脂溢性脱发患者Wnt/β-catenin信号通路异常与祛湿健发汤疗效的相关性

邱础; 陈彩飞; 陈笑; 朱晓燕; 蔡路炜

doi:10.16766/j.cnki.issn.1674-4152.004487

脂溢性脱发患者Wnt/β-catenin信号通路异常与祛湿健发汤疗效的相关性

doi: 10.16766/j.cnki.issn.1674-4152.004487

绍兴市中医院皮肤科，浙江绍兴 312000

基金项目:

浙江省中医药科技计划项目 2025ZL579

详细信息

通讯作者:
邱础, E-mail: qiuchuzijun@163.com

中图分类号: R758.71
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- 文章访问数: 12
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出版历程
- 收稿日期: 2025-12-24
- 网络出版日期: 2026-10-23

Correlation between abnormalities in the Wnt/β-catenin signaling pathway and the therapeutic effect of Qushi Jianfa Decoction in seborrheic alopecia

Department of Dermatology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的探究Wnt/β-catenin信号通路关键分子（Wnt3a、β-catenin、DKK1）在脂溢性脱发患者中的表达异常，并分析其与祛湿健发汤疗效的关联及预测价值。方法选择2024年8月—2025年8月绍兴市中医院收治的120例脂溢性脱发患者，采用随机数字表法分为研究组(60例)和阳性对照组(n=60例)，另选100例健康体检者为对照组。检测3组血清Wnt3a、β-catenin、DKK1水平，将研究组按疗效分有效组(49例)与无效组(11例)。采用点二列相关、多因素logistic回归、ROC曲线分析。结果研究组与阳性对照组Wnt3a[(35.62±8.94)pg/mL、(36.29±9.12)pg/mL]、β-catenin[(2.15±0.68)ng/mL、(2.31±0.81)ng/mL]低于对照组[(58.73±10.25)pg/mL、(3.82±0.95)ng/mL]，DKK1[(189.35±32.67)pg/mL、(187.71±33.16)pg/mL]高于对照组[(102.46±25.38) pg/mL，F=153.378、96.853、228.845，均P < 0.001]。有效组治疗后Wnt3a、β-catenin升高，DKK1降低(P < 0.05)。Wnt3a、βcatenin与疗效呈正相关关系，DKK1呈负相关关系(P < 0.001)。病程≥3年、重度脱发、治疗前DKK1水平偏高、治疗前Wnt3a水平偏低、治疗前β-catenin水平偏低均是祛湿健发汤疗效的独立危险因素（P < 0.05）；治疗前Wnt3a水平偏高、治疗前β-catenin水平偏高均是祛湿健发汤疗效的独立保护因素（P < 0.05）。Wnt3a、β-catenin、DKK1三者联合检测预测效能最优(AUC=0.850)。结论脂溢性脱发存在Wnt/β-catenin通路异常，其关键分子与病情及祛湿健发汤疗效密切相关。
- 脂溢性脱发 /
- Wnt/β-catenin信号通路 /
- 祛湿健发汤 /
- 临床疗效 /
- 相关性
Abstract: Objective To investigate the abnormal expression of key molecules (Wnt3a, β-catenin, DKK1) in the Wnt/β-catenin signaling pathway in patients with seborrheic alopecia and to evaluate their correlation with the therapeutic efficacy of Qushi Jianfa Decoction, as well as their predictive value. Methods A total of 120 patients with seborrheic alopecia admitted to Shaoxing Hospital of Traditional Chinese Medicine between August 2024 and August 2025 were selected and randomly assigned using a random number table into the study group (n=60) and the positive control group (n=60), 100 healthy individuals undergoing physical examinations were selected as the control group. Serum levels of Wnt3a, β-catenin, and DKK1 were measured in all three groups. Patients were further stratified into an effective subgroup (n=49) and an ineffective subgroup (n=11) based on treatment efficacy. Statistical analyses included two-column correlation analysis, multivariate logistic regression, and ROC curve analysis. Results The treatment group and the positive control group exhibited lower levels of Wnt3a [(35.62±8.94) pg/mL, (36.29±9.12) pg/mL] and β-catenin [(2.15±0.68) ng/mL, (2.31± 0.81) ng/mL] compared to the control group [(58.73±10.25) pg/mL, (3.82±0.95) ng/mL], while DKK1 [(189.35±32.67) pg/mL, (187.71±33.16) pg/mL] was higher than in the control group [(102.46±25.38) pg/mL, F=153.378, 96.853, 228.845, all P < 0.001]. In the treatment group, Wnt3a and β-catenin levels increased, while DKK1 decreased after therapy (P < 0.05). Wnt3a and β-catenin showed positive correlations with therapeutic efficacy, whereas DKK1 exhibited a negative correlation (P < 0.001). A disease course of ≥3 years, severe alopecia, elevated pre-treatment DKK1 level, decreased pretreatment Wnt3a level, and decreased pre-treatment β-catenin level are independent risk factors for the efficacy of Qushi Jianfa Decoction (P < 0.05); whereas elevated pre-treatment Wnt3a level and elevated pre-treatment β-catenin level are independent protective factors for the efficacy of Qushi Jianfa Decoction (P < 0.05). The combined detection of Wnt3a, β-catenin, and DKK1 demonstrated optimal predictive performance (AUC=0.850). Conclusion Seborrheic alopecia exhibits abnormalities in the Wnt/β-catenin pathway, with its key molecules closely associated with disease severity and the therapeutic efficacy of Qushi Jianfa Decoction.
- Seborrheic alopecia /
- Wnt/β-catenin signaling pathway /
- Qushi Jianfa Decoction /
- Therapeutic efficacy /
- Correlation

