银屑病合并代谢综合征及相关因素的前瞻性研究

发布时间：2018-04-27 14:13

本文选题：银屑病 + 代谢综合征　；参考：《山东大学》2014年博士论文

【摘要】：银屑病(psoriasis)是免疫介导的多基因遗传性皮肤病。其患病率因种族、环境、地理位置等因素的不同而有很大差别,精神、外伤、感染、寒冷、潮湿及药物等均可成为该病的诱发因素。上个世纪八十年代我国大规模的流行病学调查发现银屑病的患病率为0.123%,近年来的研究表明该病患病率有增加的趋势。随着人们对银屑病临床与基础研究的不断深入,银屑病不但被认为是一种皮肤病,它还被认为是一种系统性疾病,与代谢综合征之间存在密切关系。代谢综合征(metabolic syndrome,MS)是多种物质代谢异常的病理状态,是导致心血管疾病(cardiovascular disease,CVD)和其他代谢性疾病的危险因素,与多种代谢相关性疾病有密切的联系。银屑病与代谢综合征二者之间相互关联的发病机制较为复杂,确切的发病机制尚未明确。肿瘤坏死因子-α、白介素-1、2、6、8、18、脂联素等细胞因子在银屑病合并代谢综合征的发病过程中起着非常重要的作用,在这些前炎症因子作用下银屑病与代谢综合征通过共同的慢性炎症机制相关联。另外,银屑病与代谢综合症可能存在相同的易感基因如CDKAL1等。自从2005年国际糖尿病联盟(International Diabetes Federation, IDF)对代谢综合征给出新的定义以后,越来越多的人对该病进行了深入的研究。近年来,流行病学及实验研究发现银屑病患者中患中心性肥胖、高血压、高血糖、高脂血症和动脉硬化性心血管疾病的风险增加,银屑病与代谢综合征的相关性已成为皮肤病领域的研究热点。大量的流行病学资料显示银屑病患者的代谢综合征患病率远高于自然人群。一项对有代表性样本的调查揭示美国居民中代谢综合征在银屑病患者中的患病率高达40%。Langan等在英国对银屑病与代谢综合征的相关性做了流行病学研究,结果表明二者的相关性随着代谢综合征的各独立组成部分的严重程度的增加而增强。日本、印度和韩国的学者也各自在本地区对银屑病合并代谢综合征做了相关研究,发现银屑病合并代谢综合征的患病率分别为24.4%、44.1%、17.8%。我国在银屑病与代谢综合征的流行病学、危险因素、临床特征及部分细胞因子等相关性研究方面也作了有益的探索。从世界范围内的研究来看,绝大多数是有关银屑病合并代谢综合征相关性的基础研究和回顾性的临床分析,而对银屑病患者合并代谢综合征有重要研究价值的前瞻性、临床相关性研究非常少。在这一领域开展前瞻性的研究工作具有十分重要的意义,它不仅能为广大科研工作者提供更为科学的理论依据,还能帮助皮肤科医生对银屑病患者制定更为合理的诊疗方案。为进一步探讨银屑病与代谢综合征发病的相关性,明确性别、年龄、病程、吸烟、饮酒等因素对银屑病合并代谢综合征的影响,银屑病合并代谢综合征对患者高尿酸血症、血肌酐、血尿素氮水平及肾功能的影响,我们对在山东大学附属省皮肤病医院住院的426例银屑病患者进行了一项前瞻性的临床研究。这对进一步阐明山东地区银屑病合并代谢综合征的患病率；银屑病合并代谢综合征的发病机制及银屑病合并代谢综合征后对患者生理机能的影响,从而采取相应对策来避免或减少银屑病患者代谢综合征和肾功能损伤、甚至衰竭的发生都会有重要的意义。研究目的 1.研究银屑病合并代谢综合征的发病情况。 2.明确银屑病合并代谢综合征的发病机制。 3.探讨诱发银屑病合并代谢综合征的相关因素。 4.分析银屑病合并代谢综合征后对患者健康的影响。研究方法 1.研究对象本研究对2013年5月-2014年5月期间在山东大学附属省皮肤病医院住院的银屑病患者共426例进行分析。同时选取山东大学附属千佛山医院健康管理中心453名健康查体者作为对照组。 2.银屑病和代谢综合征的诊断标准根据《中国临床皮肤病学》银屑病的诊断标准对银屑病进行诊断；根据2005IDF对代谢综合征所做出的统一定义对代谢综合征进行诊断。 3.排除标准(1)原发性高血压；原发性糖尿病(Ⅰ型)；家族性高脂血症。(2)Cushing综合征等严重的内分泌系统疾病。(3)近3个月内系统应用过维A酸制剂、糖皮质类固醇激素及免疫抑制剂。(4)患有风湿、类风湿及免疫系统疾病者。 4.对符合入选标准的患者入院后测量其中心性肥胖、血压；记录患者的性别、年龄、病程,吸烟、饮酒情况,并对患者的银屑病皮损进行PASI评分；进行甘油三酯、高密度脂蛋白-胆固醇、空腹血糖、血尿酸、肌酐及尿素氮等指标的实验室检查。 5.统计学分析应用SPSS17.0统计软件进行数据分析,计量资料采用均数±标准差(x±S)表示,计数资料采用百分率表示,组间比较用x2检验。统计结果以P0.05具有统计学意义。结果 1.银屑病患者中心性肥胖、甘油三酯水平、空腹血糖水平均高于对照组；银屑病患者高密度脂蛋白-胆固醇水平低于对照组；收缩压和舒张压均高于对照组。 2.银屑病合并代谢综合征的患病率在各类型中(寻常型、关节病型、脓疱型及红皮病型)分别为37.53%、38.71%、33.33%和40.63%。 3.男性银屑病患者合并代谢综合征患病率高。 4.银屑病合并代谢综合征的发生率随年龄和病程的增加而增加。 5.吸烟、饮酒的银屑病男性患者合并代谢综合征患病率高于女性。 6. PASI评分在四种类型的银屑病和银屑病合并代谢综合征患者中无差异性。 7.银屑病患者的高尿酸血症患病率高。 8.银屑病患者血肌酐水平高于正常。结论 1.银屑病患者合并代谢综合征比正常人群有较高的患病率。 2.代谢综合征与银屑病的类型没有密切相关性。 3.银屑病患者的性别、年龄、病程对银屑病合并代谢综合征起着重要作用。 4.吸烟、饮酒是男性银屑病患者代谢综合征发生的危险因素。 5. PASI评分与银屑病皮损面积和和皮损严重程度有关,与银屑病类型、是否合并代谢综合征无关。 6.银屑病与高尿酸血症关系密切。 7.银屑病是患者肾功能受损的一个危险因素。
[Abstract]:Psoriasis (psoriasis) is an immune mediated multigene hereditary dermatosis. The prevalence of psoriasis is very different from race, environment, and geographical location. Mental, traumatic, infection, cold, damp, and drugs can be the inducing factors of the disease. In 80s of last century, a large-scale epidemiological survey in China found psoriasis. The prevalence of the disease is 0.123%. Recent studies have shown that the prevalence of this disease has increased. With the continuous development of clinical and basic research on psoriasis, psoriasis is considered not only a kind of dermatosis, but also considered as a systemic disease, which is closely related to the metabolic syndrome. Metabolic syndro Me, MS) is a pathological state of abnormal metabolism of various substances. It is a risk factor for cardiovascular disease (cardiovascular disease, CVD) and other metabolic diseases. It is closely related to many metabolic diseases.
