本文選題：銀屑病 + 代謝綜合征�。� 參考：《山東大學(xué)》2014年博士論文

【摘要】：銀屑病(psoriasis)是免疫介導(dǎo)的多基因遺傳性皮膚病。其患病率因種族、環(huán)境、地理位置等因素的不同而有很大差別,精神、外傷、感染、寒冷、潮濕及藥物等均可成為該病的誘發(fā)因素。上個(gè)世紀(jì)八十年代我國(guó)大規(guī)模的流行病學(xué)調(diào)查發(fā)現(xiàn)銀屑病的患病率為0.123%,近年來(lái)的研究表明該病患病率有增加的趨勢(shì)。隨著人們對(duì)銀屑病臨床與基礎(chǔ)研究的不斷深入,銀屑病不但被認(rèn)為是一種皮膚病,它還被認(rèn)為是一種系統(tǒng)性疾病,與代謝綜合征之間存在密切關(guān)系。代謝綜合征(metabolic syndrome,MS)是多種物質(zhì)代謝異常的病理狀態(tài),是導(dǎo)致心血管疾病(cardiovascular disease,CVD)和其他代謝性疾病的危險(xiǎn)因素,與多種代謝相關(guān)性疾病有密切的聯(lián)系。 銀屑病與代謝綜合征二者之間相互關(guān)聯(lián)的發(fā)病機(jī)制較為復(fù)雜,確切的發(fā)病機(jī)制尚未明確。腫瘤壞死因子-α、白介素-1、2、6、8、18、脂聯(lián)素等細(xì)胞因子在銀屑病合并代謝綜合征的發(fā)病過(guò)程中起著非常重要的作用,在這些前炎癥因子作用下銀屑病與代謝綜合征通過(guò)共同的慢性炎癥機(jī)制相關(guān)聯(lián)。另外,銀屑病與代謝綜合癥可能存在相同的易感基因如CDKAL1等。 自從2005年國(guó)際糖尿病聯(lián)盟(International Diabetes Federation, IDF)對(duì)代謝綜合征給出新的定義以后,越來(lái)越多的人對(duì)該病進(jìn)行了深入的研究。近年來(lái),流行病學(xué)及實(shí)驗(yàn)研究發(fā)現(xiàn)銀屑病患者中患中心性肥胖、高血壓、高血糖、高脂血癥和動(dòng)脈硬化性心血管疾病的風(fēng)險(xiǎn)增加,銀屑病與代謝綜合征的相關(guān)性已成為皮膚病領(lǐng)域的研究熱點(diǎn)。 大量的流行病學(xué)資料顯示銀屑病患者的代謝綜合征患病率遠(yuǎn)高于自然人群。一項(xiàng)對(duì)有代表性樣本的調(diào)查揭示美國(guó)居民中代謝綜合征在銀屑病患者中的患病率高達(dá)40%。Langan等在英國(guó)對(duì)銀屑病與代謝綜合征的相關(guān)性做了流行病學(xué)研究,結(jié)果表明二者的相關(guān)性隨著代謝綜合征的各獨(dú)立組成部分的嚴(yán)重程度的增加而增強(qiáng)。日本、印度和韓國(guó)的學(xué)者也各自在本地區(qū)對(duì)銀屑病合并代謝綜合征做了相關(guān)研究,發(fā)現(xiàn)銀屑病合并代謝綜合征的患病率分別為24.4%、44.1%、17.8%。 我國(guó)在銀屑病與代謝綜合征的流行病學(xué)、危險(xiǎn)因素、臨床特征及部分細(xì)胞因子等相關(guān)性研究方面也作了有益的探索。從世界范圍內(nèi)的研究來(lái)看,絕大多數(shù)是有關(guān)銀屑病合并代謝綜合征相關(guān)性的基礎(chǔ)研究和回顧性的臨床分析,而對(duì)銀屑病患者合并代謝綜合征有重要研究?jī)r(jià)值的前瞻性、臨床相關(guān)性研究非常少。在這一領(lǐng)域開(kāi)展前瞻性的研究工作具有十分重要的意義,它不僅能為廣大科研工作者提供更為科學(xué)的理論依據(jù),還能幫助皮膚科醫(yī)生對(duì)銀屑病患者制定更為合理的診療方案。 為進(jìn)一步探討銀屑病與代謝綜合征發(fā)病的相關(guān)性,明確性別、年齡、病程、吸煙、飲酒等因素對(duì)銀屑病合并代謝綜合征的影響,銀屑病合并代謝綜合征對(duì)患者高尿酸血癥、血肌酐、血尿素氮水平及腎功能的影響,我們對(duì)在山東大學(xué)附屬省皮膚病醫(yī)院住院的426例銀屑病患者進(jìn)行了一項(xiàng)前瞻性的臨床研究。