银屑病与心血管疾病发病风险相关性研究进展

银屑病病因目前尚不明确,一般认为与遗传、免疫功能紊乱及环境因素有关。银屑病与心血管疾病发病风险的相关性日益受到重视。本文从遗传危险因素、亚临床表现及主要心血管事件等方面对近年来银屑病与心血管疾病发病风险的相关研究进行了概述。     

Cardiovascular risk factors following renal transplant

Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients(RTRs) remain at an increased risk of fatal and non-fatal cardiovascular(CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease(CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population.     

Carpet weaving: an occupational risk for onychomycosis?

Background Some occupations carry a risk for fungal infections. Objective To investigate the prevalence of onychomycosis in carpet weavers. Methods Seventy‐seven weavers (the mean age ± SD = 32.97 ± 12.38) from three factories and 77 controls (the mean age ± SD = 38.32 ± 12.38) were examined for onychomycosis. Samples from nails and the carpets, which were being weaved, were taken for mycological investigations. Results Direct microscopic examination of only two controls’ normal‐appearing nails was positive. Fungal growth was observed in the culture of four weavers’ normal‐appearing nails. It was watched over that most of the weavers had polished‐appearing nails and were using a glue containing cynoacrylate to restore their broken nails due to weaving. Conclusion The fungal growth observed in weavers’ nails has been accepted as colonization. There is no data about the presence of fungi on normal‐appearing nails. So, we thought that the weavers with fungal colonization should be followed for the development of onychomycosis.     

131例STD高危人群泌尿生殖道沙眼衣原体感染状况调查

本文应用ＭｃＣｏｙ细胞培养法结合直接荧光法对１０９名卖淫妇女及２２名嫖宿男性进行了泌尿生殖道沙眼衣原体（ＣＴ）感染状况调查。结果前者感染率为４０．３％，后者感染率为１８．２％，须引起各方面重视。另外也报告了与ＣＴ感染有关的一些情况。     

The risk of coronary heart disease in men with androgenetic alopecia

BACKGROUND: The meaningful association of androgenetic alopecia and coronary heart disease has been well documented, but few studies have focused on the importance of lipid parameters, such as total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, lipoprotein (a), apolipoprotein A1 and apolipoprotein B in patients with androgenetic alopecia. OBJECTIVE: The aim of this study is to investigate the relation between androgenetic alopecia and coronary heart disease and to determine the significance of certain lipid parameters on this relationship. SUBJECTS: Forty-one men with vertex type androgenetic alopecia (study group) and 36 men, age-matched, with normal hair status (control group) were the subjects of this study. RESULTS: We found significant differences in serum lipoprotein (a) and triglyceride levels between the study and control groups (P < 0.05). Forty-seven percent of patients and 30% of controls had a lipoprotein (a) level more than 30 mg/dl higher than the level critical for atherosclerotic heart disease. CONCLUSION: Dermatologists should investigate lipid profile, especially lipoprotein (a), of patients with androgenetic alopecia and refer to a cardiologist if necessary.     

尿毒症患者发生颈动脉重构的危险因素分析

目的采用颈动脉内膜-中层厚度来评价颈动脉重构程度,分析尿毒症患者发生颈动脉重构的危险因素。方法采用回顾性队列研究,选取维持性血液透析的尿毒症患者120例,按有无动脉重构分为颈动脉重构组（A组,n=74例）,非颈动脉重构组（B组,n=46例）,分别评价两组患者年龄、血压、吸烟、脉搏波传导速度及生化指标。结果采用二分类的非条件Logistic回归多因素方法,筛选出5个危险因素：收缩压（OR=1．85）、吸烟（OR＝1．77）、年龄（OR=1．74）、甘油三酯（OR=1．08）、总胆固醇（OR=1．05）,上述指标回归系数均为正值,差异有统计学意义（P〈0．05）。结论收缩压、吸烟、年龄、甘油三酯、总胆固醇可能是尿毒症患者发生颈动脉重构的危险因素。     

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.     

老年男性缺血性心血管疾病流行病学调查及危险因素分析

目的 研究老年男性缺血性心血管疾病发病情况及相应的干预措施.方法 准确记录2003年10月～2009年10月北京地区某医院数据库记录在案的年龄＞65岁,无ICVD病史的所有老年男性.记录其一般信息,吸烟史,体重指数、收缩压、血总胆固醇浓度、血甘油三酯浓度、血高密度脂蛋白-胆固醇浓度、血肌酐浓度、血载脂蛋白A1浓度、空腹血糖等相关指标,连续监测目标人群研究期间的ICVD累计发病率,并使用Logistic多元回归分析进行危险因素筛查,寻找其防治的环节.结果 2 123例老年男性,6年内ICVD累计发病率为23.5％.Logistic多元回归分析结果显示：高收缩压、空腹血糖升高、体重超标是最主要的危险因素.结论 ICVD在老年保健人群中呈高发病率.降低未来ICVD事件措施应包括：严格控制血压,降低血糖,控制体重.     

