寻常型银屑病中医辩证分型与CXCR-4、IL-8表达水平的相关性研究

目的探讨寻常型银屑病中医辨证分型与白细胞介素-8(Interleukin-8,IL-8)、趋化因子受体-4(Chemokine receptor-4,CXCR-4)表达水平的相关性,为寻常型银屑病中医辨证分型的客观化、微观化提供理论依据。方法将56例寻常型银屑病患者分为血热证、血瘀证、血燥证,分别检测患者血清IL-8、CXCR4表达水平,并与30例健康人血清对照。结果寻常型银屑病患者的IL-8、CXCR4水平与正常对照组比较明显增高,其差异有统计学意义(P0.05)。通过不同证型间的比较发现,血瘀组患者的CXCR-4水平明显高于血燥组及血热组,其差异有统计学意义(P0.05),血热组IL-8水平明显高于血燥组及血瘀组,其差异有统计学意义(P0.05)。结论 IL-8、CXCR-4水平与中医血热、血瘀证组间存在一定相关性,IL-8在血热证中占优势;CXCR-4在血瘀组中占优势。IL-8、CXCR-4可作为寻常型银屑病中医辩证的客观指标之一。     

血管内皮生长因子在寻常型银屑病患者中医辨证分型皮损和血清中的表达

目的探讨血管内皮生长因子(VEGF)在寻常型银屑病患者中医辨证分型(血热型、血燥型和血瘀型)皮损和血清中的表达。方法采用免疫组化法和酶联免疫吸附法(ELISA法)对60例寻常型银屑病患者(中医辨证分型)皮损处及血清中VEGF的水平进行了检测。结果皮损处VEGF水平为血热型组>血燥型组及血瘀型组;血清中VEGF的水平为血热型组>血燥型组>血瘀型组。结论对寻常型银屑病患者皮损处及血清中VEGF水平的检测有可能用于血热型银屑病与非血热型银屑病的中医辨证分型。     

寻常型银屑病中医辨证分型与Th1/Th2的相关性研究

目的:确定寻常型银屑病中医辨证分型与Th1/Th2的相关性,为辨证施治提供依据.方法:将100例寻常型银屑病分为血热证、血瘀证、血燥证,分别检测患者血清TNF-α、IL-2、IL-4、IL-6和IL-8因子,并与30例健康人血清对照.结果:TNF-α和IL-8在血燥证与健康组之间无显著性差异(P>0.05),而其他组别两两比较有显著性差异(P<0.01),血热证水平最高.IL-4在四组之间比较具有显著性差异(P<0.05),血瘀证水平最高.IL-2、IL-6在四组两两比较无显著性差异(P>0.05).结论:寻常型银屑病患者体内存在免疫失调情况,与健康对照组均有差异.以Th1型介导为主的细胞因子TNF-α、IL-8在血热证中占优势,与血瘀证及血燥证比较有显著性差异;IL-4在血瘀证中占优势,与血热证及血燥证比较有显著性差异.     

利用MALDI-TOF-MS技术初步探讨不同中医证型的银屑病外周血T淋巴细胞膜蛋白

目的:研究不同中医证型寻常型银屑病患者外周血T淋巴细胞膜上的差异表达蛋白,筛选特异性蛋白质标记物。方法:收集寻常型银屑病患者30例(其中血热证10例,血瘀证10例,血燥证10例)和健康对照10例的外周抗凝血;分别用磁珠分选出T淋巴细胞;提取T淋巴细胞的细胞膜蛋白;应用双向电泳/基质辅助激光解析电离飞行时间质谱联用技术(MALDI-TOF-MS),检测细胞膜蛋白的蛋白峰值。结果:寻常型银屑病组与健康对照组间差异蛋白峰为4个;血热证患者与血瘀证患者之间差异蛋白峰为1个,血热证患者与血燥证患者之间无差异蛋白峰,血瘀证患者与血燥证患者之间差异蛋白峰为1个。结论:寻常型银屑病和健康对照以及不同中医证型间外周血T淋巴细胞膜蛋白表达谱可能存在差异,但相关蛋白质的鉴定、筛选尚需更大样本量的研究。     

清热养血解毒汤联合钙泊三醇倍他米松治疗寻常型银屑病血燥证及对外周血IL-17、IL-23的影响

目的 观察清热养血解毒汤联合钙泊三醇倍他米松软膏治疗寻常型银屑病血燥证的疗效,及对患者外周血白细胞介素(IL)-17、IL-23表达水平的影响,探讨清热养血解毒汤治疗寻常型银屑病血燥证的作用机制.方法 收集72例寻常型银屑病血燥证患者随机分为对照组与观察组(n=36),观察组予清热养血解毒汤联合钙泊三醇倍他米松软膏,对...     