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图 1 Wnt3a、β-catenin、DKK1预测脂溢性脱发患者祛湿健发汤疗效的ROC曲线

Figure 1. ROC curve for predicting the therapeutic efficacy of the dampness-reducing and hair-strengthening decoction in patients with seborrheic alopecia by Wnt3a, β-catenin, and DKK1

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表 1 脂溢性脱发(脾虚湿滞型)中医证候积分表

Table 1. Integrated score table for seborrheic hair loss (type of deficiency of spleen and accumulation of dampness) in traditional Chinese medicine

证候	无(0分)	(1~2分)	(3~4分)	(5~6分)
皮屑增多	无皮屑	少量皮屑，无明显不适	中等量皮屑，偶有瘙痒	大量皮屑，瘙痒明显且频繁
发质油腻	发质干爽	轻微油腻，1~2 d清洗1次	中度油腻，每天需清洗	重度油腻，当天清洗仍油腻
发量稀疏	发量正常	发量轻微减少，不明显	发量中度减少，可见头皮	发量重度减少，头皮裸露明显
舌红、纳呆	舌质正常，纳食正常	舌质偏红，纳食略减	舌红，纳食减少明显	舌红绛，纳呆严重，不思饮食
苔黄腻	舌苔正常	舌苔薄黄微腻	舌苔黄腻	舌苔黄厚腻，附着紧密
头皮瘙痒	无瘙痒	偶尔瘙痒，可耐受	频繁瘙痒，影响日常	剧烈瘙痒，严重影响生活
注：每个证候按严重程度分为无(0分)、轻度(1~2分)、中度(3~4分)、重度(5~6分)4个等级，总分0~36分，分数越高表明证候越严重。

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表 2 2组脂溢性脱发患者一般资料比较

Table 2. Comparison of general information of patients with seborrheic alopecia in the two groups

组别	例数	性别(男/女，例)	年龄(x±s, 岁)	病程[M(P₂₅, P₇₅), 岁]	脱发程度(例)		中医证候积分(x±s, 分)		家族史(例)
组别	例数	性别(男/女，例)	年龄(x±s, 岁)	病程[M(P₂₅, P₇₅), 岁]	轻中度	重度	中医证候积分(x±s, 分)	有	无
研究组	60	37/23	32.65±8.42	2.60(1.70，3.60)	45	15	16.82±4.35	21	39
阳性对照组	60	36/24	33.15±8.60	2.70(1.79，3.70)	44	16	17.18±4.41	22	38
统计量		0.035^a	0.322^b	0.274^c	0.043^a		0.450^b	0.036^a
P值		0.852	0.748	0.876	0.835		0.653	0.849
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 3组研究对象Wnt/β-catenin信号通路关键分子表达比较(x±s)

Table 3. Comparison of the expression of key molecules in the Wnt/β-catenin signaling pathway between the research group, the control group, and the positive control group(x±s)

组别	例数	Wnt3a (pg/mL)	β-catenin (ng/mL)	DKK1 (pg/mL)
对照组	100	58.73±10.25	3.82±0.95	102.46±25.38
研究组	60	35.62±8.94^a	2.15±0.68^a	189.35±32.67^a
阳性对照组	60	36.29±9.12^a	2.31±0.81^a	187.71±33.16^a
F值		153.378	96.853	228.845
P值		＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05。

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表 4 不同临床特征研究组脂溢性脱发患者Wnt3a、β-catenin、DKK1表达水平比较(x±s)

Table 4. Relationship between the expression levels of Wnt3a, β-catenin, and DKK1 in patients with seborrheic alopecia in the research group and their clinical characteristics(x±s)

