本文選題：銀屑病　切入點(diǎn)：系統(tǒng)評(píng)價(jià)　出處：《河北醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的:銀屑病是皮膚科一種常見的慢性炎癥性增殖性疾病。其病程長,難治愈,易復(fù)發(fā)給患者生活質(zhì)量造成很大負(fù)面影響。銀屑病的病因至今不明。目前研究大多數(shù)認(rèn)為銀屑病發(fā)病與T細(xì)胞介導(dǎo)的免疫有關(guān)。銀屑病發(fā)病的免疫機(jī)理主要概括為外源性誘導(dǎo)性抗原和內(nèi)源性自身抗原被朗格漢斯細(xì)胞、樹突狀細(xì)胞等抗原遞呈細(xì)胞捕獲后表達(dá)于細(xì)胞表面。成熟的抗原遞呈細(xì)胞經(jīng)血管進(jìn)入皮膚淋巴結(jié),將抗原遞呈給自然T細(xì)胞。自然T細(xì)胞經(jīng)活化、分化、增殖成為致病的記憶效應(yīng)性T細(xì)胞。記憶效應(yīng)性T細(xì)胞遷移到皮膚并在病灶區(qū)誘導(dǎo)產(chǎn)生各種炎癥因子和細(xì)胞因子,導(dǎo)致了銀屑病一系列病理改變。目前較公認(rèn)的是皮損內(nèi)異常浸潤的T淋巴細(xì)胞及細(xì)胞因子的作用是銀屑病發(fā)病的關(guān)鍵步驟。sICAM-1(可溶性細(xì)胞間粘附分子1)就是重要的細(xì)胞因子之一。近年定量測定銀屑病患者sICAM-1的研究較多,研究樣本量大小不一,結(jié)果不盡一致。Meta分析是對(duì)已有的資料進(jìn)行綜合分析和評(píng)價(jià)的方法,它可以對(duì)具有相同研究目的多個(gè)獨(dú)立研究結(jié)果進(jìn)行綜合統(tǒng)計(jì)分析和評(píng)價(jià)。Meta分析能夠改進(jìn)和提高由于樣本量小而影響的統(tǒng)計(jì)效能;可以對(duì)某些研究結(jié)果不一致的情況作出較客觀的判斷,得出較為可靠的結(jié)論;解釋了在單獨(dú)研究中尚未解釋或不能解釋的問題。 本研究通過Meta分析的方法評(píng)價(jià)sICAM-1與銀屑病相關(guān)性。為銀屑病病因相關(guān)研究及治療提供客觀的參考依據(jù)。 方法:以檢索詞:Psoriasis、Soluble intercellular adhesion molecule-1、sICAM-1、銀屑病、可溶性細(xì)胞間粘附分子1,檢索數(shù)據(jù)庫:Cochrane圖書館、PubMed、中國學(xué)術(shù)文獻(xiàn)網(wǎng)絡(luò)出版總庫(含碩博論文)(CNKI新)、中國生物文獻(xiàn)服務(wù)系統(tǒng)(sinomed)。納入所有研究sICAM-1與銀屑病相關(guān)性的配對(duì)與非配對(duì)的病例對(duì)照研究。由2名評(píng)價(jià)者共同評(píng)價(jià)納入研究質(zhì)量。采用RevMan4.2.8軟件對(duì)納入文獻(xiàn)進(jìn)行Meta分析。 結(jié)果:共納入21篇配對(duì)或非配對(duì)的病例對(duì)照研究,包括銀屑病患者788例,正常對(duì)照624例。所有研究均采用ELISA方法檢測銀屑病患者及?正常對(duì)照志愿者外周血血清中sICAM-1的濃度。部分研究說明了所用檢測方法的靈敏度、特異度及重復(fù)性。通過分析發(fā)現(xiàn)未分型,分期銀屑病患者高于正常對(duì)照Z = 4.70 (P 0.00001)、WMD147.68、95%CI(86.05, 209.31);尋常型銀屑病患者高于正常對(duì)照Z = 6.14 (P 0.00001)、WMD152.95、95%CI(104.09, 201.81);進(jìn)行期銀屑病患者高于正常對(duì)照Z = 4.85 (P 0.00001)、WMD176.04、95%CI(104.94, 247.14);靜止期銀屑病患者高于正常對(duì)照Z = 3.14 (P = 0.002)、WMD89.69、95%CI(33.64, 145.74);退行期銀屑病患者與正常對(duì)照無差別Z = 1.44 (P = 0.15)、WMD81.49、95%CI(-29.75, 192.73);進(jìn)行期銀屑病患者高于靜止期銀屑病患者Z = 4.25 (P 0.0001)、WMD83.06、95%CI(44.76, 121.37);進(jìn)行期銀屑病患者高于退行期銀屑病患者Z = 10.84 (P 0.00001)、WMD125.12、95%CI(102.50, 147.74);靜止期銀屑病患者與退行期銀屑病患者無差別Z = 1.09 (P = 0.28)、WMD36.69、95%CI(-29.39, 102.76)。銀屑病患者血清sICAM-1濃度與患者PASI評(píng)分呈正相關(guān)關(guān)系。 結(jié)論:研究結(jié)果顯示,未分型分期銀屑病患者及尋常型銀屑病患者血清中sICAM-1水平升高,表明銀屑病的發(fā)病與sICAM-1升高相關(guān)。進(jìn)行期、靜止期銀屑病患者血清中sICAM-1水平高于正常對(duì)照,說明銀屑病進(jìn)行期和靜止期血清中sICAM-1與病情的嚴(yán)重程度有關(guān)。呈正相關(guān)性。