同型半胱氨酸和尿酸与寻常型银屑病中医辨证分型的研究

目的探讨同型半胱氨酸(HCY)和尿酸(UA)在寻常型银屑病及其不同中医证型中的作用机制以及与中医辨证分型的关系。方法采用循环酶法和酶动力学比色法分别检测67例寻常型银屑病患者(血热型27例、血毒型18例、血瘀型22例)血中的HCY和UA,并与对照组(61例)行对比分析。结果寻常型银屑病组血HCY、UA水平分别为(14.13±8.18)μmol/L和(305.14±79.71)μmol/L,高于对照组(9.31±2.38)μmol/L和(258.63±73.10)μmol/L(P0.01),及各证型组亦高于对照组(P0.05或0.01);血毒型和血瘀型血HCY、UA水平高于血热型。结论 HCY与UA在寻常型银屑病的过程中可能起一定的作用,可作为寻常型银屑病的中医辨证分型参考依据。     

CD34在寻常型银屑病中医辨证分型皮损中的表达

目的探讨CD34在寻常型银屑病中医辨证分型(血热型、血燥型和血瘀型)皮损中的表达及其意义。方法采用免疫组化法对30例寻常型银屑病中医辨证分型皮损中CD34的表达情况及真皮浅层微血管密度(MVD)进行检测。结果在寻常型银屑病中医辨证分型皮损中,CD34的阳性表达分布于真皮浅层血管内皮细胞,特别是真皮乳头部血管内皮细胞,以血热型皮损的CD34阳性表达最明显。MVD检测的统计分析结果证实:三型银屑病皮损的MVD值与正常对照相比较有显著性差异。结论银屑病的中医辨证分型与真皮乳头部血管新生的程度具有一定的相关性;CD34的阳性表达强弱有可能成为血热型银屑病与非血热型银屑病的微观辨证指标之一。     

顽固性寻常性银屑病皮损在十二皮部分布规律初探

目的应用中医学十二皮部理论观察顽固性寻常性银屑病的主要皮损分布部位,分析其在十二皮部的分布规律以及血热证、血瘀证、血燥证3个基本证型之间皮损所在皮部的分布规律,为进一步完善银屑病辨证论治理论、提高临床疗效奠定理论基础。方法对顽固性寻常性银屑病患者皮损所在皮部进行观察,将主要皮损部位描画于"皮损所在皮部研究观察表",记录患者皮损所在的皮部。总结皮损在十二皮部出现的频数及百分率,并进行排序,分析其在十二皮部的分布规律以及不同证型间皮损所在皮部的分布规律。结果顽固性寻常性银屑病皮损在十二皮部分布的频率差异具有统计学意义(P0.05),皮损主要分布在足太阳膀胱经皮部、足阳明胃经皮部、足少阳胆经皮部、足厥阴肝经皮部和足太阴脾经皮部。顽固性寻常性银屑病各证型(血热证、血燥证、血瘀证)之间皮损在十二皮部分布的频率差异,以及各证型与总体相比较皮损在十二皮部分布的频率差异,尚均未发现具有统计学意义(P0.05)。结论顽固性寻常性银屑病皮损在十二皮部的分布具有一定规律性,足太阳膀胱经、足阳明胃经、足少阳胆经、足厥阴肝经和足太阴脾经等皮部皮损分布较多,提示以上经络脏腑可能与顽固性寻常性银屑病具有一定相关性;顽固性寻常性银屑病皮损在十二皮部的分布与银屑病"从血论治"的分型尚无明显相关性。     

应用ClinProt技术筛查寻常性银屑病不同中医证型患者的相关蛋白表达特征

目的应用Clin Prot技术联合MALDI-TOF技术,检测正常人和不同中医证型寻常性银屑病患者血浆及血T淋巴细胞膜上的相关蛋白。方法选择血热证、血瘀证、血燥证的寻常性银屑病患者各10例,同时选取10例健康人作为对照组,采用ClinProt技术联合MALDI-TOF技术建立血浆和T淋巴细胞膜差异蛋白图谱进行对比。结果与对照组的T淋巴细胞膜蛋白相比,血热组有1个表达上调的差异蛋白峰(4 747D),血瘀组有1个表达上调(4 747D)、2个表达下调的差异蛋白峰(2 068D、7 764D),血燥组有1个表达上调的差异蛋白峰(4 747D)。而对照组和不同证型银屑病患者的血浆差异蛋白相比较,血热组有3个表达上调的差异蛋白峰(6 631D,9 288D,4 965D),血瘀组有5个表达上调的差异蛋白峰(2863D,4 418D,6 631D,4 965D,3 241D),血燥组有2个表达上调的差异蛋白峰(4 965D,9 288D)和1个表达下调的差异蛋白峰(3 957D)。结论不同证型寻常性银屑病患者与健康人相比,血T淋巴细胞膜上及血浆中存在差异蛋白峰,这些蛋白可能与各个证型寻常性银屑病的发病机制有关。     

