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中华整形外科杂志
中华整形外科杂志

曹谊林

双月刊

1009-4598

cjpls@cma.org.cn

010-88960006

100144

北京市石景山区八大处路33号

中华整形外科杂志/Journal Chinese Journal of Plastic SurgeryCSCD北大核心CSTPCD
查看更多>>1985年创刊，中华医学会主办。本刊是中国协和医科大学整形外科研究所出版的整形外科专业学术期刊。以整形外科、烧伤外科、显微外科、骨科、口腔科、耳鼻喉科、眼科、泌尿外科、皮肤科等学科临床医师及科研工作者为读者对象，刊登对整形外科发展具有导向性、指导性的评论和文件，报道整形外科领域先进的科研成果和诊疗经验，以及对整形外科临床有指导作用、与整形外科临床密切结合的基础理论研究。主要栏目有：论著、工作研究、经验交流、病例报告、技术改进、综述、讲座、警钟等。本刊被多家国内外生物医学期刊数据库和医学文摘所收录。
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    2023中国临床实践指南：雄激素性脱发诊断与治疗

    张菊芳吴文育牛冬龙笑...
    1-20页
    查看更多>>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。 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.

    脱发雄激素性脱发整形外科指南

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    基于眶周形态及组织特点设计毛发移植治疗烧伤后眉缺损

    蒋文杰林俊青王博刘晓娜...
    21-26页
    查看更多>>摘要：目的 总结基于眶周形态及组织特点设计毛发移植治疗烧伤后眉缺损的经验。 方法 回顾性分析2011年1月至2023年9月于中国医学科学院整形外科医院毛发移植中心治疗的烧伤后眉缺损患者的临床资料。根据烧伤后患者眶周形态和组织特点对眉毛的位置和形态进行设计：以枕部靠近后发际线处或耳后发际处为供区，使用头皮条切取法或毛囊单位切取术(FUE)获取毛囊，有头皮瘢痕需要切除或曾行头皮扩张手术有"猫耳"畸形需要修整的头皮也可以作为供区，将毛囊分为含单根毛发的毛囊单位(FUs)；用规格为21或22 G针头在受区穿刺打孔直至皮下浅层，然后用显微镊夹持毛干部，将毛发移植到受区，以修复眉毛形态。术后对患者眉毛密度、形态和方向以及供区瘢痕情况进行观察和随访。 结果 共纳入197例患者(282条眉毛)，其中男133例，女64例；年龄9～62岁，平均33.7岁；眉弓区皮片移植术后17例，皮瓣及扩张皮瓣修复术后33例，眼睑部皮片移植术后36例，烧伤创面瘢痕愈合111例；双侧眉完全缺失51例、部分缺损34例，单侧眉完全缺失65例、部分缺损47例。282条眉毛的植发量为53～600 FUs，其中采用头皮条切取分离法75例，FUE法122例。术后随访9个月至10年，有17例患者出现毛囊炎，经75%乙醇涂擦后痊愈；9例眉毛密度不足，1年后再次通过毛发移植进行加密；其余患者植入毛发生长良好，接近正常眉毛的形态及方向，效果满意。供区瘢痕不明显。 结论 采用毛发移植治疗烧伤后眉缺损时，首先要根据眶周形态及组织特点设计眉形，再考虑眉毛的整体位置和双侧的对称性。只有充分考虑烧伤后受区的特点，才能获得理想的眉毛修复效果。 Objective To summarize the experience of designing transplanted hair based on the orbital morphology and tissue characteristics for the treatment of eyebrow defects after burns. Methods A retrospective analysis was conducted on clinical data of the patients with eyebrow defects after burns who treated at Hair Transplantation Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences between January 2011 and September 2023. The location and appearance of eyebrow were designed according to the orbital morphology and tissue characteristics. The follicles were extracted by incision of scalps strips and follicle unit excision (FUE) on the donor area of the occipital region near the posterior hairline or the posterior ear hairline. Scalps with scars that needed to be removed or had "dog ear" deformities following scalp expansion surgery that needed to be repaired were also be used as donor sites. The follicles were divided as follicle units (FUs) including single hair. The recipient area was punched with syringe needle of 22 or 22 G to subcutaneous superficial layer. Then the hair shaft was clamped with microforceps and the hairs were transplanted to the defective area to restore the appearance of eyebrow. The density, morphology, direction and scars of the donor sites were observed by following-ups. Results A total of 197 patients with 282 eyebrows were recruited. There were 133 males and 64 females. The average age was 33.7 (9 to 62) years. There were 17 patients with skin graft transplantation in the eyebrow arch, 33 with flap and expanded flap repair, 36 with eyelid skin grafting, 111 with burn scar healing. A total of 51 patients had complete eyebrow defects on both sides, and 34 had partial defects. Sixty-five patients had complete eyebrow defects on single side, and 47 had partial defects. The amount of hair transplantation was from 53 to 600 FUs on 282 eyebrows. Seventy-five patients extracted follicles with incision of scalps strips and 122 with FUE. The patients were followed up for 9 months to 10 years. Folliculitis were found in 17 patients and completely cured by 75% alcohol disinfection. Nine patients with insufficient density underwent hair transplantation for a second time to increase the density of hairs one year later. And the implanted hairs grew well, which were similar to the shape and direction of normal eyebrows. Transplanted hairs of the rest patients grew well. The direction and appearance were satisfied. The scar in the donor site was not obvious. Conclusion The transplanted hair should be designed primarily based on the orbital morphology and tissue characteristics for the treatment of eyebrow defects after burns. Then the position of the eyebrow and the bilateral symmetry should be considered. The ideal effect of eyebrow reconstruction would depend on the full consideration of the receipt site.

