银屑病伴发高脂血症的相关因素分析

目的探讨银屑病伴发高脂血症的相关因素及内在机制。方法对413例住院银屑病患者病例资料进行回顾性统计分析。结果伴有高脂血症的银屑病患者占同期住院银屑病患者总数的25.91%,其住院时平均年龄、平均病程及银屑病平均始发年龄均明显大于不伴高脂血症者;伴高脂血症的银屑病患者中,吸烟者比例及高血压、糖尿病、高尿酸血症、脂肪肝、肝功异常及肾脏损害发生率均高于不伴高脂血症者,而饮酒者比例亦较高。银屑病严重型比例则低于不伴高脂血症者。结论高脂血症是一种与年龄相关的代谢性疾病,银屑病严重型、高血压、糖尿病、高尿酸血症、脂肪肝、肝功异常及肾脏损害可能与银屑病伴发高脂血症有关。     

银屑病患者血清尿酸水平检测及意义

目的探讨血清尿酸与银屑病的关系,以及血清尿酸在银屑病患者中的形成过程。方法对307例银屑病患者和286名正常人的临床资料进行回顾性分析,并进行统计学分析。结果银屑病患者血清尿酸水平与正常人相比差异有统计学意义(P<0.01);寻常性银屑病与非寻常性银屑病患者相比差异有统计学意义(P<0.01);银屑病病期与血清尿酸水平升高无相关性(P>0.05);血清尿酸水平升高与性别相关(P<0.01),与年龄无相关性(P>0.05)。结论银屑病与高尿酸血症关系密切,银屑病患者的高尿酸血症可能是由银屑病本身引起。     

天疱疮患者感染危险因素分析

目的探讨天疱疮患者感染的危险因素。方法回顾性分析2012-2017年本科58例住院的天疱疮患者的临床特点、感染部位、病原体,分析可能的易感因素。结果有39例发生感染,感染率67.24%;单因素分析显示寻常型天疱疮、口腔受累、病情重、合并糖尿病、低蛋白血症的患者感染率更高,差异有统计学意义(P0.05);病情重、合并糖尿病的患者院感率也更高,差异有统计学意义(P0.05);单独糖皮质激素和糖皮质激素联合环磷酰胺治疗的患者感染率和院感率差异均无统计学意义(P0.05)。多因素分析显示口腔受累(OR=12.373)、病情重(OR=11.300)、合并糖尿病(OR=17.268)、低蛋白血症(OR=8.699)是感染的独立危险因素;病情重(OR=8.390)、合并糖尿病(OR=4.109)也是院感的独立危险因素。结论天疱疮患者病情严重程度、合并糖尿病、低蛋白血症、口腔黏膜损害是感染的危险因素,环磷酰胺的应用没有增加感染的风险。     

银屑病患者抑郁症状检出情况及影响因素调查分析

目的:了解银屑病患者的抑郁检出情况及影响因素。方法:采用流调中心用抑郁自评量表,对我院皮肤科门诊128名银屑病患者进行调查;使用卡方检验、logistic回归分析进行统计分析。结果:银屑病患者CES-D平均得分为(16.14±4.36),CES-D得分≥16的有56人,抑郁检出率为43.75%;银屑病患者抑郁检出率在不同年龄(χ~2=16.75,P0.01)、文化程度(χ~2=13.01,P0.01)、病情分类(χ~2=43.05,P0.01)和病程(χ~2=9.02,P0.01)患者中均存在明显差异;两两比较发现,30~60岁及60岁以上抑郁症状检出率显著高于30岁以下年龄组(χ~2值分别为16.55、10.37,P0.05),大学及以上组抑郁症状检出率显著低于其他三组(χ~2值分别为12.91、6.12、6.38,P值均0.05);Logistic回归发现重度银屑病患者病情是患者抑郁的明显影响因素,重度银屑病患者抑郁检出风险更高(OR=40.905,95%OR=9.499-176.145)。结论:银屑病患者抑郁的检出率较高,患者抑郁与银屑病病情显著相关。应重视银屑病患者个体化心理健康教育。     

