银屑病与心血管疾病相关性的研究进展

银屑病作为一种自身免疫性疾病不仅影响患者的皮肤和关节,还可能与多种心血管疾病有关。现回顾近几年国内外有关银屑病与心血管疾病相关的文献,发现心血管疾病在银屑病患者中的发病率明显高于各种对照人群,且银屑病是心血管疾病的独立危险因素;银屑病与心血管疾病之间存在一定的遗传重叠,但遗传并不能完全概括二者之间的联系;而炎性反应是将银屑病与心血管疾病联系起来的重要因素,两病在许多效应细胞、细胞因子和炎性细胞网络中重叠,此外,同型半胱氨酸、脂肪因子、活性氧等其他因素亦参与了两病的致病机制;归纳银屑病治疗对心血管疾病的影响,为皮肤科医生更好地预防和治疗银屑病及相关的心血管疾病提供参考。     

银屑病与心血管疾病

银屑病是一种自身免疫性慢性炎症性疾病.最近流行病学研究显示,银屑病患者较易伴发心血管疾病.银屑病和动脉粥样硬化具相同病理特征.都涉及T细胞、单核细胞、巨噬细胞,尤其是T细胞经内皮外渗.活化的炎性细胞和促炎性因子参与银屑病皮损和动脉粥样硬化斑块的形成.同时发现,银屑病患者的高血压、高血脂、糖尿病、肥胖发生率比普通人群高,有些治疗银屑病的药物增加了银屑病患者心血管疾病的危险性.     

银屑病与代谢综合征相关性研究进展

近年来流行病学及实验研究发现银屑病不仅是一种慢性炎症性皮肤病,而且是一种系统性疾病,银屑病与肥胖、高血压、高血糖及高脂血症组成的代谢综合征及并发症心血管疾病有关。本文对近年来银屑病和代谢综合征的发病概况、发病机制及二者的相关性等进行了综述。     

miRNA与银屑病发病机制相关性研究进展

miRNA是长约18~25个核苷酸的非编码小RNA,通过与靶mRNA结合而抑制其表达或促进其降解。研究表明miRNA通过多种途径参与细胞的多种病理生理过程。银屑病是一种常见的慢性皮肤病,发病机制涉及遗传、感染及免疫等方面。文章综述了miRNA与银屑病发病机制相关性研究的进展。     

免疫相关性基因在银屑病发病机制中的研究进展

银屑病是一种常见的慢性免疫相关性皮肤病,其病因复杂,涉及遗传风险因素和环境诱因.本文对银屑病目前已知的免疫相关性基因及其在银屑病易感性中的编码途径进行综述.这些基因涉及一系列生物功能,包括先天免疫(CARD1、TRAF31IP2、DDX58、IFIH1),皮肤屏障(LCE3、DEFB4、GJB2、DEFB4),T细胞极...     

银屑病发病机制的研究进展

银屑病是一种与多种因素相关的慢性炎症性皮肤疾病.在过去10年研究人员提出了该病发病机制可能涉及的因素,但未能建立一个包含所有致病因素的模型.伴随分子生物学技术的进步,现将银屑病发病机制的研究进展综述如下.     

银屑病发病机制中免疫学研究进展

银屑病的发病机制与免疫关系密切,近几年研究倾向于银屑病是Th1/Th17混合途径的免疫性疾病.银屑病的发病中除了有树突细胞、T细胞、角质形成细胞以及Tb1型的细胞因子如白介素12、白介素18等参与外,还有Th17型细胞因子,如白介素23及白介素22等的参与,Th17型免疫反应可能在银屑病发病中起到重要的作用.     