退行期銀屑病患者血清中sICAM-1水平與正常對(duì)照無差別,說明隨著銀屑病病情好轉(zhuǎn),進(jìn)入退行期血清中sICAM-1水平也下降到近似正常水平更加說明血清中sICAM-1水平與病情的活動(dòng)有關(guān)。進(jìn)行期銀屑病患者血清中sICAM-1水平高于靜止期及退行期銀屑病患者,說明病情由發(fā)展到維持或消退血清中sICAM-1水平均有明顯下降。此現(xiàn)象也說明血清中sICAM-1水平與病情的的嚴(yán)重程度有關(guān)。靜止期銀屑病患者與退行期銀屑病患者血清中sICAM-1水平無差別說明病情由維持到消退階段血清中sICAM-1水平下降已不明顯。銀屑病患者血清sICAM-1濃度與皮損PASI評(píng)分有統(tǒng)計(jì)學(xué)意義且呈正相關(guān)。 本文研究結(jié)果顯示血清sICAM-1水平與銀屑病的臨床分期及嚴(yán)重程度有關(guān)。由于本研究及納入文獻(xiàn)存在一定局限性,期待將來高質(zhì)量的文獻(xiàn)納入本研究,進(jìn)一步驗(yàn)證本研究結(jié)果。
[Abstract]:Objective: Department of Dermatology psoriasis is a common chronic inflammatory proliferative disease. Its long course, difficult to cure, easy relapse to the quality of life of patients caused great negative impact. The cause of this disease is still unknown. At present most studies that the pathogenesis of psoriasis and T cell mediated immunity. The main mechanism of the immune pathogenesis of psoriasis is summarized exogenous and endogenous antigen induced self antigen is langer Hans cells, dendritic cells and antigen presenting cells expressed on the cell surface. After the capture of mature antigen-presenting cells through blood vessels into the skin lymph node, present antigen to T cells. The natural natural T cell activation, differentiation, proliferation become pathogenic memory effect T cells. Memory effect of T cells to migrate to the skin and induce lesions in various inflammatory factors and cytokines, cause a series of pathological changes of psoriasis. The Is recognized as T lymphocytes and cytokines in lesions with abnormal infiltration of the role of.SICAM-1 is the key step in the pathogenesis of psoriasis (soluble intercellular adhesion molecule 1) is one of the most important cytokines. More research in the quantitative determination of sICAM-1 in patients with psoriasis, the amount of sample size, the results are not consistent with.Meta analysis method make a comprehensive analysis and evaluation on the existing data, it can have the same purpose of multiple independent research results of comprehensive statistical analysis and evaluation.Meta analysis can improve and improve due to the small sample size affects the efficiency of the statistics; on some research results inconsistent situation objectively judge, draw more reliable conclusion; explain the explanation in the separate studies have not yet been or can not explain the problem.