特殊类型银屑病伴发高尿酸血症相关因素分析

目的:探讨特殊型银屑病伴发高尿酸血症的相关因素。方法:对117例红皮病型、泛发性脓疱型或/及关节病型银屑病患者的临床资料进行回顾性分析;根据尿酸代谢过程、影响因素、银屑病的临床表现等确定分析指标15项,对高尿酸血症组、正常组间各指标先后进行单因素分析及多因素Logistic回归分析;同时分析特殊用药、病情演变与患者血尿酸水平变化间的关系。结果:特殊类型银屑病伴高尿酸血症发生率为31.62%;高尿酸血症组与正常组比较,性别、红皮病型损害、泛发性脓疱型损害及血甘油三酯增高间的差异均有统计学意义(P<0.05);红皮病型损害、男性、甘油三酯增高、泛发性脓疱型损害是影响高尿酸血症发生的重要因素,其相对危险度(RR)依次为8.93、6.83、2.86、0.31。结论:特殊型银屑病伴发高尿酸血症可能与性别、红皮病型损害、泛发性脓疱型损害、甘油三酯增高及特殊用药有关。     

血清尿酸水平与2型糖尿病患者心血管疾病发病的相关性

目的探讨2型糖尿病患者血清尿酸水平与心血管疾病发病的关系。方法选取2014年1月-2017年6月共162例于芜湖市第二人民医院就诊的2型糖尿病患者,采用全自动生化仪检测患者血清中尿酸水平,根据尿酸水平分为高尿酸血症组和尿酸水平正常组。比较两组糖尿病患者心血管疾病发病情况。利用Spearman相关性分析血清尿酸水平与各临床指标的相关性,利用多元Logistic回归分析新发心血管事件的危险因素。结果高尿酸血症组心血管疾病发生率高于尿酸水平正常短(30.7%vs.17.3%,P<0.05)。Spearfnan相关分析显示,高尿酸血症与2型糖尿病病竑呈正相关(P<0.01),与收缩压呈负相关(P<0.05),与其他指标如性别、年龄、吸烟史、HbAlc、BMI等无相关性(均P>0.05)。多元Logistic回知分析显示,高尿酸血症(β=0.308,P<0.05)、收缩压(β=0.144,P<0.05)和HbA1c(β=0.224,P<0.05)为2型糖尿病患者新发心血管事件的危险因素。结论血清尿酸水平与2型糖尿病患暑心血管疾病发病风险有相关性.     

甘肃地区寻常性银屑病病情相关因素分析

目的探讨影响银屑病发病及病情的饮食因素及其他因素,指导银屑病患者合理饮食与健康生活。方法采用问卷调查的方法,运用1:1配比病例对照研究,使用单因素Logistic回归分析结合多因素条件Logistic回归模型分析。结果与银屑病病情密切相关的因素主要有:面粉(OR=2.214)、牛肉(OR=3.308)、羊肉(OR=2.145)、鱼虾(OR=1.952)、辣椒(OR=2.559)、洋葱(OR=1.519)、吸烟(OR=2.515)、饮酒(OR=2.205)、咸菜和酸菜(OR=1.752),以及失眠(OR=1.502)与肥胖(OR=1.557),这些可能是银屑病的危险因素;而大米(OR=0.422)、粗粮(OR=0.252)、蛋类(OR=0.459)、鲜奶(OR=0.576)、苹果(OR=0.650)、香蕉(OR=0.656)、芹菜(OR=0.515)、茄子(OR=0.652)可能是银屑病的保护因素。结论银屑病患者应戒烟、戒酒,避免失眠,避免进食鱼虾、辛辣、羊肉、牛肉、辣椒、面粉、洋葱等食物,多食大米、粗粮、鸡蛋、鲜奶、苹果、香蕉、芹菜、茄子等食物,注意控制体重,保证睡眠质量。     