华中地区银屑病中医证候分布情况研究

目的探讨华中地区银屑病中医证候的分布情况。方法通过填写银屑病中医证候调查表,采集500例华中地区银屑病患者中医证候四诊资料,确立中医证候,采用Epidata3.1软件包对调查资料进行录入、核查,再转换成SPSS11.5统计软件包进行统计,得出在不同性别、不同年龄组、不同病期、家族史及舌象方面的证候分布情况。结果银屑病以血热证、血瘀证、血燥证、血热血瘀证、血热血燥证、血瘀血燥证为主要证候,不同性别、不同年龄组、不同病期、家族史及舌质的中医证候分布不同(P<0.05),在舌苔中差异无统计学意义(P>0.05)。结论本研究进一步验证了对血的辨证应是银屑病的主要辨证方法,中医证候在不同性别、不同年龄组、不同病情分期、有无家族史及舌质方面分布不同,而在舌苔方面差异无统计学意义。     

Prevalence of smoking,alcohol consumption and metabolic syndrome in patients with psoriasis

Background:Coexistence of obesity, hypertension, insulin resistance and dyslipidemia is defined as metabolic syndrome (MBS), which is among the important risk indicators for cardiovascular diseases, diabetes and stroke. Smoking and alcohol consumption are the other factors which lead to an increase in the risk of cardiovascular disease.Objective:To investigate the prevalence of metabolic syndrome, smoking and alcohol consumption in psoriasis patients and the relationship between disease severity and these factors.Methods:This cross-sectional study enrolled 563 patients with chronic plaque-type psoriasis, all of which completed a questionnaire and underwent a complete physical examination. Data about MBS components, psoriasis severity/duration, smoking and alcohol consumption, and cardiovascular diseases were recorded.Results:A total of 563 patients with ages ranging from 18 to 78 years were evaluated. Metabolic syndrome was found in 12.6% of the patients [central obesity (38.7%), hypertension (14.3%), dyslipidemia (18.6%), diabetes (9.2%)], while 50.3% had smoking, and 3.3% had alcohol consumption. Patients with metabolic syndrome were older and more likely to have a longer disease duration than those without metabolic syndrome (p<0.05 for each). The prevalence of metabolic syndrome was higher in women than in men. Psoriasis was more severe in patients with central obesity, diabetes and smoking than in those without (p<0.05 for each).Study Limitations:Retrospective design.ConclusionsOur results indicate that MBS is a risk factor for psoriasis patients with advanced age. The relationship between disease severity and obesity, diabetes, and smoking in psoriasis patients indicates that the patients should be informed about the potential metabolic risks and receive therapies for behavioral changes besides anti-psoriatic treatment in order to minimize these risks.     

Frequent use of tobacco and alcohol in Chinese psoriasis patients

BACKGROUND: This study aimed to explore smoking and drinking as risk factors in psoriasis. METHODS: Data collected from 789 psoriasis patients and 789 healthy controls were analyzed to determine whether there was an association between smoking/drinking and psoriasis. RESULTS: The proportion of male psoriasis patients using tobacco and alcohol was much higher than that of the control group (P < 10(-6)), whereas no statistical differences were found between female smokers and the control group. In general, heavy smokers were more likely to have severe psoriasis. CONCLUSION: Tobacco use in patients is correlated with psoriasis.     