這對(duì)進(jìn)一步闡明山東地區(qū)銀屑病合并代謝綜合征的患病率；銀屑病合并代謝綜合征的發(fā)病機(jī)制及銀屑病合并代謝綜合征后對(duì)患者生理機(jī)能的影響,從而采取相應(yīng)對(duì)策來(lái)避免或減少銀屑病患者代謝綜合征和腎功能損傷、甚至衰竭的發(fā)生都會(huì)有重要的意義。 研究目的 1.研究銀屑病合并代謝綜合征的發(fā)病情況。 2.明確銀屑病合并代謝綜合征的發(fā)病機(jī)制。 3.探討誘發(fā)銀屑病合并代謝綜合征的相關(guān)因素。 4.分析銀屑病合并代謝綜合征后對(duì)患者健康的影響。 研究方法 1.研究對(duì)象本研究對(duì)2013年5月-2014年5月期間在山東大學(xué)附屬省皮膚病醫(yī)院住院的銀屑病患者共426例進(jìn)行分析。同時(shí)選取山東大學(xué)附屬千佛山醫(yī)院健康管理中心453名健康查體者作為對(duì)照組。 2.銀屑病和代謝綜合征的診斷標(biāo)準(zhǔn)根據(jù)《中國(guó)臨床皮膚病學(xué)》銀屑病的診斷標(biāo)準(zhǔn)對(duì)銀屑病進(jìn)行診斷；根據(jù)2005IDF對(duì)代謝綜合征所做出的統(tǒng)一定義對(duì)代謝綜合征進(jìn)行診斷。 3.排除標(biāo)準(zhǔn)(1)原發(fā)性高血壓；原發(fā)性糖尿病(Ⅰ型)；家族性高脂血癥。(2)Cushing綜合征等嚴(yán)重的內(nèi)分泌系統(tǒng)疾病。(3)近3個(gè)月內(nèi)系統(tǒng)應(yīng)用過(guò)維A酸制劑、糖皮質(zhì)類固醇激素及免疫抑制劑。(4)患有風(fēng)濕、類風(fēng)濕及免疫系統(tǒng)疾病者。 4.對(duì)符合入選標(biāo)準(zhǔn)的患者入院后測(cè)量其中心性肥胖、血壓；記錄患者的性別、年齡、病程,吸煙、飲酒情況,并對(duì)患者的銀屑病皮損進(jìn)行PASI評(píng)分；進(jìn)行甘油三酯、高密度脂蛋白-膽固醇、空腹血糖、血尿酸、肌酐及尿素氮等指標(biāo)的實(shí)驗(yàn)室檢查。 5.統(tǒng)計(jì)學(xué)分析應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±S)表示,計(jì)數(shù)資料采用百分率表示,組間比較用x2檢驗(yàn)。統(tǒng)計(jì)結(jié)果以P0.05具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.銀屑病患者中心性肥胖、甘油三酯水平、空腹血糖水平均高于對(duì)照組；銀屑病患者高密度脂蛋白-膽固醇水平低于對(duì)照組；收縮壓和舒張壓均高于對(duì)照組。 2.銀屑病合并代謝綜合征的患病率在各類型中(尋常型、關(guān)節(jié)病型、膿皰型及紅皮病型)分別為37.53%、38.71%、33.33%和40.63%。 3.男性銀屑病患者合并代謝綜合征患病率高。 4.銀屑病合并代謝綜合征的發(fā)生率隨年齡和病程的增加而增加。 5.吸煙、飲酒的銀屑病男性患者合并代謝綜合征患病率高于女性。 6. PASI評(píng)分在四種類型的銀屑病和銀屑病合并代謝綜合征患者中無(wú)差異性。 7.銀屑病患者的高尿酸血癥患病率高。 8.銀屑病患者血肌酐水平高于正常。 結(jié)論 1.銀屑病患者合并代謝綜合征比正常人群有較高的患病率。 2.代謝綜合征與銀屑病的類型沒(méi)有密切相關(guān)性。 3.銀屑病患者的性別、年齡、病程對(duì)銀屑病合并代謝綜合征起著重要作用。 4.吸煙、飲酒是男性銀屑病患者代謝綜合征發(fā)生的危險(xiǎn)因素。 5. PASI評(píng)分與銀屑病皮損面積和和皮損嚴(yán)重程度有關(guān),與銀屑病類型、是否合并代謝綜合征無(wú)關(guān)。 6.銀屑病與高尿酸血癥關(guān)系密切。 7.銀屑病是患者腎功能受損的一個(gè)危險(xiǎn)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R758.63;R589

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10 召玉;銀屑病能否根治？[N];經(jīng)濟(jì)日?qǐng)?bào).農(nóng)村版;2005年

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