有无家族史银屑病环境因素与HLA-DQA1等位基因交互作用的研究

目的　研究银屑病环境危险因素与HLA DQA1等位基因交互作用。方法　采用病例 对照方法调查 176例银屑病患者及 185例健康人环境因素 ,用PCR SSP方法检测HLA DQA1等位基因 ;对环境危险因素与HLA DQA1等位基因交互作用进行研究。结果　①在有及无家族史银屑病中 ,HLA DQA1 0 10 4与受潮存在交互作用 (P <0 .0 5 ,OR>4.0 ) ;在无家族史银屑病中HLA DQA1 0 10 4与饮酒 (P =0 .0 190 ,OR =4.62 )、食鱼虾 (P =0 .0 42 6,OR =2 .82 )存在交互作用。②HLA DQA1 0 2 0 1与食鱼虾 (P =0 .0 0 74,OR =4.72 )仅在无家族史银屑病中存在交互作用。③HLA DQA1 0 5 0 1与受潮 (P =0 .0 0 40 ,OR =10 .5 0 )、食鱼虾 (P =0 .0 3 3 8,OR =5 .41)和精神紧张 (P =0 .0 482 ,OR =8.14 )仅在有家族史银屑病中存在交互作用。结论　HLA DQA1等位基因能增加银屑病环境危险因素发生该病的危险性 ,在有及无家族史银屑病中存在差异。     

银屑病合并高尿酸血症相关性研究进展

目前普遍认为,银屑病与高尿酸血症之间存在相关性,但确切机制尚未明确。研究认为,遗传因素、单钠尿酸盐晶体(MSU)、嘌呤代谢相关酶及代谢相关疾病等都有参与。对于合并高尿酸血症的银屑病患者,通过降尿酸治疗可以更好地控制患者心血管及代谢等危险因素,进而预防银屑病的进展及恶化。了解高尿酸血症对银屑病发病及治疗等方面的影响,将有助于银屑病的治疗。本文从病理生理学及治疗方面阐述两者之间的相关性。     

银屑病患者所生育新生儿低体质量的影响因素研究

目的:探讨银屑病患者所生育新生儿低体质量的影响因素。方法:回顾性收集2016年3月至2018年3月在本院就诊的54例孕产妇临床资料,对影响银屑病患者所生育的新生儿体质量的因素进行单因素和Logistic回归分析。结果:新生儿低体质量发生率为66.67%,单因素分析结果显示,银屑病患者的年龄、妊娠前BMI、孕期增重、PASI评分、存在被动吸烟、TC、TG、Alb和Hb对新生儿低体质量存在影响。多因素分析结果显示,银屑病患者的妊娠前BMI(OR=0.311,P=0.001)、孕期增重(OR=0.561,P=0.000)、PASI评分(OR=2.785,P=0.002)、Alb(OR=0.432,P=0.001)和Hb(OR=0.521,P=0.002)是新生儿出生低体质量的风险因素。结论:银屑病患者的妊娠前BMI、孕期增重、PASI、Alb和Hb是影响新生儿出生低体质量的重要因素。     

Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study

We conducted a case-control study to analyse the association of psoriasis of recent onset with smoking habits, body mass index (BMI) and stressful life events. Cases (n=560; median age 38) were patients with a first diagnosis of psoriasis and a history of skin manifestations of no longer than two years after the reported disease onset. Patients with a new diagnosis of skin diseases other than psoriasis (n=690; median age 36) were selected as controls. The risk of psoriasis was higher in ex- and current smokers than in never-smokers, the relative risk estimates (OR) being 1.9 for ex-smokers and 1.7 for smokers. Smoking was strongly associated with pustular lesions (32 patients, OR=5.3 for smokers). The frequency of psoriasis varied significantly in relation to a family history of psoriasis in first degree relatives, BMI (OR=1.6 and 1.9 for over weighted, BMI 26-29, and obese, BMI >/= 30, respectively) and stressful life event score (compared to the lower index quartile, the OR being 2.2 for index values >/=115). Risk estimates, when taking into consideration the combined effect of these factors with smoking habits, were consistent with a multiplicative model of risk combination with no significant statistical interaction.     

