發(fā)布時(shí)間：2018-09-19 16:36

【摘要】：銀屑病是一種常見(jiàn)的皮膚病,在全球的發(fā)病率約為1-3%,除了累及皮膚,對(duì)患者的社交以及心理方面造成影響以外,銀屑病合并其他系統(tǒng)性疾病的報(bào)道也層出不窮。越來(lái)越多的流行病學(xué)證據(jù)證實(shí)銀屑病病人比一般人群發(fā)生心血管事件的風(fēng)險(xiǎn)更常見(jiàn)。銀屑病患者死亡率較普通人群高,也主要?dú)w功于并發(fā)的心血管疾病的發(fā)生。目前并沒(méi)有對(duì)銀屑病患者進(jìn)行Framingham評(píng)分的相關(guān)研究。我們進(jìn)行了一項(xiàng)前瞻性的病例-對(duì)照研究來(lái)評(píng)估銀屑病患者10年心血管疾病的發(fā)生風(fēng)險(xiǎn)。2015年10月一2016年10月,收集66例尋常型銀屑病病人,109例年齡和性別相當(dāng)?shù)恼ｓw檢人群作為對(duì)照組。所有銀屑病病人均進(jìn)行臨床和組織病理學(xué)診斷。納入研究者應(yīng)排除腎衰或肝衰竭,甲狀腺功能減退,已經(jīng)發(fā)生過(guò)心血管事件和在3個(gè)月內(nèi)服用降脂藥物治療者以消除影響血脂水平的因素。對(duì)銀屑病組和對(duì)照組詳細(xì)詢問(wèn)病史后,對(duì)銀屑病病人進(jìn)行體格檢查,并按照固定的方程式計(jì)算病人PASI評(píng)分。采集清晨空腹血液標(biāo)本由南京軍區(qū)總醫(yī)院全軍檢驗(yàn)中心進(jìn)行檢測(cè)。10年的Framingham風(fēng)險(xiǎn)評(píng)分包括年齡,性別,總膽固醇,HDL-C,收縮壓,吸煙史,通過(guò)固定的方程式計(jì)算銀屑病組和對(duì)照組的Framingham評(píng)分,最后依據(jù)Framingham評(píng)分將兩組患者分為3類:低危(10%),中危(10%-20%),高危(20%)。研究發(fā)現(xiàn)尋常型銀屑病組的10年心血管病發(fā)生風(fēng)險(xiǎn)顯著高于對(duì)照組,尋常型銀屑病病人中,尤其是老年(50歲)、男性的銀屑病病人10年心血管病發(fā)生風(fēng)險(xiǎn)明顯升高。輕度和重度銀屑組10年心血管病發(fā)生風(fēng)險(xiǎn)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.0167),銀屑病組載脂蛋白A水平顯著低于對(duì)照組(P0.05);銀屑病組舒張壓、收縮壓、空腹血糖、TC、TG、HDL、LDL、載脂蛋白A、載脂蛋白B、載脂蛋白E、脂蛋白a、C反應(yīng)蛋白、游離脂肪酸水平和對(duì)照組的組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。由于參加本研究的人群都比較年輕,大多數(shù)病人罹患心血管病風(fēng)險(xiǎn)為低危(銀屑病組81.11%和對(duì)照組89.78%,P0.05)。然而,還有一部分銀屑病病人與對(duì)照組相比心血管病風(fēng)險(xiǎn)為中危和高危(銀屑病組16.67%和2.22%,對(duì)照組9.49%和0.73%,P0.05)。研究發(fā)現(xiàn)尋常型銀屑病組的10年心血管病發(fā)生風(fēng)險(xiǎn)顯著高于對(duì)照組,尋常型銀屑病病人中,尤其是老年(50歲)、男性的銀屑病病人10年心血管病發(fā)生風(fēng)險(xiǎn)明顯升高。這可能是由于傳統(tǒng)的心血管危險(xiǎn)因素增加,或長(zhǎng)期慢性炎癥導(dǎo)致,或二者共同起作用。銀屑病患者應(yīng)對(duì)心血管疾病進(jìn)行風(fēng)險(xiǎn)評(píng)估,并且對(duì)其并發(fā)癥積極進(jìn)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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R758.63;R54

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