    眉毛毛发移植毛囊烧伤

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    自体脂肪移植联合毛发移植治疗头皮烧伤后瘢痕

    谢祥毕洪森王关卉儿谢宏彬...
    27-33页
    查看更多>>摘要：目的 探讨应用自体脂肪移植联合毛发移植治疗烧伤后质硬、菲薄头皮扁平瘢痕的临床效果。 方法 回顾性分析2017年1月至2022年12月北京大学第三医院成形外科收治的烧伤后质硬、菲薄头皮扁平瘢痕患者的临床资料。术中于下腹部或大腿外侧抽吸脂肪，静置15 min后注射于头皮瘢痕下，质硬、菲薄瘢痕区域约0.8 ml/cm2，较厚柔软瘢痕区域0.2～0.4 ml/cm2。脂肪移植3个月之后再于瘢痕秃发区行毛发移植，移植密度：质硬、菲薄瘢痕区域为25～35毛囊单位(FUs)/cm2，较厚柔软瘢痕区域为30～40 FUs/cm2。由2名第三方整形外科主治医师应用温哥华瘢痕量表(VSS)，分别在头皮脂肪移植术前和移植3个月后毛发移植前对所有患者头皮质硬、菲薄的瘢痕区域进行评分。VSS评分以M(Q1，Q3)表示，术前和术后比较采用配对样本Wilcoxon符号秩检验。植发术中记录质硬、菲薄的瘢痕区域内植入毛发的密度，毛发移植术后末次随访时测量该部位成活头发的密度，计算出毛发成活率(成活毛发密度/植入毛发密度×100%)。由1名第三方整形外科主治医师评价植发区头皮瘢痕被遮盖的程度，包括完全被遮盖、基本被遮盖、部分被遮盖。患者对手术效果进行评价，分为非常满意、满意和不满意。 结果 共纳入57例烧伤后头皮瘢痕患者，其中男31例，女26例；年龄13～47岁；头皮瘢痕形成至就诊时间为8～41年；头皮瘢痕面积为17～120 cm2，平均63.3 cm2。57例患者脂肪注射量为13～75 ml，在1次脂肪移植术后3～8个月行毛发移植，移植毛发总量为510～3 120 FUs。脂肪移植术后VSS总分为4(3，4)分，明显低于术前的7(6，7)分(W＝6.70，P<0.001)，其中的色泽、厚度、血管分布、柔软度评分均较术前降低(P<0.01)。毛发移植术后随访12～18个月，平均14个月。质硬、菲薄瘢痕区域毛发成活率为68.2%(22.7 FUs/cm2/33.3 FUs/cm2)～89.7%(26.1 FUs/cm2/29.1 FUs/cm2)，平均为81.3%；32例患者头皮瘢痕完全被遮盖，25例基本被遮盖；29例患者对手术效果表示非常满意，28例表示满意。 结论 在质硬、菲薄的头皮瘢痕下方先注射脂肪再行毛发移植，能获得较高的毛发成活率，是一种有效的改善头皮瘢痕外观的治疗方法。 Objective To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn. Methods The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm2 in the hard and thin scar area, and 30-40 FUs /cm2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M (Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm2, with an average of 63.3 cm2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) (W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm2/33.3 FUs/cm2) to 89.7% (26.1 FUs/cm2/29.1 FUs/cm2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