The interrelated pathogenesis of psoriasis and metabolic syndrome is complex, and the exact pathogenesis is not clear. Tumor necrosis factor - alpha, interleukin -1,2,6,8,18, adiponectin and other cytokines play a very important role in the pathogenesis of psoriasis and metabolic syndrome, and the effect of these proinflammatory factors on silver chips The disease is associated with metabolic syndrome through a common mechanism of chronic inflammation. In addition, psoriasis and metabolic syndrome may have the same susceptible genes, such as CDKAL1.
Since the 2005 International Diabetes Federation (IDF) provides a new definition of metabolic syndrome, more and more people have studied the disease. In recent years, epidemiological and experimental studies have found central fat, hypertension, hyperglycemia, hyperlipidemia, and arteriosclerosis in patients with psoriasis. The increased risk of cardiovascular disease has become a hot topic in the field of dermatology.
A large number of epidemiological data showed that the prevalence of metabolic syndrome in patients with psoriasis was much higher than that in the natural population. A survey of representative samples revealed that the prevalence rate of metabolic syndrome in patients with psoriasis in the United States was as high as 40%.Langan and other epidemiological studies on the correlation between psoriasis and metabolic syndrome in the UK. The results showed that the correlation between the two was enhanced with the increase in the severity of the independent components of the metabolic syndrome. The Japanese, India and Korean scholars also studied the metabolic syndrome of psoriasis in the region, and found that the prevalence of psoriasis with metabolic syndrome was 24.4%, 44.1%, 17.8%., respectively.
The epidemiology, risk factors, clinical characteristics, and partial cytokine related studies of psoriasis and metabolic syndrome have also been explored in our country. In the world, most of them are basic and retrospective clinical analysis related to the association of psoriasis with metabolic syndrome, and the psoriasis is related to psoriasis. Patients with metabolic syndrome have important research value and very little clinical relevance. It is of great significance to carry out prospective research in this field. It can not only provide more scientific theoretical basis for the general scientific research workers, but also help Department of Dermatology doctors to make more reasonable for patients with psoriasis. The plan of diagnosis and treatment.
To further investigate the correlation between psoriasis and metabolic syndrome, the influence of sex, age, course of disease, smoking, drinking and other factors on psoriasis combined with metabolic syndrome, the effect of psoriasis with metabolic syndrome on hyperuricemia, serum creatinine, blood urea nitrogen level and renal function in patients with psoriasis, and we were on the provincial skin of Shandong University. A prospective clinical study was conducted in 426 patients with psoriasis in the skin disease hospital, which further elucidated the prevalence of psoriasis associated with metabolic syndrome in Shandong, the pathogenesis of psoriasis with metabolic syndrome and the effect of psoriasis combined with metabolic syndrome on the physiologic function of the patients. Avoiding or reducing the incidence of metabolic syndrome, renal impairment and even failure in psoriasis patients is of great importance.
research objective
1. to study the incidence of psoriasis complicated with metabolic syndrome.
2. clarify the pathogenesis of psoriasis complicated with metabolic syndrome.
3. to explore the related factors of psoriasis complicated with metabolic syndrome.
