【摘要】：銀屑病是一種常見的皮膚病,在全球的發(fā)病率約為1-3%,除了累及皮膚,對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)性疾病的報道也層出不窮。越來越多的流行病學證據(jù)證實銀屑病病人比一般人群發(fā)生心血管事件的風險更常見。銀屑病患者死亡率較普通人群高,也主要歸功于并發(fā)的心血管疾病的發(fā)生。目前并沒有對銀屑病患者進行Framingham評分的相關(guān)研究。我們進行了一項前瞻性的病例-對照研究來評估銀屑病患者10年心血管疾病的發(fā)生風險。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?shù)恼ｓw檢人群作為對照組。所有銀屑病病人均進行臨床和組織病理學診斷。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)生過心血管事件和在3個月內(nèi)服用降脂藥物治療者以消除影響血脂水平的因素。對銀屑病組和對照組詳細詢問病史后,對銀屑病病人進行體格檢查,并按照固定的方程式計算病人PASI評分。采集清晨空腹血液標本由南京軍區(qū)總醫(yī)院全軍檢驗中心進行檢測。10年的Framingham風險評分包括年齡,性別,總膽固醇,HDL-C,收縮壓,吸煙史,通過固定的方程式計算銀屑病組和對照組的Framingham評分,最后依據(jù)Framingham評分將兩組患者分為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)生風險顯著高于對照組,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)生風險明顯升高。輕度和重度銀屑組10年心血管病發(fā)生風險差異均無統(tǒng)計學意義(P0.0167),銀屑病組載脂蛋白A水平顯著低于對照組(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照組的組間差異無統(tǒng)計學意義(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險為低危(銀屑病組81.11%和對照組89.78%,P0.05)。然而,還有一部分銀屑病病人與對照組相比心血管病風險為中危和高危(銀屑病組16.67%和2.22%,對照組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)生風險顯著高于對照組,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)生風險明顯升高。這可能是由于傳統(tǒng)的心血管危險因素增加,或長期慢性炎癥導致,或二者共同起作用。銀屑病患者應(yīng)對心血管疾病進行風險評估,并且對其并發(fā)癥積極進行防治。
[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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R758.63;R54

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