    头皮扁平瘢痕毛发移植脂肪移植

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    女性型脱发相关实验室指标分析

    钱锡飞黄哲炜范崇祥屠静宜...
    34-40页
    查看更多>>摘要：目的 探讨女性型脱发患者相关实验室指标对脱发的影响。 方法 选取2022年11月至2023年11月就诊于杭州市第一人民医院医疗美容科门诊的女性型脱发患者作为研究组，选取同期该院体检中心与研究组年龄相当的健康女性作为对照组。记录受试者的一般情况，并对受试者行毛发镜检测，以排除其他模式脱发。从实验室检测项目中选择具有代表性的指标做进一步分析，包括睾酮、硫酸脱氢表雄酮、促甲状腺激素、25-羟维生素D、血清铁蛋白，并根据25-羟维生素D水平计算缺乏(<20 ng/ml)比例(缺乏例数/各组总例数×100%)。计数资料以例(百分数)表示，组间比较采用卡方检验；正态分布计量资料以±s表示，组间比较采用独立样本t检验，非正态分布计量资料以M(Q1，Q3)表示，组间比较采用Wilcoxon秩和检验；应用多元logistic回归分析女性型脱发的影响因素。P<0.05为差异有统计学意义。 结果 2组均纳入37例女性受试者，其中研究组年龄为(28.8±1.3)岁，对照组为(29.6±0.9)岁(t＝0.49，P＝0.625)；研究组体重指数为(22.8±0.4) kg/m2，对照组为(23.5±0.3) kg/m2(t＝1.26，P＝0.211)。研究组睾酮水平为0.58(0.49，0.79) nmol/L，对照组为0.54(0.50，0.78) nmol/L(Z＝1.42，P＝0.157)；研究组硫酸脱氢表雄酮水平为6.21(5.18，9.60) μmol/L，对照组为6.20(5.20，9.34) μmol/L(Z＝2.75，P＝0.006)；研究组促甲状腺激素水平为2.56(1.55，3.66) mU/L，对照组为1.49(1.05，2.65) mU/L(Z＝2.51，P＝0.012)；研究组25-羟维生素D水平为15.44(11.80，21.20) ng/ml，对照组为20.32(12.07，21.20) ng/ml (Z＝2.30，P＝0.021)，研究组25-羟维生素D缺乏比例为64.9%(24/37)，高于对照组的40.5%(15/37)(χ2＝4.39，P＝0.036)；研究组血清铁蛋白水平为64.44(39.47，133.45) μg/L，对照组为67.75(52.63，143.83) μg/L(Z＝0.70，P＝0.484)。多元logistic回归分析结果显示，硫酸脱氢表雄酮水平增高、促甲状腺激素水平升高、25-羟维生素D水平低下会增加女性型脱发的风险(P均<0.05)。 结论 硫酸脱氢表雄酮、促甲状腺激素、25-羟维生素D水平的异常可能增加女性型脱发疾病风险。 Objective To investigate the effect of laboratory indicators on hair loss in patients with female pattern hair loss (FPHL). Methods Patients with FPHL who visited the Outpatient Clinic of the Department of Medical Aesthetics in Hangzhou First People’s Hospital from November 2022 to November 2023 were selected as the study group, and healthy women who matched the age of the study group in the physical examination center during the same period were selected as the control group. The general information of the patient was recorded, and was also tested by trichoscopy to rule out other patterns of alopecia. Representative indicators including testosterone, dehydroepiandrosterone sulfate(DHEA-S), thyroid-stimulating hormone, 25-hydroxyvitamin D, and serum ferritin were selected from laboratory tests for further analysis. Otherwise, the proportion of deficiency in vitamin D(<20 ng/ml) was calculated based on 25-hydroxyvitamin D levels (number of deficiency cases/total number of cases in each group×100%). Count data were presented as samples (percentages), and chi-square test was used for comparison between groups. Normally distributed continuous data were presented with Mean±SD, independent samplest-test was used for comparison between groups, M(Q1, Q3) was used for non-normally distributed continuous data, and Wilcoxon rank-sum test was used for comparison between groups. Multivariate logistic regression was used to analyze the influencing factors of FPHL. P<0.05 was statistically significant. Results A total of 37 patients were selected in both groups. The mean age was (28.8±1.3) years in the study group and (29.6±0.9) years in the control group (t=0.49, P=0.625). The body mass index was (22.8±0.4) kg/m2 in the study group, and (23.5±0.3) kg/m2 in the control group (t=1.26, P=0.211). The testosterone level was 0.58 (0.49, 0.79) nmol/L in the study group, and 0.54 (0.50, 0.78) nmol/L in the control group(Z=1.42, P=0.157). The level of DHEA-S was 6.21 (5.18, 9.60) μmol/L in the study group, and 6.20 (5.20, 9.34) μmol/L in the control group ( Z=2.75, P=0.006). The level of thyroid-stimulating hormone was 2.56 (1.55, 3.66) mU/L in the study group and 1.49 (1.05, 2.65) mU/L in the control group (Z=2.51, P=0.012). The level of 25-hydroxyvitamin D was 15.44 (11.80, 21.20) ng/ml in the study group, and the level of 25-hydroxyvitamin D was 20.32 (12.07, 21.20) ng/ml in the control group (Z=2.30, P=0.021), and the proportion of 25-hydroxyvitamin D deficiency in the study group was 64.9% (24/37), which was higher than that in the control group [40.5% (15/37)] (χ2=4.39, P=0.036). The serum ferritin level was 64.44 (39.47, 133.45) μg/L in the study group and 67.75 (52.63, 143.83) μg/L in the control group ( Z=0.70, P=0.484). The results of multivariate logistic regression analysis showed that the risk of FPHL was increased by the high level of DHEA-S and thyroid-stimulating hormone, and the low level of 25-hydroxyvitamin D (all P<0.05). Conclusion Abnormal level of DHEA-S, thyroid-stimulating hormone, and 25-hydroxyvitamin D may be risk factors for FPHL.