项目	例数	Wnt3a (pg/mL)	β-catenin (ng/mL)	DKK1 (pg/mL)
性别
男性	37	36.15±9.02	2.18±0.70	188.52±33.15
女性	23	34.86±8.76	2.11±0.65	190.63±32.08
t值		0.766	0.545	0.341
P值		0.445	0.587	0.733
年龄
＜35岁	27	36.02±8.89	2.16±0.69	187.95±32.86
≥35岁	33	35.31±9.01	2.14±0.67	190.58±32.45
t值		0.446	0.159	0.435
P值		0.656	0.874	0.664
病程
＜3年	32	40.25±8.56	2.48±0.63	168.73±28.95
≥3年	28	30.21±7.89	1.76±0.58	212.46±30.12
t值		6.602	6.436	8.038
P值		＜0.001	＜0.001	＜0.001
脱发程度
轻中度	45	38.56±8.78	2.32±0.66	176.52±30.25
重度	15	27.89±7.56	1.65±0.52	235.68±31.89
t值		5.944	5.047	9.124
P值		＜0.001	＜0.001	＜0.001
家族史
有	21	35.28±8.91	2.13±0.67	189.87±32.76
无	39	35.86±8.95	2.16±0.68	189.01±32.58
t值		0.338	0.231	0.137
P值		0.736	0.818	0.891
中医证候积分
＜18分	36	38.95±8.82	2.36±0.67	175.23±31.05
≥18分	24	31.26±8.75	1.86±0.62	208.57±32.14
t值		3.319	2.916	4.018
P值		0.002	0.005	＜0.001

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表 5 不同疗效研究组脂溢性脱发患者治疗前后Wnt3a、β-catenin、DKK1表达水平比较(x±s)

Table 5. Comparison of expression levels of Wnt3a, β-catenin, and DKK1 in patients with seborrheic alopecia in the effective group and the ineffective group before and after treatment(x±s)

组别	例数	Wnt3a(pg/mL)		β-catenin(ng/mL)		DKK1(pg/mL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
有效组	49	38.76±8.54	52.34±9.87^b	2.35±0.66	3.42±0.85^b	175.32±30.15	120.56±26.78^b
无效组	11	25.34±7.65	26.58±7.89	1.42±0.53	1.48±0.55	245.67±35.89	238.95±34.67
统计量		4.792^a	8.078^c	4.359^a	7.212^c	6.519^a	10.654^c
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 6 影响脂溢性脱发患者祛湿健发汤疗效的多因素logistic回归分析

Table 6. Multivariate logistic regression analysis of multiple factors influencing the therapeutic effect of the dampness- resolving and hair-strengthening decoction in patients with seborrheic alopecia

变量	B	SE	Waldχ²	P值	OR值	95% CI
病程≥3年	2.356	0.578	16.615	0.003	10.549	3.393~32.788
重度脱发	3.134	0.689	20.690	＜0.001	22.966	5.952~88.621
治疗前Wnt3a(pg/mL)	-0.337	0.105	10.313	0.001	0.714	0.581~0.877
治疗前β-catenin(ng/mL)	-0.483	0.152	10.098	0.001	0.617	0.458~0.831
治疗前DKK1(pg/mL)	0.018	0.006	9.026	0.003	1.018	1.006~1.030
注：自变量赋值如下，病程，＜3年=0，≥3年=1；脱发程度，轻中度=0，重度=1；性别, 男=1，女=0；年龄(岁，连续变量)；家族史(有=1，无=0)；治疗前Wnt3a、β-catenin、DKK1均以连续变量实际测量值录入模型。OR值对应连续变量每增加1个单位无效风险的变化。

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表 7 Wnt3a、β-catenin、DKK1预测脂溢性脱发患者祛湿健发汤疗效的效能分析

Table 7. Analysis of the efficacy of Wnt3a, β-catenin, and DKK1 in predicting the therapeutic effect of the dampness- reducing and hair-strengthening decoction in patients with seborrheic alopecia

项目	AUC	95% CI	灵敏度(%)	特异度(%)	准确度(%)	P值
Wnt3a	0.714	0.636~0.792	77.27(8/11)	68.75(33/48)	70.00(41/60)	＜0.001
β-catenin	0.680	0.593~0.767	72.73(8/11)	70.83(34/48)	71.67(42/60)	＜0.001
DKK1	0.746	0.672~0.819	68.18(7/11)	72.92(35/48)	71.67(42/60)	＜0.001
联合检测	0.850	0.793~0.907	95.45(10/11)	77.08(37/48)	81.67(49/60)	＜0.001

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