【摘要】 目的 总结儿童斑秃的中医证候规律，为临床辨证论治提供依据。方法 回顾性分析2012年1月1日至2021年12月31日中日友好医院毛发医学中心收治的800例斑秃患儿的临床资料。采用四诊信息调查表收集患儿的临床资料，包括：临床特征（就诊年龄、发病年龄、病程、家族史、严重程度分级），斑秃发病相关因素（诱因），四诊信息（包括睡眠、饮食、情绪、二便等）。对其进行描述性频数分析、秩和检验、因子分析和聚类分析，并结合临床资料归纳出主要的中医证候分布情况。结果 800例斑秃患儿男449例，女351例；就诊时处于婴儿期8例（1.00%），幼儿期36例（4.50%），学龄前期180例（22.50%），学龄期380例（47.50%），青春期196例（24.50%）；平均就诊年龄（8.31±3.86）岁，平均发病年龄（5.40±3.82）岁，平均病程（2.94±2.77）年；重度斑秃患儿527例（65.87%）;85例（13.56%）患儿有脱发家族史；772例患儿（96.50%）首次脱发诱因不详，28例（3.50%）患儿表示存在明显诱因，包括惊吓（9例）、高热（5例）、过敏反应（4例）、微量元素（锌、铁等）缺乏（4例）、饮食不当（2例）、环境因素（1例，新房装修）、特应性皮炎（1例）、变异性哮喘（1例）和肺炎（1例）。四诊信息共40个，出现频率前10位的依次为踢被子（380例，47.50%）、挑食（369例，46.13%）、睡卧不宁（334例，41.75%）、易怒（334例，41.75%）、偏食（306例，38.25%）、脾气暴躁（297例，37.13%）、大便干（233例，29.13%）、小便黄（215例，26.88%）、咬指甲（213例，26.63%）、口臭（211例，26.38%）。根据因子分析和聚类分析得出5种中医证型，依次为气血亏虚证（110例，13.75%）、脾虚失荣证（114例，14.25%）、肾精不足证（140例，17.50%）、饮食积滞证（150例，18.75%）、肝郁脾虚证（286例，35.75%）。各年龄段和各SALT分级的患儿均以肝郁脾虚证为主。结论 儿童斑秃中医证候以气血亏虚、脾虚失荣、肾精不足、饮食积滞、肝郁脾虚证为主，其中不同年龄及病情分级均以肝郁脾虚证为多见。更多还原

【Abstract】 Objective To study the traditional Chinese medicine(TCM) syndromes of children with alopecia areata, and provide evidence for TCM differentiation and treatment in clinic. Methods A retrospective analysis was conducted on the clinical data of 800 children with alopecia areata admitted to the Hair Medicine Center of the ChinaJapan Friendship Hospital from January 1, 2012 to December 31, 2021. The clinical data of the children were collected using a four-examination information questionnaire, including clinical characteristics(age of consultation, age of onset, course of disease, family history, severity grading), alopecia areata-related factors(triggers), and four-examination information(including sleep, diet, emotions, bladder and bowel function, etc.). Descriptive frequency analyses, rank sum tests, factor analyses and cluster analyses were performed, and the distribution of the major TCM syndromes was summarised with the clinical data. Results There were 800 children with alopecia areata, including 449 males and 351 females; 8 cases(1. 00%) were in infancy, 36 cases(4. 50%) were in early childhood, 180 cases(22. 50%) were in preschool, 380 cases(47. 50%) were in school age, and 196 cases(24. 50%) were in puberty at the time of consultation; the average age of consultation was 8. 31±3. 86 years, the average age of onset of disease was 5. 40±3. 82 years, and the average duration of disease was 2. 94±2. 77 years; 527 children(65. 87%) with severe alopecia areata; 85children(13. 56%) had a family history of alopecia areata; 772 children(96. 50%) had unknown triggers for their first alopecia areata, and 28 children(3. 50%) reported the presence of obvious triggers, including fright(9 cases), high fever(5 cases), allergic reactions(4 cases), micronutrient(zinc, iron, etc.) deficiencies(4 cases), inappropriate diet(2 cases), environmental factors(1 case, new house renovation), atopic dermatitis(1 case), atopic asthma(1 case), and pneumonia(1 case). A total of 40 four-examination information items were collected, among which the frequency of kicking quilts was the highest with 380 cases(47. 50%), followed by picky eating(369 cases, 46. 13%), sleeplessness(334 cases, 41. 75%), irritability(334 cases, 41. 75%), partiality towards certain foods(306 cases, 38. 25%), impulsiveness(297 cases, 37. 13%), dry stools(233 cases, 29. 13%), yellow urine(215cases, 26. 88%), nail biting(213 cases, 26. 63%), bad breath(211 cases, 26. 38%). According to factor analysis and cluster analysis, five types of TCM syndromes were obtained, in order as qi and blood deficiency syndrome(110cases, 13. 75%), spleen deficiency syndrome(114 cases, 14. 25%), kidney essence deficiency syndrome(140 cases, 17. 50%), dietary stagnation syndrome(150 cases, 18. 75%), and liver depression and spleen deficiency syndrome(286 cases, 35. 75%). Patients in each age group and SALT grading are mainly liver depression and spleen deficiency syndrome. Conclusion The TCM symptoms of children with alopecia areata are mainly based on qi and blood deficiency syndrome, spleen deficiency syndrome, kidney essence deficiency syndrome, dietary stagnation syndrome, and liver depression and spleen deficiency syndrome, of which liver depression and spleen deficiency syndrome is the most common type at different ages and stages of the disease.更多还原