    脱发女性型脱发维生素D硫酸脱氢表雄酮促甲状腺激素

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    睡眠剥夺对小鼠毛发生长周期的影响

    赵钧徐伟力周玥竺璐...
    41-45页
    查看更多>>摘要：目的 探讨睡眠剥夺对小鼠毛发生长周期的影响。 方法 将72只成年C57BL/6J小鼠采用抽签法随机分为对照组和实验组，每组36只。对照组小鼠脱毛后在水平台环境下常规饲养，每天16 h；实验组小鼠脱毛后通过改良水平台的方法进行睡眠剥夺，每天16 h。于实验后第1、9、19天，取2组小鼠脱毛区皮肤组织制作HE染色切片，通过光学显微镜观察毛囊形态，对小鼠毛发进行分期和评分：以休止期为起始点，设为0分；生长期Ⅰ～Ⅴ期分别设为1～5分；生长期Ⅵ期及退行期Ⅰ期设为6分；退行期Ⅱ～Ⅷ期分别设为7～13分。采用SPSS 26.0软件进行统计学分析，毛发周期评分以±s表示，组间同一时间点评分比较采用独立样本t检验，组内不同时间点评分比较采用韦尔奇检验，P<0.05为差异有统计学意义。 结果 第1、9、19天，对照组小鼠毛发周期评分分别为(1.00±0.57)、(5.04±0.94)、(9.52±0.87)分，实验组分别为(0.85±0.62)、(2.40±0.50)、(6.08±0.42)分。组间比较显示，3个时间点实验组毛发周期评分均低于对照组，第1天差异无统计学意义(t＝1.03，P＝0.307)，第9天(t＝13.38，P<0.001)及第19天(t＝16.41，P<0.001)差异均有统计学意义；组内比较显示，对照组和实验组3个时间点间毛发周期评分比较差异均有统计学意义(P均<0.01)，评分随时间推移而增加。 结论 睡眠剥夺会造成小鼠毛发生长周期循环的滞后，但不会造成毛发生长周期循环停止，滞后的程度随着剥夺天数的增加而逐渐增大。 Objective To explore the effect of sleep deprivation on hair growth cycle in mice. Methods Seventy-two adult C57BL/6J mice were randomly divided into a control group of 36 mice and an experimental group of 36 mice using a lottery method. After hair removal, in the control the group the mice were subjected to routine feeding in a horizontal platform environment for 16 hours per day, while in the experimental group the mice were subjected to sleep deprivation using an improved water platform for 16 hours per day. On the 1st, 9th, and 19th day after the experiment, the skin tissue from the hair removal area of the two groups of mice was taken for HE staining. Then the mouse hair was staged and scored by observing hair follicle morphology under an optical microscope. The cycle and score of the hair was started from the telogen, which was set as 0 points the anagen Ⅰ to V were set as 1-5 points the anagen Ⅵ and catagen Ⅰ were set as 6 points the catagen Ⅱ to Ⅷ were set at 7-13 points. Statistical analysis was conducted by SPSS 26.0. The hair cycle score was expressed as Mean±SD. Student’s t-test was used for comparison between groups at the same time point, and Welch-test was used for comparison of scores at different time points within the group. P<0.05 indicated a statistically significant difference. Results On the 1st, 9th, and 19th day, the hair cycle scores of the control group were 1.00 ± 0.57, 5.04 ± 0.94, and 9.52 ± 0.87 points, while the hair cycle scores of the experimental group were 0.85 ± 0.62, 2.40 ± 0.50 and 6.08 ± 0.42 points. Inter group comparison showed that the hair cycle scores of the experimental group were lower than those of the control group at all three time points. There was no statistically significant difference on the 1st day (t=1.03, P=0.307), while the differences were statistically significant on the 9th day (t=13.38, P<0.001) and the 19th day (t=16.41, P<0.001). Intragroup comparison showed that there was a statistically significant difference in hair cycle scores between the control group and the experimental group at different time points(P<0.01), and the scores increased over time. Conclusion Sleep deprivation can cause a lag in the hair growth cycle of mice, but it does not cause a cessation of the hair growth cycle. The degree of lag gradually increases with the number of deprivation days.

    毛发睡眠剥夺毛发周期脱发

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    女性雄激素性脱发代谢相关蛋白质组学研究

    王季安林尽染李海洋杨凯...
    46-55页
    查看更多>>摘要：目的 研究女性雄激素性脱发(FAGA)患者血浆中代谢相关蛋白及其价值。 方法 2021年3月至2023年3月从复旦大学附属华山医院皮肤科门诊招募年龄18～50岁的FAGA患者(FAGA组)及健康对照女性(HC组)。采集每位受试者的外周静脉血3 ml，离心获得血浆。对血浆行Olink蛋白质组学分析，通过R语言筛选2组间的差异表达蛋白，并以受试者工作特征(ROC)曲线评估差异蛋白的诊断性能；对差异表达蛋白行基因本体论(GO)分析。取FAGA组顶区、HC组枕区毛囊行免疫荧光分析，对筛选的差异表达蛋白进行验证。应用SPSS 25.0软件对数据进行分析，正态分布计量资料以±s表示，2组受试者基本资料比较、毛囊中差异蛋白相对荧光强度比较采用t检验；对血浆中代谢相关蛋白与受试者基本资料行Pearson相关分析。P<0.05为差异有统计学意义。 结果 FAGA组纳入61例患者，年龄(33.8±7.4)岁，发病年龄(29.5±7.8)岁，其中轻度38例、中度14例、重度9例；HC组纳入27例健康女性，年龄(32.0±7.7)岁。2组受试者的基本资料(年龄、体重指数及睾酮、25-羟维生素D、尿酸、铁蛋白水平)比较，差异均无统计学意义(P>0.05)。与HC组相比，FAGA组血浆中有26种差异蛋白表达显著上调(P<0.05)，其中AHCY、NECTIN2差异最为显著(P均＝0.003)，ROC曲线评估显示AHCY和NECTIN2的曲线下面积均大于0.7，表现出良好的诊断准确性。GO分析显示，差异蛋白主要富集在BAT3复合物(细胞组分)，泛素依赖性ERAD途径、自然杀伤细胞活化(生物学过程)，以及泛素蛋白连接酶结合、泛素特异性蛋白酶结合(分子功能)等方面。Pearson相关分析显示，AHCY(r＝－0.23，P＝0.010)、NECTIN2(r＝－0.31，P＝0.033)均与FAGA患者的脱发严重程度呈负相关。毛囊免疫荧光分析结果显示，FAGA组中AHCY、NECTIN2相对荧光强度高于HC组(P<0.05)，即AHCY、NECTIN2均在FAGA组中表达上调。 结论 代谢相关蛋白在FAGA中起着重要作用，AHCY及NECTIN2有可能作为FAGA的早期诊断生物标志物。 Objective To investigate the metabolism-related proteins and their presence in the plasma of female androgenetic alopecia (FAGA) patients. Methods From March 2021 to March 2023, FAGA patients aged 18-50 (FAGA group) and healthy women (HC group) were recruited from the Dermatology Outpatient Department of Huashan Hospital. 3 ml of peripheral venous blood was collected from each participant and centrifuged to obtain plasma. Olink proteomics analysis was performed on the collected plasma, differentially expressed proteins were screened with R language, the diagnostic accuracy of the differentially expressed proteins was assessed using receiver operating characteristic (ROC) curve. Gene ontology (GO) analysis was performed on differentially expressed proteins. Immunofluorescence analysis on hair follicles in the parietal region of the FAGA group and the occipital region of the HC group was performed to validate the differentially expressed proteins identified. SPSS 25.0 software was used to analyze the data, with normal distribution metric data represented by Mean±SD. Student’s t-test was used to compare the basic information of two groups of subjects and the relative fluorescence intensity of differentially expressed proteins in hair follicles. Pearson correlation analysis was performed on plasma metabolism-related proteins and the basic information of subjects. P<0.05 indicates a statistically significant difference. Results Sixty-one cases were included in the FAGA group, with an average age of (33.8±7.4) years and an onset age of (29.5±7.8) years. Among them, 38 cases were mild FAGA, 14 cases were moderate, and 9 cases were severe. Twenty-seven cases were included in the HC group, with an average age of (32.0±7.7) years. There was no statistically significant difference in the basic information (age, body mass index, testosterone, 25-hydroxyvitamin D, uric acid, and ferritin levels) between the two groups of subjects (P>0.05). Compared to the HC group, the plasma of the FAGA group showed 26 significantly upregulated differentially expressed proteins (P<0.05), with AHCY and NECTIN2 exhibiting the most significant differences (allP=0.003). The ROC curve evaluation revealed that the area under the curve for AHCY and NECTIN2 was greater than 0.7, indicating good diagnostic accuracy. The GO analysis revealed that the differentially expressed proteins were primarily enriched in the BAT3 complex (cellular component), ubiquitin-dependent ERAD pathway, natural killer cell activation (biological process), as well as ubiquitin protein ligase binding and ubiquitin-specific protease binding (molecular function). Pearson correlation analysis revealed that AHCY (r=-0.23, P=0.010) and NECTIN2 (r=-0.31, P=0.033) were negatively correlated with the severity of hair loss in FAGA patients. The results of hair follicle immunofluorescence analysis showed that the relative fluorescence intensity of AHCY and NECTIN2 in the FAGA group was higher than that in the HC group (P<0.05). In other words, both AHCY and NECTIN2 were upregulated in the FAGA group. Conclusion Metabolism-related proteins play an important role in FAGA. AHCY and NECTIN2 may serve as early diagnostic biomarkers for FAGA.