HLA-DQA1 and DQB1 alleles are associated with genetic susceptibility to psoriasis vulgaris in Chinese Han

BACKGROUND: Psoriasis vulgaris is a chronic skin disorder characterized by infiltration of inflammatory elements, keratinocyte hyperproliferation and altered differentiation. Although the pathogenesis of psoriasis is not fully understood, there is solid evidence of a susceptibility locus in the human leukocyte antigen (HLA) region. OBJECTIVES: To investigate whether HLA-DQA1 and DQB1 alleles are associated with genetic susceptibility to psoriasis vulgaris in Chinese Han. PATIENTS AND METHODS: The polymerase chain reaction-sequence-specific primer (PCR-SSP) method was used to analyse the distribution of HLA-DQA1 and DQB1 alleles in 189 patients with psoriasis and 273 healthy controls. RESULTS: The HLA-DQA1*0104 (OR = 2.33, P = 0.0001154, Pc = 2.0 x 10-3), DQA1*0201 (OR = 3.36, P < 1.0 x 10-7, Pc < 1.0 x 10-6), DQB1*0201 (OR = 1.64, P = 0.0192, Pc > 0.05) and DQB1*0303 (OR = 1.55, P = 0.0377, Pc > 0.05) alleles were more prevalent in patients with psoriasis vulgaris than in controls, and HLA-DQA1*0501 (OR = 0.30, P = 0.0000039, Pc < 4.0 x 10-5) alleles were less prevalent. The HLA-DQA1*0104 (OR = 2.42, P = 0.0001159, Pc < 2.0 x 10-3), DQA1*0201 (OR = 3.74, P < 1.0 x 10-7, Pc < 1.0 x 10-6) and DQA1*0501 (OR = 0.30, P = 0.0000374, Pc < 4.0 x 10-4) alleles were only associated with type I psoriasis. HLA-DQA1*0104 and DQA1*0201 were more prevalent in patients with or without a family history of psoriasis. However, the DQA1*0501 allele was only more prevalent in patients without a family history of psoriasis. CONCLUSION: HLA-DQA1*0104 and DQA1*0201 alleles may be psoriasis susceptibility genes or may be in close linkage with the susceptibility genes. The HLA-DQA1*0501 allele seems to have a protective effect against the development of psoriasis vulgaris in Chinese Han. There may be a difference in genetic background between psoriasis patients with and without a family history of psoriasis.     

182例天疱疮患者合并感染状况的回顾分析

【摘要】 目的 分析天疱疮患者合并感染的情况和并发感染的危险因素及其对预后的影响。方法 回顾性分析2011年5月至2017年5月于第四军医大学西京皮肤医院住院治疗的182例天疱疮患者的临床资料,分析感染发生率与年龄、病情严重程度、合并症、糖皮质激素最大用量、住院时间及住院费用的关系。采用SPSS 22.0软件,Logistic回归分析首次住院天疱疮患者并发感染的危险因素。结果 182例首次住院患者中,82例（45.05%）出现感染,取77例患者皮损分泌物培养出107株病原菌,其中金黄色葡萄球菌60株（56.07%）,58株对青霉素耐药（96.67%）。182例中,低蛋白血症患者14例,11例发生感染,无低蛋白血症患者168例中69例（41.07%）发生感染。轻度天疱疮患者27例中4例（4.81%）、中度90例中34例（37.7%）、重度65例中42例（67.69%）发生感染。Logistic回归分析显示,低蛋白血症患者感染发生率高于无低蛋白血症患者（OR = 5.559,95% CI 1.053 ~ 29.347,P = 0.043）;与轻度天疱疮患者相比,中度（OR = 4.676,95% CI 1.276 ~ 17.123）、重度（OR = 16.529,95% CI 4.183 ~ 65.314）天疱疮患者感染的发生率均明显升高（P < 0.05或 < 0.001）。性别、疾病类型以及是否合并高血压病、糖尿病对天疱疮患者感染发生率的影响差异无统计学意义（均P > 0.05）。随访145例患者,完全治愈33例,临床治愈67例,好转23例,复发或加重10例,死亡12例。死亡患者中,3例因肺炎、2例因天疱疮加重伴皮肤感染、1例因败血症去世。结论 病情重、低蛋白血症是天疱疮患者感染的危险因素,细菌感染是天疱疮患者常见的合并症,重症感染是导致天疱疮患者死亡的原因之一。     