4. to analyze the impact of psoriasis combined with metabolic syndrome on patients' health.
research method
1. a total of 426 cases of psoriasis hospitalized in the affiliated provincial Dermatology Hospital of Shandong University in May 2013 -2014 year were analyzed in this study. At the same time, 453 health care providers in the health management center of Qianfo Hill Hospital Affiliated to Shandong University were selected as the control group.
2. the diagnostic criteria for psoriasis and metabolic syndrome are based on the diagnostic criteria of Chinese Clinical Dermatology, psoriasis and psoriasis, and the diagnosis of metabolic syndrome is based on the unified definition of 2005IDF for metabolic syndrome.
3. exclusion criteria (1) primary hypertension; primary diabetes (type I); familial hyperlipidemia. (2) severe endocrine system diseases such as Cushing syndrome. (3) systemic use of vitamin A, glucocorticoids and immunosuppressants in nearly 3 months. (4) people with rheumatic, rheumatoid and immune system diseases.
4. patients who were eligible for admission were tested for central obesity, blood pressure, sex, age, course of illness, smoking, drinking, and PASI scores on psoriatic lesions of the patients, and laboratory tests of triglycerides, high density lipoprotein cholesterol, fasting blood sugar, blood uric acid, creatinine and urea nitrogen.
5. statistical analysis was used to analyze the data with SPSS17.0 statistical software, and the measured data were expressed with mean mean standard deviation (x + S). The count data were expressed as percentage, and X2 test was used for comparison between groups. The statistical results were statistically significant with P0.05.
Result
1. central obesity, triglyceride level and fasting blood glucose level were higher in patients with psoriasis than in the control group; the level of high density lipoprotein cholesterol in psoriasis patients was lower than that in the control group, and the systolic and diastolic pressure were higher than those in the control group.
2. the prevalence of psoriasis combined with metabolic syndrome was 37.53%, 38.71%, 33.33% and 40.63%. in all types (vulgaris, arthropathy, pustular and erythroderma) respectively.
3. male psoriasis patients had a high prevalence of metabolic syndrome.
4. the incidence of psoriasis complicated with metabolic syndrome increases with age and duration.
5. the prevalence rate of psoriasis male patients with smoking and drinking combined with metabolic syndrome is higher than that of females.
The 6. PASI score showed no difference in four types of psoriasis and psoriasis complicated with metabolic syndrome.
7. patients with psoriasis have high prevalence of hyperuricemia.
The level of serum creatinine in 8. patients with psoriasis was higher than that of normal.
conclusion
1. patients with psoriasis complicated with metabolic syndrome have a higher prevalence rate than the normal population.
2. there is no close correlation between the metabolic syndrome and the type of psoriasis.
3. the gender, age and course of psoriasis play an important role in psoriasis complicated with metabolic syndrome.
4. smoking and drinking are risk factors for metabolic syndrome in male patients with psoriasis.
5. the PASI score was related to the lesion area and severity of psoriasis, but not to the type of psoriasis and the presence of metabolic syndrome.
6. psoriasis is closely related to hyperuricemia.
7. psoriasis is a risk factor for impaired renal function in patients.

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R758.63;R589

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