    脱发女性雄激素性脱发蛋白质组学诊断

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    ⅩⅦ型胶原蛋白对雄激素性脱发模型小鼠毛发生长的作用及机制研究

    程含皛戚吉妮许言文钱锡飞...
    56-68页
    查看更多>>摘要：目的 探讨ⅩⅦ型胶原蛋白(COL17)对雄激素性脱发(AGA)模型小鼠毛发生长的作用及机制。 方法 将48只C57BL/6J小鼠建立AGA模型(脱去小鼠背部毛发并外涂二氢睾酮溶液)，采用随机数表法分为6组，每组8只。阴性对照组，脱毛区注射生理盐水(单点注射0.05 ml，共5个点)；阳性对照组，脱毛区外用5%米诺地尔酊，1 ml/d；COL17低、中、高浓度组，在脱毛区分别注射0.5、1.0、2.0 mg/ml的COL17(单点注射0.05 ml，共5个点)；Ⅲ型胶原蛋白(COL3)、COL17(COL3＋COL17)联合高浓度组，在脱毛区注射2.0 mg/ml的COL3和COL17(单点注射0.05 ml，共5个点)。共给药21 d，期间观察记录各组小鼠毛发生长情况；21 d后，取小鼠脱毛区皮肤及皮下组织制作病理切片行HE染色，观察毛囊数量及形态变化；取小鼠脱毛区新鲜皮肤组织行总RNA测序分析，对差异共表达基因进行基因本体论(GO)功能注释、京都基因与基因组百科全书(KEGG)通路分析和基因集富集分析(GSEA)。 结果 给药21 d后，与阴性对照组相比，阳性对照组、COL17高浓度组、COL3＋COL17联合高浓度组小鼠背部脱毛面积明显缩小，HE染色显示其毛囊数量也明显增多。Pearson相关性分析、主成分分析及各组间聚类热图显示，COL17高浓度组与阳性对照组基因相关性较高(R2＝0.95，P＝0.024)，基因表达较为接近，2组有3 882个差异基因(1 705个上调，2 177个下调)，而COL3＋COL17联合高浓度组与阳性对照组基因相关性最高(R2＝0.96，P＝0.001)，基因表达最接近，2组有1 289个差异基因(385个上调，904个下调)；KEGG分析显示，与阴性对照组相比，阳性对照组、COL17高浓度组及COL3＋COL17联合高浓度组小鼠均上调了与毛发生长相关的Wnt信号通路、细胞黏附分子及hedgehog信号通路；GO富集分析提示COL17高浓度组及COL3＋COL17联合高浓度组中皮肤发育、毛发周期循环相关基因上调；GSEA富集分析发现，COL17高浓度组成纤维细胞增殖、白介素1分泌相关基因表达上调，而COL3＋COL17联合高浓度组成纤维细胞迁移、凋亡细胞清除及加速活性氧的代谢相关基因表达上调。 结论 局部注射2.0 mg/ml的COL17对AGA模型小鼠毛发生长具有一定促进作用，且联合注射2.0 mg/ml的COL3后效果更显著，激活Wnt信号通路可能是COL17促毛发生长的主要机制之一。 Objective To investigate the effect and mechanism of type ⅩⅦ collagen (COL17) on hair growth in mice with androgenetic alopecia (AGA). Methods Forty-eight C57BL/6J mice were used to establish AGA model (the back hair of the mice was removed and dihydrotestosterone solution was applied) and divided into 6 groups of 8 mice each by random number table. Negative control group, injection of saline in the depilated area (single point injection of 0.05 ml, 5 points in total) positive control group, topical application of 5% minoxidil tincture in the depilated area, 1 ml/d COL17 low, medium and high concentration groups, injection of 0.5, 1.0 and 2.0 mg/ml COL17 in the depilated area respectively (single point injection of 0.05 ml, 5 points in total) type Ⅲ and ⅩⅦ collagen (COL3+ COL17) combined high concentration group, injection of 2.0 mg/ml COL3 and COL17 in the depilated area (single point injection of 0.05 ml, 5 points in total). The total treatment time was 21 days, during which the hair growth of mice in each group was observed and recorded. After 21 days, the skin and subcutaneous tissue in the depilated area of the mice were taken to make pathological sections for HE staining, and the number and morphological changes of hair follicles were observed fresh skin tissue in the depilated area of the mice was taken for total RNA sequencing analysis, and the differentially co-expressed genes were annotated by gene ontology (GO) functional annotation, Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis and gene set enrichment analysis (GSEA). Results After 21 days of treatment, compared with the negative control group, the depilation area on the back of the mice in the positive control group, COL17 high concentration group, and COL3+ COL17 combined high concentration group was significantly reduced, and HE staining showed that the number of hair follicles was also significantly increased. Pearson correlation analysis, principal component analysis and cluster heat map between groups showed that COL17 high concentration group had high gene correlation with the positive control group (R2=0.95, P=0.024), and the gene expression was relatively close, with 3 882 differentially expressed genes (1 705 up-regulated and 2 177 down-regulated) in the two groups, while COL3+ COL17 combined high concentration group had the highest gene correlation with the positive control group (R2=0.96, P=0.001), and the gene expression was the closest, with 1 289 differentially expressed genes (385 up-regulated and 904 down-regulated). KEGG analysis showed that compared with the negative control group, the positive control group, COL17 high concentration group and COL3+ COL17 combined high concentration group of mice all upregulated Wnt signaling pathway, cell adhesion molecules and hedgehog signaling pathway related to hair growth. GO enrichment analysis suggested that COL17 high concentration group and COL3+ COL17 combined high concentration group had upregulated genes related to skin development and hair cycle. GSEA enrichment analysis found that COL17 high concentration group had upregulated genes related to fibroblast proliferation and interleukin-1 secretion, while COL3+ COL17 combined high concentration group had upregulated genes related to fibroblast migration, clearance of apoptotic cells and accelerated metabolism of reactive oxygen species. Conclusion Local injection of 2.0 mg/ml COL17 has a certain promoting effect on hair growth in AGA model mice, and the effect is more significant after combined injection of 2.0 mg/ml COL3. Activation of Wnt signaling pathway is one of the main mechanisms of COL17 promoting hair growth.

