女性外阴硬化性苔藓患者血清性激素水平与疾病严重程度的相关性分析

摘要

目的:探讨女性外阴硬化性苔藓(VLS)患者血清性激素水平与疾病严重程度的相关性.方法:收集2016年1月～2018年6月我院确诊的49例女性外阴硬化性苔藓患者作为VLS组,45例健康志愿者为对照组进行回顾性分析,比较两组受试者血清性激素水平间的差异,采用Pearson相关分析探讨血清性激素水平与外阴白斑面积及瘙痒程度积分的相关性.结果:外阴硬化性苔藓患者外阴白斑多位于大小阴唇、尿道口和阴蒂,外阴白斑面积严重程度为轻度的患者占67.35％(33/49),轻度瘙痒患者占65.30％(32/49),外阴白斑面积和瘙痒程度评分分别为(4.12±0.53)分和(1.18±0.67)分.外阴硬化性苔藓患者血清DHT和E2水平分别为(0.13±0.01)nmol/L和(20.53±4.17)pg/mL,明显低于健康对照组DHT(0.52±0.06)nmol/L和E2(27.45±6.63)pg/mL水平,且差异均具有统计学意义(t值分别为-33.35,-6.11,P值均<0.05).复发的外阴硬化性苔藓患者血清DHT(0.09±0.01)nmol/L和E2(17.35±6.13)pg/mL水平明显低于初发外阴硬化性苔藓患者血清DHT(0.15±0.07)nmol/L和E2(23.58±3.48)pg/mL水平,且差异均具有统计学意义(t值分别为4.33、4.17,P值均<0.05).外阴硬化性苔藓患者血清DHT和E2水平与外阴白斑面积积分呈负相关性,相关系数r分别为-0.78和-0.21,且差异均具有统计学意义(P值均<0.05).结论:外阴硬化性苔藓患者血清性激素水平与病情严重程度具有负相关性,低水平的DHT和E2与其复发有关.%Objective:To investigate the correlation between serum sex hormone levels and severity of disease in female patients with vulvar lichen sclerosus.Methods:We retrospectively analyzed clinical data from 45 healthy controls and 49 female patients with vulvar lichen sclerosus who visited our hospital from January 2016 to June 2018. Serum levels of sex hormones were compared between the two groups. Pearson analysis was used to assess the correlation between serum sex hormone levels and the scores of area of vulvar leukoplakia and extent of pruritus. Results:The vulvar leukoplakias were primarily located on the labia majora, labia minora, meatus urinarius and clitoris in patients with vulvar lichen sclerosus. Regarding disease severity based on the size of vulvar leukoplakia, 67.35％ of patients (33/49) were mild. Thirty two out of 49 patients (65.30％) exhibited mild pruritus. The scores of area and pruritus of vulva leukoplakia were 4.12±0.53 and 1.18±0.67, respectively. Serum levels of both dihydrotestosterone and estradiol in patients with vulva lichen sclerosus were significantly lower than that in normal controls (P<0.05). Moreover, serum levels of dihydrotestosterone and estradiol in recurrent patients with vulvar lichen sclerosus were significantly lower than that in primary patients (dihydrotestosterone: 0.09±0.01 vs 0.15±0.07 nmol/L;estradiol: 17.35±6.13 vs 23.58±3.48 pg/mL) (all P<0.05). Finally, serum levels of both dihydrotestosterone and estradiol correlated negatively with the area scores of vulvar leukoplakia (r=-0.78 for dihydrotestosterone and r=-0.21 for estradiol) (all P<0.05). Conclusions:Serum sex hormone levels correlate negatively with disease severity of vulvar lichen sclerosus. Low levels of dihydrotestosterone and estradiol are associated with relapse of vulvar lichen sclerosus.