链球菌感染在银屑病发病中的研究进展

链球菌感染与银屑病的相关性近年来得到人们的关注。银屑病发病的上呼吸道感染病史、咽拭子培养链球菌以及控制链球菌感染治疗银屑病的临床现象均提示银屑病发病与链球菌感染密切相关。银屑病是一类由T细胞介导的自身免疫性疾病，链球菌抗原可在易感人群中诱发或加重银屑病和使银屑病慢性持续存在，HLA的遗传多态性可能与此有关。本中将链球菌感染与银屑病发病相关性的临床研究，可能涉及的体液免疫、细胞免疫及遗传易感性方面的研究进展进行综述。     

银屑病与超抗原相关性的研究进展

临床可见产生超抗原毒素的金黄色葡萄球菌，化脓性链球菌的皮肤或咽部感染与银屑病发病及症状加重有关，细菌超抗原能选择性激少激活表达特异Ｔ细胞受体ＶβＴ细胞，并使之增殖，诱导细胞因子释放，银屑病皮损中Ｖβ２，Ｖβ５．１Ｔ细胞增多，可能与细菌超抗原金葡菌系毒素Ｂ，胃蛋白酶纯化的Ｍ５，链球菌致热性外毒素Ａ，Ｃ有关，其中链球菌Ｍ与５０ｋＤ角蛋白间存在结构同源性和免疫交叉反应，推测细菌超抗原有Ｔ细胞水平操作可能     

MicroRNAs在银屑病发病机制中的研究进展

近年来在MicroRNAs（miRNAs）与银屑病的相关研究中发现,其在银屑病的发病机制中扮演了重要角色,包括调控T细胞、细胞因子、固有免疫及调节角质形成细胞增殖分化、皮肤屏障等方面。miRNAs在血清和组织中均可以稳定存在,未来可能成为银屑病诊断、评价疾病严重程度、监测治疗后反应及预后的新的标志物。本文对miRNAs在银屑病发病机制中的研究进展进行了综述。     

Psoriasis and cardiovascular disease

Current epidemiological data support the association between psoriasis and cardiovascular (CV) risk, in apparent correlation with psoriasis severity. Although less unanimously, evidence of an increased prevalence of CV diseases among psoriasis patients has been reported, including ischemic heart disease, cerebrovascular, peripheral vascular and heart structural disorders. In particular, various studies showed a correlation between psoriasis and major CV events (i.e., myocardial infarction, stroke), while others investigated subclinical changes of blood vessels, such as intima‐media thickness increase, arterial stiffness and coronary artery calcification. A series of different mechanisms, like traditional CV risk or iatrogenic risk factors, inflammation, hemostasis dysregulation, hyperhomocysteinemia, and shared genetic susceptibility, are thought to underlie this epidemiological association. Among these elements, inflammation and its related cytokine milieu, including Th1‐mediated response and Th17/Treg imbalance, C reactive protein and the newly implicated osteopontin are considered to play a primary role, even if yet to be fully understood.     

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.     

Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: Implications in cardiovascular risk factors management and primary prevention of cardiovascular disease

Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long‐term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long‐term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real‐world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.     

Psoriasis: a possible risk factor for development of coronary artery calcification

BACKGROUND: Psoriasis is a chronic inflammatory skin disorder affecting about 2% of white-skinned individuals. Epidemiological data on the prevalence and degree of coronary artery calcification (CAC) as an indicator for cardiovascular diseases in patients with psoriasis are contradictory. OBJECTIVES: To study the prevalence and degree of CAC as an indicator for cardiovascular diseases in 32 patients with psoriasis matched for age, sex and risk factors to an equally sized control population. METHODS: Noncontrast-enhanced 16-row spiral computed tomography was performed in patients and controls. RESULTS: We found a significantly increased prevalence (59.4% vs. 28.1%, P = 0.015) and severity (CAC score according to Agatston 3.7 vs. 0.0, P = 0.019) of CAC in patients with psoriasis. Multiple linear regression calculations identified psoriasis as a likely independent risk factor for CAC. CONCLUSIONS: Our results point towards the potentially systemic nature of the inflammatory processes underlying the pathogenesis of psoriasis, which may therefore be considered a potentially severe systemic disease.     