    毛发雄激素性脱发ⅩⅦ型胶原蛋白Ⅲ型胶原蛋白毛发再生

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    基于全形再造理念和技术 趾组织瓣再造手指指端

    方杰朱辉刘桂谦许硕...
    69-75页
    查看更多>>摘要：目的 探讨基于全形再造理念和技术采用趾组织瓣再造手指指端的临床效果。 方法 回顾性分析2022年9月至2023年2月徐州仁慈医院采用全形再造的理念和技术以趾组织瓣修复指端缺损患者的临床资料。根据手指甲床、骨质、软组织缺损程度，于同侧趾设计并切取甲骨皮瓣或甲皮瓣，游离移植再造缺损的指端，供区无法直接缝合的创面予湿性换药。术后对患者进行定期随访，观察手术并发症、再造指和供区外观；末次随访时测量再造指两点分辨觉(2PD)，采用Semmes-Weinstein monofilament(SWM)尼龙单丝测试再造指触觉(测试结果以所用单丝规格表示)；参照中华医学会手外科分会拇、手指再造功能评定试用标准评价再造指功能，13～15分为优，9～12分为良，5～8分为可，≤4分为差；调查患者对手术效果是否满意。 结果 共纳入8例患者(9只手指)，其中男5例，女3例；年龄22～46岁，平均32.4岁；拇指1只，示指2只，中指5只，环指1只。以甲骨皮瓣修复7例8只手指，甲瓣修复1例1只手指，术后再造指均顺利成活，受区伤口均一期愈合，供区伤口换药愈合，无感染等并发症发生。术后随访3～7个月，再造指外观和供区甲板恢复至接近正常，受区部分甲板连接处可见凹陷形成，供区趾外观仅趾腹和腓侧处遗留瘢痕。末次随访时再造指均恢复保护性感觉，其中2例测得2PD，分别为9和10 mm；SWM单丝测试结果：所用单丝规格为3.60～4.31，平均为3.96，表明手指保护性感觉减弱；再造指功能评价：8例9只手指评分为13～14分，均达到优的水平；患者均对手术效果表示满意。 结论 基于全形再造理念和技术采用趾组织瓣再造手指指端，短期内即可获得外形和功能接近正常的手指，同时保证了趾供区整体的外形和功能，达到供受区平衡，临床效果满意。 Objective To investigate the clinical efficacy of reconstruction with the hallux tissue flap for the fingertip defects of thumb and fingers based on the concept and technique of full reconstruction. Methods From September 2022 to February 2023, the patients with thumb and fingertip defects who were reconstructed using the concept and technology of full reconstruction in Xuzhou Renci Hospital were respective analysised. Based on the degree of defect in the nail bed, bone, and soft tissue of the hand, a hallux osteo-onychocutaneous flap or hallux nail flap was designed and harvested from the same side of the toe, and free transplantation was performed to reconstruct the damaged fingertip. The wounds in the donor site that could not be sutured primarily were treated with dressing change. The surgical complications, the appearance of the reconstructed finger and donor site, Semmes-Weinstein monofilament (SWM) examination, 2-point discrimination (2PD) measurement, and patient satisfaction were regularly recorded. According to the functional evaluation criteria for thumb and finger reconstruction issued by the Hand Surgery of the Chinese Medical Association, the function of the reconstructed fingers was evaluated as excellent (13-15 points), good (9-12 points), fair (5-8 points), and poor (≤4 points). The patients were investigated whether they were satisfied with the outcomes. Results A total of 8 patients (9 fingers) including 5 males and 3 females were enrolled. The average age was 32.4 years (range, 22-46 years). There were 1 thumb, 2 index fingers, 5 middle fingers, and 1 ring finger. 7 cases (8 fingers) were repaired with the hallux osteo-onychocutaneous flap, and 1 case (1 finger) was repaired with the hallux nail flap. All the reconstructed fingers survived uneventfully, and the recipient site healed primarily, and the donor site healed after dressing change, without infection and other complications. All the 8 patients (9 fingers) were followed up for 3-7 months. The nail plate of the donor site naturally grew and recovered nearly normal. Depression formation was observed at part of the deck junction of the recipient site, and scars were left in the pulp and fibular side of the hallux. At the final follow-up, the reconstructed fingers recovered protective sensation and tactile sense, and the 2PD of the reconstructed fingers was 9 mm and 10 mm in two cases. The SWM score was 3.60-4.31, mean 3.96. The results were the monofilament specifications and indicating the protective sensation was diminished. Functional evaluation of reconstructed fingers: 9 fingers in 8 cases scored 13-14 points, all reaching an excellent level. All patients were satisfied with the surgical results. Conclusion Based on the concept and technology of full reconstruction, the fingertip defects of the thumb and finger can recover close to normal with the hallux tissue flap in the short-term, while ensuring the overall shape and function of the hallux donor area, achieving a balance between the donor and recipient areas, and achieving satisfactory clinical results.