银屑病患者罹患冠心病的风险评估

目的 评估银屑病患者10年内患冠心病的风险值,探讨银屑病病程、家族史及类型对冠心病风险的影响。 方法 银屑病组来自2008年12月至2010年12月四川大学华西医院皮肤科322例银屑病住院患者。对照组来自同期的297例急性皮肤病（急性荨麻疹１５１例、药疹３３例、带状疱疹１１３例）住院患者。运用Framingham风险评分模型估计银屑病组与对照组10年内患冠心病的风险。用Wilcoxon秩和检验、Kruskal-Wallis检验、?字２检验分析两组之间危险因素及风险值差异性。结果 10年内首次发生冠心病事件的风险在银屑病组与对照组分别为6%和4%（Z = 4.342,P = 0.000）,在寻常性银屑病组、脓疱性银屑病组、关节病性银屑病组和红皮病性银屑病组分别为6%、4%、7%、7%（H = 8.484,P < 0.05）,在银屑病家族史阳性组与阴性组均为6%。冠心病的风险值与银屑病病程无相关性（P > 0.05）。结论 银屑病患者10年内患冠心病的风险高于急性荨麻疹、药疹和带状疱疹患者,关节病性、红皮病性银屑病的风险值比脓疱性高。冠心病的风险值与银屑病病程无相关性,银屑病家族史对冠心病风险值无明显影响。     

Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors,but not with cardiovascular events in a population‐based sample

Background Psoriasis may significantly reduce quality of life. Previous studies reported an association of psoriasis and cardiovascular risk factors and cardiovascular events. The extent to which psoriasis is associated with psychiatric morbidity and the role of psychiatric comorbidity as a potential confounder of the association between psoriasis and cardiovascular morbidity require further investigation. Objectives To study the association between psoriasis, psychiatric morbidity and cardiovascular morbidity. Methods Case–control study utilizing an interdisciplinary administrative outpatient database from Germany. Patients with confirmed diagnosis of prevalent psoriasis within the study period (2003–2004) (n = 3147, mean age 57 years) were individually matched for age and gender with 3147 controls without psoriasis. The relationship of psoriasis with psychiatric morbidities (depression, stress‐related disorders, behaviour disorders and schizophrenic disorders), cardiovascular risk factors (diabetes, hypertension, obesity and dyslipidaemia) and cardiovascular events [myocardial infarction (MI), stroke] was investigated using logistic and linear regression models. Results Crude analyses suggested an association of psoriasis with depression, stress‐related disorders, behaviour disorders and cardiovascular risk factors, but not with MI [odds ratio (OR) 1.14; 95% confidence interval (95% CI) 0.81–1.62] or stroke (OR 0.97; 95% CI 0.61–1.54). Multivariate models controlling for age, gender and consulting behaviour indicated that psoriasis is independently associated with depression (OR 1.49; 95% CI 1.20–1.86), stress‐related disorders (OR 1.41; 95% CI 1.22–1.62), behaviour disorders (OR 1.58; 95% CI 1.05–2.39), diabetes (OR 1.21 95% CI 1.04–1.40), hypertension (OR 1.34; 95% CI 1.18–1.51), dyslipidaemia (OR 1.29; 95% CI 1.07–1.55), and obesity (OR 1.63; 95% CI 1.39–1.90). For each psychiatric condition, the likelihood of being affected significantly increased with each physician visit due to psoriasis, suggesting that the risk of psychiatric comorbidity increases with the severity of psoriasis. Conclusion Psoriasis appears to be independently associated with major psychiatric disorders and with cardiovascular risk factors, but not with cardiovascular events.     