This study evaluated the correlation between sICAM-1 and psoriasis by Meta analysis, and provided an objective reference for the related research and treatment of psoriasis.
Methods: the key words: Psoriasis Soluble, intercellular adhesion molecule-1, sICAM-1, psoriasis, soluble intercellular adhesion molecule 1, database: Cochrane library, PubMed, China Academic Literature Network Publishing Database (including thesis) (CNKI), China biological literature service system (sinomed). In the control study of all related research sICAM-1 and psoriasis paired with non paired cases. By 2 reviewers evaluated the quality of studies. Meta analysis of the literature by RevMan4.2.8 software.
Results: a total of 21 paired or non paired case-control study, including 788 cases of patients with psoriasis, 624 cases of normal control. All studies were detected by ELISA in patients with psoriasis and normal control? SICAM-1 concentration in serum of volunteers. Some studies illustrate the sensitivity of detection methods for the specificity and repetition through the analysis found. Without typing, staging in patients with psoriasis is higher than the normal control Z = 4.70 (P 0.00001), WMD147.68,95%CI (86.05, 209.31); the patients with psoriasis vulgaris is higher than the normal control Z = 6.14 (P 0.00001), WMD152.95,95%CI (104.09, 201.81); of psoriasis patients than normal control (Z = 4.85 P 0.00001), WMD176.04,95%CI (104.94, 247.14); patients with psoriasis still higher than the normal control Z = 3.14 (P = 0.002), WMD89.69,95%CI (33.64, 145.74); catagen psoriasis patients and normal controls, no difference in Z = 1.44 (P = 0.15), WMD81.49,95%CI (-29.75, 192.73); of psoriasis patients were higher than the resting stage in patients with psoriasis Z = 4.25 (P 0.0001), WMD83.06,95%CI (44.76, 121.37); of psoriasis patients than in patients with psoriasis catagen Z = 10.84 (P 0.00001), WMD125.12,95%CI (102.50, 147.74); stationary psoriasis patients with psoriasis catagen no difference Z = 1.09 (P = 0.28), WMD36.69,95%CI (-29.39, 102.76). The serum concentration of sICAM-1 in patients with psoriasis and PASI score were positively correlated.
Conclusion: the results showed that no type of elevated stage sera of patients with psoriasis patients with psoriasis vulgaris and sICAM-1, suggesting that sICAM-1 and increased incidence of psoriasis. The period, the level of serum sICAM-1 in patients with psoriasis vulgaris in stationary phase was higher than the control, indicating the severity of illness and 5-LO sICAM-1 in serum and resting periods the positive correlation. The level of serum sICAM-1 in patients with psoriasis catagen and normal control had no difference with psoriasis condition improved, serum levels of sICAM-1 into catagen also decreased to near normal levels more shows in serum sICAM-1 levels and disease activity. SICAM-1 serum levels in patients with psoriasis is higher than that of patients in resting and degeneration psoriasis, explain the illness from growth to maintain or subside in serum sICAM-1 levels were significantly decreased. This phenomenon also said The serum sICAM-1 levels and disease severity. The level of sICAM-1 in patients with psoriasis and catagen telogen psoriasis in patients with no difference to explain the illness by maintaining the level of sICAM-1 in serum decreased subsided stage was not obvious. The serum concentration of sICAM-1 in patients with psoriasis lesions and PASI scores were statistically significant and positive correlation.
The results of this study show that serum sICAM-1 level is related to the clinical stages and severity of psoriasis. Due to the limitations of this study and the inclusion of literature, we expect high quality literature to be included in this study, and further verify the results of this study.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R758.63

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