寻常型银屑病亚临床附着点炎、滑膜炎的临床研究

发布时间：2018-06-17 08:25

本文选题：银屑病 + 附着点炎　；参考：《中国人民解放军医学院》2017年博士论文

【摘要】：研究背景银屑病性关节炎是一种与银屑病相关的慢性炎性关节病,大部分患者关节损害呈进行性加重,可引起关节强直或残疾,严重影响患者的生活质量。越来越多证据支持银屑病性关节炎确诊越早,结果越好。有研究发现银屑病患者亚临床关节炎可以发展成有症状的银屑病性关节炎,因此筛查亚临床关节炎对于早期诊断银屑病性关节炎具有重要意义。目的探讨寻常型银屑病患者亚临床附着点炎、滑膜炎的发生率,寻常型银屑病患者发生亚临床附着点炎、滑膜炎潜在的影响因素和血清标志物。方法1.采用高频多普勒超声技术检测52例寻常型银屑病患者和52例健康对照者的外周关节及下肢附着点。2.采用Logistic回归分析寻常型银屑病患者不同特征与发生亚临床滑膜炎的相关性。3.采用Luminex和ELISA方法检测银屑病组和对照组14种血清标志物。4.采用Logistic回归和ROC曲线分析筛选寻常型银屑病患者发生亚临床滑膜炎潜在的血清标志物。结果1.寻常型银屑病患者亚临床滑膜炎的发生率(7/52)显著高于健康对照者(0/52),P0.01,两组均未发现附着点炎。2.有滑膜炎银屑病组PASI评分、NAPSI评分、TG值、ESR值显著高于无滑膜炎银屑病组,P0.05; 一级家族史、高血脂、高尿酸、ESR增高以及吸烟、饮酒比例显著高于无滑膜炎银屑病组,P0.05。3.有一级家族史、PASI和NAPSI评分高、高血脂、高尿酸、ESR增高、吸烟、饮酒与寻常型银屑病患者发生亚临床滑膜炎相关。4.有滑膜炎银屑病组血清IL-12/23p40、VEGF-A、MMP-3、COMP水平显著高于无滑膜炎银屑病组,P0.05。5.血清VEGF-A、RANKL、MMP3、COMP水平增高与寻常型银屑病患者发生亚临床滑膜炎相关,4种标志物曲线下面积分别是0.74、0.78、0.72、0.86。结论1.寻常型银屑病患者亚临床滑膜炎的发生率显著高于健康对照者。2.有一级家族史、PASI评分和NAPSI评分高、高血脂、高尿酸、ESR增高、吸烟、饮酒是寻常型银屑病患者发生亚临床滑膜炎潜在的危险因素。3. VEGF-A、RANKL、MMP3、COMP是寻常型银屑病患者发生亚临床滑膜炎潜在的血清标志物,COMP可能是最佳的预测因子。
[Abstract]:Background Psoriatic arthritis is a chronic inflammatory arthropathy associated with psoriasis. There is growing evidence that the earlier the diagnosis of psoriatic arthritis, the better the outcome. Some studies have found that subclinical arthritis in psoriatic patients can develop into symptomatic psoriatic arthritis, so screening subclinical arthritis is of great significance for early diagnosis of psoriatic arthritis. Objective to investigate the incidence of subclinical attachment inflammation and synovitis in patients with psoriasis vulgaris, the possible influencing factors and serum markers of subclinical attachment inflammation in patients with psoriasis vulgaris. Method 1. The attachment points of peripheral joints and lower extremities of 52 patients with psoriasis vulgaris and 52 healthy controls were detected by high frequency Doppler ultrasound. Logistic regression analysis was used to analyze the correlation between different characteristics of psoriasis vulgaris and subclinical synovitis. Luminex and Elisa were used to detect 14 serum markers. 4. 4 in psoriasis group and control group. Logistic regression and ROC curve analysis were used to screen the potential serum markers of subclinical synovitis in patients with psoriasis vulgaris. Result 1. The incidence of subclinical synovitis in patients with psoriasis vulgaris was significantly higher than that in healthy controls. The PASI score of psoriasis with synovitis and the TG and ESR of PASI score were significantly higher than those of psoriasis without synovitis (P 0.05), the family history of grade one, the increase of ESR of hyperuricemia and hyperuricemia, and smoking, and the proportion of drinking alcohol was significantly higher than that of psoriasis without synovitis (P 0.05.3). PASI and NAPSI scores were high, hyperlipidemia, hyperuric acid ESR, smoking and drinking were associated with subclinical synovitis in patients with psoriasis vulgaris. The level of serum IL-12 / 23p40 VEGF-AmMMP in psoriasis with synovitis was significantly higher than that in psoriasis without synovitis (P 0.05.5). The area under the curve of four markers associated with subclinical synovitis in patients with psoriasis vulgaris was 0.74 卤0.780.72 卤0.86, respectively. Conclusion 1. The incidence of subclinical synovitis in patients with psoriasis vulgaris was significantly higher than that in healthy controls. High PASI and NAPSI scores, hyperlipidemia, elevated ESR, smoking and drinking were potential risk factors for subclinical synovitis in patients with psoriasis vulgaris. VEGF-A RANKL MMP3 comp may be the best predictor of subclinical synovitis in patients with psoriasis vulgaris.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R758.63

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