银屑病与心血管疾病发生风险相关性的初步研究

发布时间：2018-09-19 16:36

【摘要】：银屑病是一种常见的皮肤病,在全球的发病率约为1-3%,除了累及皮肤,对患者的社交以及心理方面造成影响以外,银屑病合并其他系统性疾病的报道也层出不穷。越来越多的流行病学证据证实银屑病病人比一般人群发生心血管事件的风险更常见。银屑病患者死亡率较普通人群高,也主要归功于并发的心血管疾病的发生。目前并没有对银屑病患者进行Framingham评分的相关研究。我们进行了一项前瞻性的病例-对照研究来评估银屑病患者10年心血管疾病的发生风险。2015年10月一2016年10月,收集66例寻常型银屑病病人,109例年龄和性别相当的正常体检人群作为对照组。所有银屑病病人均进行临床和组织病理学诊断。纳入研究者应排除肾衰或肝衰竭,甲状腺功能减退,已经发生过心血管事件和在3个月内服用降脂药物治疗者以消除影响血脂水平的因素。对银屑病组和对照组详细询问病史后,对银屑病病人进行体格检查,并按照固定的方程式计算病人PASI评分。采集清晨空腹血液标本由南京军区总医院全军检验中心进行检测。10年的Framingham风险评分包括年龄,性别,总胆固醇,HDL-C,收缩压,吸烟史,通过固定的方程式计算银屑病组和对照组的Framingham评分,最后依据Framingham评分将两组患者分为3类:低危(10%),中危(10%-20%),高危(20%)。研究发现寻常型银屑病组的10年心血管病发生风险显著高于对照组,寻常型银屑病病人中,尤其是老年(50岁)、男性的银屑病病人10年心血管病发生风险明显升高。轻度和重度银屑组10年心血管病发生风险差异均无统计学意义(P0.0167),银屑病组载脂蛋白A水平显著低于对照组(P0.05);银屑病组舒张压、收缩压、空腹血糖、TC、TG、HDL、LDL、载脂蛋白A、载脂蛋白B、载脂蛋白E、脂蛋白a、C反应蛋白、游离脂肪酸水平和对照组的组间差异无统计学意义(P0.05)。由于参加本研究的人群都比较年轻,大多数病人罹患心血管病风险为低危(银屑病组81.11%和对照组89.78%,P0.05)。然而,还有一部分银屑病病人与对照组相比心血管病风险为中危和高危(银屑病组16.67%和2.22%,对照组9.49%和0.73%,P0.05)。研究发现寻常型银屑病组的10年心血管病发生风险显著高于对照组,寻常型银屑病病人中,尤其是老年(50岁)、男性的银屑病病人10年心血管病发生风险明显升高。这可能是由于传统的心血管危险因素增加,或长期慢性炎症导致,或二者共同起作用。银屑病患者应对心血管疾病进行风险评估,并且对其并发症积极进行防治。
[Abstract]:Psoriasis is a common skin disease. The incidence of psoriasis is about 1-3 in the world. In addition to skin involvement and social and psychological effects, psoriasis and other systemic diseases have also been reported. A growing body of epidemiological evidence confirms that psoriasis patients are more at risk of cardiovascular events than the general population. The mortality rate of psoriatic patients is higher than that of the general population, mainly due to the occurrence of cardiovascular disease. There is no current study of Framingham scores in psoriatic patients. We conducted a prospective case-control study to assess the risk of 10 years of cardiovascular disease in patients with psoriasis. 66 patients with psoriasis vulgaris (n = 109) were selected as control group. All patients with psoriasis were diagnosed clinically and histopathologically. Inclusion researchers should exclude those with renal or liver failure, hypothyroidism, cardiovascular events and lipid-lowering drugs within 3 months to eliminate factors affecting blood lipid levels. After the psoriasis group and the control group were inquired about the history of the disease, the physical examination was carried out and the PASI score of the patient was calculated according to the fixed equation. Fasting blood samples were collected and tested by the military testing Center of Nanjing military region General Hospital. The 10-year Framingham risk scores included age, sex, total cholesterol, HDL-C, systolic blood pressure, smoking history. The Framingham scores of psoriasis group and control group were calculated by fixed equation. According to Framingham score, the two groups were divided into three groups: low risk (10%), moderate risk (10-20%) and high risk (20%). The study found that the 10-year risk of cardiovascular disease in psoriasis vulgaris group was significantly higher than that in control group. The risk of 10 years cardiovascular disease in psoriasis vulgaris patients, especially in the elderly (50 years) and men (50 years old), was significantly increased. There was no significant difference in 10 years risk of cardiovascular disease between mild and severe silver droppings group (P0.0167), the level of apolipoprotein A in psoriatic group was significantly lower than that in control group (P0.05), diastolic blood pressure and systolic blood pressure in psoriasis group were significantly lower than those in control group (P0.05). There was no significant difference in fasting blood glucose levels between the two groups (P 0.05). There were no significant differences in fasting blood glucose levels between the two groups (P 0.05), and there was no significant difference between the two groups in the levels of serum apolipoprotein A, apolipoprotein B, apolipoprotein E, lipoprotein A C-reactive protein and free fatty acids. Most of the patients were at low risk of cardiovascular disease (81.11% in psoriasis group and 89.78% in control group). However, some patients with psoriasis had moderate and high risk of cardiovascular disease compared with the control group (16.67% and 2.22% in psoriasis group and 9.49% and 0.73% in control group respectively). The study found that the 10-year risk of cardiovascular disease in psoriasis vulgaris group was significantly higher than that in control group. The risk of 10 years cardiovascular disease in psoriasis vulgaris patients, especially in the elderly (50 years) and men (50 years old), was significantly increased. This may be due to an increase in traditional cardiovascular risk factors, chronic inflammation, or both. Patients with psoriasis should assess the risk of cardiovascular disease and actively prevent and treat its complications.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.63;R54

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