    指损伤显微外科手术组织移植

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    软聚硅酮银离子泡沫敷料在烧伤患者头部供皮区创面处理中的应用效果

    王鹏徐承新孙晓晨魏霞...
    76-81页
    查看更多>>摘要：目的 探讨软聚硅酮银离子泡沫敷料在烧伤患者头部供皮区创面处理中的临床效果。 方法 回顾性分析2020年1月至2023年1月联勤保障部队第九四○医院收治的烧伤患者临床资料，患者术中取头部刃厚皮片修复深度烧伤创面，头部供皮区创面覆盖软聚硅酮银离子泡沫敷料(A组)或凡士林油纱(B组)。比较2组间以下5个指标的差异：(1)术后创面愈合时间；(2)初次换药疼痛评分，采用数字评定量表(NRS)评估，0分为无痛，1～3分为轻度疼痛，4～6分为中度疼痛，7～10分为重度疼痛；(3)创面换药次数；(4)二次创伤评分，总分1～3分，评分越高创伤越严重；(5)创面甲级愈合比例(甲级愈合例数/各组总例数×100%)。根据数据类型组间比较采用t检验、Wilcoxon秩和检验或卡方检验，P<0.05为差异有统计学意义。 结果 共纳入60例患者，A、B组各30例。A组男18例，女12例；年龄(29.4±16.6)岁；烧伤面积为(21.43±5.66)%总体表面积(TBSA)，头部取皮面积为(1.80±0.61)% TBSA；B组男20例，女10例；年龄(30.2±16.2)岁；烧伤面积为(21.37±5.67)%TBSA，头部取皮面积为(1.78±0.63)% TBSA。2组患者性别、年龄、烧伤面积、头部取皮面积比较，差异均无统计学意义(P均>0.05)。A组头部供皮区创面愈合时间短于B组[(5.97±0.41) d vs. (6.93±0.58) d，t＝－7.40，P<0.001]；A组初次换药疼痛NRS评分低于B组[3.0(2.0，4.0)分vs. 5.5(4.0，6.0)分，Z＝－4.82，P<0.001]；A组创面换药次数低于B组[2(2，2)次vs. 4(3，5)次，Z＝－6.64，P<0.001]；A组二次创伤评分低于B组[1(1，1)分vs. 3(3，3)分，Z＝ －7.08, P<0.001]；A组创面甲级愈合比例为96.7%(29/30)，B组为90.0%(27/30)，两者比较差异无统计学意义(χ2＝0.27，P＝0.605)。 结论 应用软聚硅酮银离子泡沫敷料覆盖烧伤患者头部供皮区创面，疗效明显优于凡士林油纱，能缩短创面愈合时间，减少换药次数，减轻疼痛，减少二次创伤发生，提高患者舒适度。 Objective Exploring the clinical effects of silicone silver ion foam dressing in managing scalp donor site wounds in burn patients. Methods A retrospective analysis was conducted on the clinical data of burn patients admitted to the 940th Hospital of Joint Logistics Support Force of PLA from January 2020 to January 2023. Patients underwent intraoperative harvesting of split-thickness skin grafting to repair deep burn wounds, with the denuded scalp area covered by either silicone silver ion foam dressing (Group A) or petrolatum gauze (Group B). Comparison of the following 5 parameters between the two groups: (1) Postoperative wound healing time. (2) Initial dressing change pain score was assessed using the numeric rating scale (NRS). 0 points indicated no pain, 1-3 points indicated mild pain, 4-6 points indicated moderate pain, and 7-10 points indicated severe pain. (3) Number of dressing changes. (4) Secondary trauma score, with a total score ranging from 1 to 3, where a higher score indicates more severe trauma. (5) Proportion of wounds healed to grade A (number of grade A healed cases/total number of cases in each group×100%). Depending on the data type, between-group comparisons were performed using t-test, Wilcoxon rank-sum test, or chi-square test. P<0.05 was considered a statistically significant difference. Results A total of 60 patients, with 30 in each Group A and Group B, were included in the study. Group A was comprised of 18 males and 12 females, with an average age of (29.4±16.6) years. The burn area was (21.43±5.66)% of the total body surface area (TBSA), and the area of skin taken from the scalp was (1.80±0.61)% of TBSA. Group B was comprised of 20 males and 10 females, with an average age of (30.2±16.2) years. The burn area was (21.37±5.67)% of TBSA, and the area of skin taken from the scalp was (1.78±0.63)% of TBSA. No statistically significant differences were observed in gender distribution, age, burn area, and scalp area between the two groups(P>0.05). The wound healing time in the denuded scalp area was shorter in Group A than in Group B [(5.97±0.41) days vs. (6.93±0.58) days,t=-7.40, P<0.001]. The initial NRS pain score during dressing change was lower in Group A than in Group B [3.0 (2.0, 4.0) points vs. 5.5 (4.0, 6.0) points,Z=-4.82, P<0.001]. Group A had fewer frequency of dressing changes compared to Group B [2 (2, 2) vs. 4 (3, 5),Z=-6.64, P<0.001]. The secondary injury score was lower in Group A than in Group B [1 (1, 1) points vs. 3 (3, 3) points,Z=-7.08, P<0.001]. The proportion of grade A healing was 96.7% (29/30) in Group A and 90.0% (27/30) in Group B, with no statistically significant difference between the two groups (χ2=0.27, P=0.605). Conclusion The application of silicone silver ion foam dressing to cover the denuded scalp area of burn patients significantly improves therapeutic efficacy compared to petrolatum gauze. It can shorten wound healing time, reduce the frequency of dressing changes, alleviate pain, minimize the occurrence of secondary injuries, and enhance patient comfort.

