA病因是多方面的，其中遗传因素和雄激素在疾病的发生和发展中起着重要作用。尽管血液中的雄激素浓度正常，但有遗传倾向的个体的毛囊细胞对雄激素的高反应性会导致AGA
[
1
]。有证据表明，与同一头皮上的非脱发毛囊相比，5α-还原酶和雄激素受体在脱发毛囊中均呈高表达，Ⅱ型5α-还原酶活性增加，睾酮通过毛囊中的5α-还原酶代谢为双氢睾酮(dihydrotestosterone，DHT)，这种代谢产物与雄激素受体具有更强的亲和力
[
1
]。同时，AGA患者头皮毛囊雄激素受体水平的增加也导致其对循环雄激素异常敏感
[
1
]，雄激素受体的激活会缩短正常毛发生长周期中的生长期，导致休止期毛囊数量增加，逐渐缩短的生长期导致毛囊微小化，即毛囊变薄变短，最终毛发可能无法穿透表皮
[
2
,
3
]。
AGA是从病因对该疾病进行的命名，由于男、女性均可罹患此病，因此该病的中英文名称比较多，除AGA外还包括：雄激素性秃发、男性型脱发、脂溢性脱发、早秃、男性和女性模式型脱发、女性型脱发等。为更好地规范诊断和治疗，本指南中将该类型脱发统一命名为"雄激素性脱发(androgenetic alopecia，AGA)"。
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备注信息
A
张菊芳，西湖大学医学院附属杭州市第一人民医院医疗美容科，杭州 310006, Email:
mocdef.aabnis.pivfujhz；
B
吴文育，复旦大学附属华山医院皮肤科，上海 200040, Email:
nc.defgrabo.nahsauhuynewuw；
C
牛冬，浙江农林大学动物科技学院、动物医学院，杭州 311300, Email:
nc.defudabe.ufazuind；
D
龙笑，中国医学科学院北京协和医学院北京协和医院整形外科，北京 100032, Email:
mocdef.6ab21oaixgnolcmup
E
本文作者与论文刊登的内容无利益关系
F
The authors have no financial interest to declare in relation to the content of this article.
G
中国医学科学院北京协和医学院整形外科医院马辰浩博士在本指南的制订和撰写规范方面给予了全过程的指导，特此鸣谢
H
本指南根据近期文献报告结论及专家讨论意见编写而成，体现整形外科、皮肤科及医学美容科等相关科室专家主流观点，但临床实践中应根据患者具体情况选择合理方案。本指南提出的治疗规范适用于指导整形外科、皮肤科及医学美容科等相关科室医生进行临床工作，不作为患者和非相关专业医师寻求治疗的参考。本指南不作为医疗纠纷、医疗事故鉴定、司法鉴定、司法审判的依据。
指南工作组保留对本指南的解释权和修订权。指南工作组不保证指南应用的结果及有效性，也不承认无限制的担保、表达及暗示。指南工作组及其成员、参与本指南编写的人员不对涉及指南无限制性应用的任何结果承担任何责任。
I
杭州市医学重点学科 (OO20200044)
上海市级医院皮肤科临床能力促进与提升专科联盟 (SHDC22022302)
上海市重中之重研究中心建设项目 (2023Z702018)
上海毛发医学工程技术研究中心 (19DZ2250500)
浙江省自然科学基金重点项目 (LZ22C010003)
北京协和医院中央高水平医院临床科研专项 (2022-PUMCH-B-042)
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