Cardiovascular and metabolic risk profile in German patients with moderate and severe psoriasis: a case control study

Patients with psoriasis have a higher risk of cardiovascular and metabolic comorbidities, attributable to lifestyle factors, but also to shared inflammatory pathways and genetic factors. To investigate the association between moderate and severe psoriasis and metabolic and cardiovascular comorbidities, 100 patients hospitalized at University Medical Centre Mannheim, Germany, for psoriasis treatment were compared to two age- and sex-matched control groups, the first comprising other hospitalized patients (HCG) and the second comprising healthy individuals from an industrial cohort study (ICG). Multivariate logistic regression analysis with stepwise inclusion of cardiovascular risk factors was performed. Patients with psoriasis had significantly increased prevalences of smoking, obesity, diabetes, insulin resistance, pro-atherogenic cholesterol profiles and myocardial infarction and significantly decreased cardioprotective adiponectin. Unexpectedly, regression models controlling for confounding factors predicted significantly decreased OR for elevated total cholesterol in psoriasis cases (vs HCG: OR=0.50, p=0.045; vs ICG: OR=0.26, p=0.006). In contrast, OR for pro-atherogenic cholesterol profiles with LDL/HDL >3 was markedly increased (OR=2.45, p=0.012 or OR=3.02, p=0.020). Moreover, participants with psoriasis had significantly increased OR for elevated CRP as compared to the ICG (5.25, p=0.001). Our findings underscore the importance of cardiovascular and metabolic risk screening for all patients with moderate and severe psoriasis, including young patients.     

多形性日光疹110例临床及危险因素分析

目的探讨影响多形性日光疹(PLE)发病的危险因素。方法采用一对一问卷调查和多元Logistic回归分析评价PLE发病的危险因素。结果 PLE发病与性别(OR=2.668)、防晒的重视程度(OR=0.103)、患免疫相关疾病(OR=2.024)、吸烟(OR=9.819)、家族史(OR=7.542)和服用避孕药(OR=5.036)6个因素相关。结论女性、患免疫相关疾病、吸烟、家族史和口服避孕药等是PLE发病的危险因素,防晒的重视程度是PLE发病的保护因素。     

Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients

Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV‐only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV‐only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.     

Relationship between smoking and the clinical severity of psoriasis

OBJECTIVE: To evaluate the association between different components of smoking history and the clinical severity of psoriasis. DESIGN: A hospital-based cross-sectional study. SETTING: Inpatient wards of a hospital for skin diseases in Rome, Italy. PATIENTS: A total of 818 adults with psoriasis. MAIN OUTCOME MEASURE: The Psoriasis Area and Severity Index was used to assess the clinical severity of psoriasis between February 21, 2000, and February 19, 2002. RESULTS: After adjustment for potential confounders (sex, age, body mass index, psychological distress, family history of psoriasis, duration of psoriasis disease, and alcohol consumption), high intensity of smoking (>20 cigarettes daily) vs a lower level of consumption (< or =10 cigarettes daily) was associated with a more than 2-fold increased risk of clinically more severe psoriasis (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.1). Cigarette-years, measured as the product of the intensity and duration (years) of smoking, significantly increased the risk of clinically more severe psoriasis after adjustment for confounding factors (OR,1.3; 95% CI, 1.0-1.6, for a 600-U increase in cigarette-years). Separate analyses for men and women showed that the effect of cigarette-years was stronger for women (OR, 1.8; 95% CI, 1.2-2.6, for a 400-U increase in cigarette-years) than for men (OR, 1.2; 95% CI, 0.9-1.6, for a 700-U increase in cigarette-years). CONCLUSION: Smoking is associated with the clinical severity of psoriasis and highlights the importance of smoking cessation in patients with psoriasis.