Increased risk of atherosclerotic cardiovascular disease among patients with psoriasis in Korea: A 15‐year nationwide population‐based cohort study

The association between psoriasis and risk of atherosclerotic cardiovascular disease has not been thoroughly evaluated in a large longitudinal cohort of an Asian population. We conducted a nationwide population‐based retrospective cohort study encompassing more than 1.7 million Koreans with a 15‐year follow‐up period. The period prevalence of psoriasis was 0.33% among the baseline participants (1997–2000). In Cox proportional hazard analyses, the individuals with psoriasis had a higher adjusted hazard ratio (HR) for incidence of overall atherosclerotic cardiovascular disease (HR, 1.18; 95% confidence interval [CI], 1.09–1.27) compared with controls. Subgroup analyses revealed that the risk for myocardial infarction was commonly increased in both sexes with moderate to severe psoriasis (male: HR, 2.09; 95% CI, 1.35–3.24; female: HR, 3.23; 95% CI, 1.34–7.76), whereas the risk for ischemic stroke was specifically increased in female individuals with moderate to severe psoriasis (HR, 2.02; 95% CI, 1.24–3.30). Our data suggest that appropriate medical screening for possible cardiovascular comorbidities is warranted in Asian psoriatic patients according to disease severity and sex.     

Impact of adalimumab treatment on cardiovascular risk biomarkers in psoriasis: Results of a pilot study

Psoriasis is a chronic systemic immune‐mediated inflammatory dermatosis associated with several comorbidities. Psoriasis patients are at increased risk of developing cardiovascular diseases (CVD), namely, coronary heart disease, stroke or peripheral vascular disease, and psoriasis seems to be an independent cardiovascular risk factor. Antipsoriatic systemic therapy, especially anti‐tumor necrosis factor (TNF)‐α, seems to exert a beneficial effect on these comorbidities. The purpose of this study was: (i) to measure the level of cardiovascular serum markers in psoriasis patients in comparison with healthy volunteers; and (ii) to compare the serum level of the same markers in patients before and 3 months after adalimumab therapy. We investigated six biomarkers connected to CVD: C‐reactive protein (measured high sensitively, hsCRP), oxidized low‐density lipoproteins (oxLDL), oxLDL/β‐glycoprotein I complex (oxLDL/β2GPI), vascular endothelial adhesion molecule 1 (VCAM‐1), E‐selectin and interleukin (IL)‐22. These biomarkers were measured in 21 patients with moderate/severe psoriasis before and after treatment with adalimumab and in healthy volunteers. hsCRP (P < 0.05), oxLDL‐β2GPI complex (P < 0.05), E‐selectin (P < 0.001) and IL‐22 (P < 0.001) were significantly increased in comparison with healthy controls, whereas oxLDL and VCAM‐1 were also higher in psoriasis patients but the difference did not reach statistical significance. A decrease of E‐selectin (P < 0.001) and IL‐22 (P < 0.001) was observed after 3 months of adalimumab therapy. Inhibition of TNF‐α seems to not only improve psoriasis but also decreases serum cardiovascular biomarkers. E‐selectin and IL‐22 could serve for monitoring of the efficacy of antipsoriatic systemic therapy on cardiovascular risk.     

Psoriasis and cardiovascular risk. Assessment by different cardiovascular risk scores

Background: Psoriasis is an inflammatory disease associated with an increased risk of cardiovascular morbidity and mortality. However, very few studies determine cardiovascular risk by means of Framingham risk score or other indices more appropriate for countries with lower prevalence of cardiovascular risk factors. Objectives To determine multiple cardiovascular risk scores in psoriasis patients, the relation between cardiovascular risk and psoriasis features and to compare our results with those in the literature. Methods We assessed demographic data, smoking status, psoriasis features, blood pressure and analytical data. Cardiovascular risk was determined by means of Framingham, SCORE, DORICA and REGICOR scores. Results A total of 395 patients (59.7% men and 40.3% women) aged 18–86 years were included. The proportion of patients at intermediate and high risk of suffering a major cardiovascular event in the next 10 years was 30.5% and 11.4%, respectively, based on Framingham risk score; 26.9% and 2.2% according to DORICA and 6.8% and 0% using REGICOR score. According to the SCORE index, 22.1% of patients had a high risk of death due to a cardiovascular event over the next 10 years. Cardiovascular risk was not related to psoriasis characteristics, except for the Framingham index, with higher risk in patients with more severe psoriasis (P = 0.032). Conclusions A considerable proportion of patients had intermediate or high cardiovascular risk, without relevant relationship with psoriasis characteristics and treatment schedules. Therefore, systematic evaluation of cardiovascular risk scores in all psoriasis patients could be useful to identify those with increased cardiovascular risk, subsidiary of lifestyle changes or therapeutic interventions.