Co‐morbidities in psoriasis: a hospital‐based case‐control study

Background Recent researches show that psoriasis is frequently associated with systemic co‐morbidities. Objectives This study aimed to identify possible associated co‐morbidities in psoriatic patients stratified by age and sex. Methods In this retrospective hospital‐based case‐control study, patients diagnosed as psoriasis at the Kaohsiung Veterans General Hospital in Taiwan between January 2008 and December 2009 were enrolled as cases and classified into severe and mild based on their use of systemic therapy. The controls were the patients without psoriasis matched the cases in 1 : 1 ratio with same birth year, sex and calendar date. Odds ratios (ORs) and 95% confidence intervals (CIs) from the conditional logistic regression method were used to assess the risk of co‐morbidities between psoriatic and non‐psoriatic patients. Results A total of 447 cases and 447 matched controls, with mean age of 51.3 ± 18.3 years and male‐to‐female ratio of 2.17 : 1 were enrolled. The ratio of mild‐to‐severe was 3.5 : 1. Compared with non‐psoriatic patients, psoriatic patients had significantly higher OR of hypertension (1.85), diabetes mellitus (2.88) and obesity (1.66). Among those aged ≥51 years old, there was significant risk in male psoriatic patients with ischaemic and hypertensive heart disease (IHHD) (OR = 2.167) after eliminating female IHHD psoriatic patients (OR = 0.125). Psoriasis was significantly negatively associated with cancers (OR = 0.267). Psoriasis patients often had the usual drinking habit (OR = 2.23) and seldom had an occasional drinking habit (OR = 0.25). Conclusions Psoriasis is strongly associated with hypertension, diabetes mellitus and obesity. The association between psoriasis and IHHD, stroke, cancers, smoking and alcohol habits warrant more investigation.     

Severity of Psoriasis Among Adult Males is Associated with Smoking,Not with Alcohol Use

Context:

Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a paucity of data on this subject from India.

Aims:

To find out whether increased severity of psoriasis in adult Indian males is associated with tobacco smoking and alcohol use.

Settings and Design:

Cross-sectional study in the Department of Dermatology of a Tertiary Care Teaching Hospital.

Subjects and Methods:

Male patients above 18 years of age attending a psoriasis clinic between March 2007 and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index – PASI) among smokers and non-smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using Fagerström Test for Nicotine Dependence) and alcohol use disorders (measured using Alcohol Use Disorders Identification Test–AUDIT).

Statistical Analysis:

Z-test, Odd''s ratio, Chi-square test, Spearman''s correlation coefficient.

Results:

Of a total of 338 patients, 148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non-smokers (Z-test, z = −2.617, P = 0.009). Those with severe psoriasis were more likely to be smokers (χ² = 5.47, P = 0.02, OR = 1.8, Confidence Interval 1.09-2.962). There was a significant correlation between PASI scores and Fagerström score (Spearman''s correlation coefficient = 0.164, P < 0.01). Mean PASI scores of persons who used to consume alcohol and those who did not were comparable.(Z-test, z = −0.458, P = 0.647). There was no association between severity of psoriasis and alcohol consumption.(χ² = 0.255, P = 0.613, Odds Ratio = 1.14, CI 0.696-1.866). There was no correlation between PASI scores and AUDIT scores (Spearman''s correlation coefficient = 0.024, P > 0.05).

Conclusions:

Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use.     

新疆维吾尔族寻常型银屑病伴发代谢相关性疾病分析

目的分析新疆维吾尔族寻常型银屑病患者伴发代谢相关性疾病的情况。方法对2010年1月—2013年3月新疆维吾尔自治区人民医院皮肤科住院的106例维吾尔族寻常型银屑病患者伴发代谢相关性疾病的临床资料进行回顾性分析,并与300例同期健康体检者伴发代谢相关性疾病的情况作比较。结果新疆维吾尔族寻常型银屑病患者伴发高血压、Ⅱ型糖尿病、高尿酸血症、代谢综合症和肥胖的几率均高于健康对照组;银屑病组中男性患代谢综合症(22.22%)和高尿酸血症(30.00%)均高于女性患者(6.25%,6.25%,P0.05)。对照组性别方面差异无统计学意义(P0.05)。银屑病合并各种代谢相关性疾病与无代谢相关性疾病比较,在年龄方面差异有统计学意义,合并代谢性疾病的患者年龄更大。在病程、发病年龄和文化程度方面差异无统计学意义。在严重程度方面组间差异有统计学意义,且代谢相关性疾病的发生随着严重程度的增加而增加。同时合并有多种代谢相关性疾病的银屑病患者,合并的代谢相关性疾病数量越多,银屑病的严重程度越重。结论新疆维吾尔族寻常型银屑病患者常伴发高血压、Ⅱ型糖尿病、高尿酸血症、代谢综合征及肥胖等代谢相关性疾病。男性较女性患者更易伴发高代谢综合征和高尿酸血症,合并代谢性疾病的患者年龄更大,代谢相关性疾病的发生随着严重程度的增加而增加,合并的代谢相关性疾病数量越多,银屑病的严重程度越重。因此应重视银屑病患者健康宣教。     

Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipidemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.     

Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipedemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.     

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.     

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.