    头皮供区创面泡沫敷料烧伤凡士林油纱

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    眼轮匝肌下脂肪浅面眶隔脂肪释放重置在下睑成形术中的应用效果

    陈鹿嘉汤洁莹李薇薇陈强...
    82-87页
    查看更多>>摘要：目的 探讨眼轮匝肌下脂肪(SOOF)浅面眶隔脂肪释放、重置在下睑成形术中的应用效果。 方法 回顾性分析2017年1月至2023年1月在清华大学附属北京清华长庚医院整形外科接受下睑成形术患者的临床资料。实施SOOF浅面眶隔脂肪释放重置下睑成形术：手术经皮肤入路，于眼轮匝肌与SOOF之间松解泪槽韧带和眼轮匝肌限制韧带；释放眶隔脂肪至眼轮匝肌与SOOF之间的间隙，外侧脂肪瓣固定于SOOF包膜，内侧脂肪瓣固定于提上唇肌浅面筋膜，重置眶隔，悬吊外眦。术后随访观察患者下睑形态及并发症情况。 结果 共纳入58例患者，其中男8例，女50例；年龄(49.8±10.4)岁(32～70岁)；患者双侧下睑袋明显，并伴有泪槽畸形和(或)睑颊沟形成。术后有57例获得随访，时间为(29.1±16.9)个月(6～67个月)，所有患者下睑区域皮肤平坦，睑袋和泪沟获得明显改善，患者对手术效果均表示满意。2例于术后1周出现轻度下睑外翻，适度按摩于术后2周缓解；1例于术后1个月出现轻度下睑退缩，无不适主诉，未予特殊处置；1例出现球结膜出血，未予特殊处理自行恢复。 结论 下睑成形术中于SOOF浅面对眶隔脂肪进行释放、重置，可有效地松解泪槽韧带和眼轮匝肌支持韧带，牢固地固定脂肪，能够降低手术操作难度，术后可获得平坦而紧致的下睑外观，且并发症少，患者满意度较高。 Objective To evaluate the clinical effect of orbital fat releasing and repositioning through supra-suborbicularis oculi fat (SOOF) in lower eyelid blepharoplasty. Methods The authors retrospectively analyzed the clinical data of patients who received lower eyelid blepharoplasty in the Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital from January 2017 to January 2023. Lower eyelid blepharoplasty with orbital fat releasing and repositioning through supra-SOOF was performed. The tear trough ligament and orbicularis retaining ligament were released between the orbicularis oculi muscle and SOOF via skin approach. Orbital septal fat was released to this space, lateral fat flap was fixed to the SOOF capsule, medial fat flap was fixed to the superficial fascia of the levator labii superioris muscle, orbital septum was repositioned, and lateral canthus was suspended. After the operation, lower eyelid morphology and complications were evaluated. Results A total of 58 patients were enrolled, including 8 males and 50 females with the age of (49.8 ± 10.4) years (32 to 70 years). All patients had obvious lower eyelid bags on both sides, combining the tear trough deformity and (or) palabromalar groove. Fifty-seven patients were followed up for (29.1 ± 16.9) months (6-67 months). All patients were satisfied with the operation. The appearance of lower eyelid was greatly improved, with elimination of fat prominence and tear trough deformity. Mild lower eyelid ectropion was observed two cases 1 week after the operation, and were relieved by moderate massage 2 weeks postoperatively. In one case, mild lower eyelid retraction was observed 1 month postoperatively, with no complaint of discomfort or further treatments. Bulbar conjunctival hemorrhage occurred in 1 case and recovered without further interventions. Conclusion Lower eyelid blepharoplasty with orbital fat releasing and reposting through supra-SOOF can effectively release the tear trough ligament and the orbicularis retaining ligament, with stronger fat fixation and less surgical difficulty. After the operation, eyelid contour was flat and tight with fewer complications and higher patient satisfaction.

    眼睑成形术眶隔脂肪重置眼轮匝肌下脂肪下睑成形术

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