白癜风并发自身免疫性甲状腺疾病的危险因素分析及列线图预测模型的建立

目的：分析白癜风并发自身免疫性甲状腺疾病的危险因素并建立列线图预测模型。方法：收集2017年2月至2019年1月我院276例白癜风患者的临床资料，使用Logistic回归分析白癜风并发自身免疫性甲状腺疾病的独立危险因素。采用R（R 3.5.3）软件包，rms程序包，建立列线图预测模型。同时应用caret程序包进行Bootstrap法重复抽样1000次做内部验证，采用rms程序包计算一致性指数（C-index）。采用ROCR及rms程序包制作ROC曲线。结果：本研究白癜风并发自身免疫性甲状腺疾病的发生率为17.75%，高血糖、白癜风病程、白癜风类型、负性情绪、吸烟、自身免疫性甲状腺病家族史及其他自身免疫性疾病家族史为白癜风并发自身免疫性甲状腺疾病的独立危险因素（均P<0.05）。基于筛选的独立危险因素，建立预测列线图模型结果显示，实际发生率与预测发生率基本一致（χ2=3.854，P=0.724），C-index指数高达0.857（95% CI：0.829~0.885）。结论：白癜风患者应尽可能筛查自身免疫性甲状腺疾病，特别是在有危险因素的白癜风患者中。     

Analysis of risk factors for acute cutaneous graft-versus-host disease after allogeneic stem cell transplantation

BACKGROUND: Although skin is typically the first site of involvement of acute graft-versus-host disease (GVHD), most standard recommended staging and grading criteria allow enrolment of patients with involvement of GVHD target organs other than the skin in studies analysing risk factors for acute GVHD after stem cell transplantation (SCT). OBJECTIVES: To determine the risk factors for developing histologically confirmed acute cutaneous GVHD in patients who underwent allogeneic SCT for different haematological disorders. METHODS: This retrospective study was based on review of clinical files and databases from 300 consecutive patients with several haematological disorders who received allogeneic SCT between 1 January 1984 and 31 December 1999 at Hospital Universitario de la Princesa, Madrid, Spain. Variables evaluated included diagnosis of haematological disorder, age and gender (donor and recipient), HLA matching, female donor to male recipient, donor and recipient viral serology (cytomegalovirus), conditioning regimen, GVHD prophylaxis, blood counts at day of engraftment, mortality, cause of death, and survival at 100 days, 5 years and 10 years following SCT. RESULTS: In multivariate analysis, risk factors for acute cutaneous GVHD were type of haematological disease (P = 0.006), HLA disparity (P = 0.006), number of transplants per patient (P = 0.017), conditioning regimen (P = 0.001), and GVHD prophylaxis (P = 0.025). Survival rates did not differ significantly for cases and controls. CONCLUSIONS: Risk factors for acute cutaneous GVHD were a diagnosis of chronic myeloid leukaemia, HLA disparity, receipt of more than one SCT, conditioning regimens including total body irradiation, and GVHD prophylaxis regimens other than ciclosporin plus methotrexate. Other common risk factors for acute GVHD without specific target organ involvement showed no significant association with the risk for developing acute GVHD affecting the skin as primary target organ.     

Men with Kennedy disease have a reduced risk of androgenetic alopecia

BACKGROUND: Spinal and bulbar muscular atrophy or Kennedy disease (KD) is an X-linked neurodegenerative disease caused by an expansion of a polymorphic tandem CAG repeat within the androgen receptor (AR) gene on chromosomal locus Xq11-q12. The CAG repeat region encodes a polyglutamine tract that, when expanded to above 40 in number, results in KD, a neurodegenerative disease primarily targeting lower motor neurones. KD is also associated with partial androgen insensitivity due to loss of receptor function. Degree of expansion of this repeat region, located in the first exon, is correlated with age at onset and disease severity. Androgenetic alopecia (AGA) is a polygenic trait also associated with functional polymorphism of the AR gene. OBJECTIVES: To test whether partial loss of function in the AR gene associated with CAG polymorphism reduces the risk of AGA in affected men. METHODS: Members of the Kennedy's Disease Association, an American-based support group, were invited to participate in an online survey to determine the age-related prevalence of AGA among men affected by KD. Data from 115 respondents with KD were compared with data from 654 white men of European descent in Maryborough, Australia. RESULTS: The mean AGA score for men with KD was 1.64 (95% confidence interval, CI 1.41-1.87). The mean score for men in Maryborough was 2.82 (95% CI 2.71-2.93). The difference between the means was highly significant (P < 0.001), indicating thicker hair among the KD cohort. Treating AGA score as a continuous variable we found age to be highly significantly related to AGA score in men from Maryborough (P < 0.001) but not among men affected by KD (P = 0.90). CONCLUSIONS: Men with KD have a reduced risk of AGA, likely to be due to a functional alteration in the AR caused by the polyglutamine expansion.     

Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis

Background Recent cross‐sectional studies reported a higher prevalence of diabetes and other risk factors for cardiovascular disease in patients with psoriasis than in the general population. Objectives To estimate the cumulative incidences of risk factors for myocardial infarction and other vascular diseases after a first recorded diagnosis of psoriasis and the hazard ratio (HR) for these conditions in patients with psoriasis compared with the general population. Methods We used the General Practice Research Database to conduct a cohort study of 44 164 patients with a first‐time diagnosis of psoriasis and 219 784 nonpsoriasis comparison subjects psoriasis‐matched on age, sex and index date. Results HRs were increased among patients with psoriasis vs. the comparison cohort for incident diabetes [HR 1·33; 95% confidence interval (CI) 1·25–1·42], hypertension (HR 1·09; 95% CI 1·05–1·14), obesity (HR 1·18; 95% CI 1·14–1·23) and hyperlipidaemia (HR 1·17; 95% CI 1·11–1·23). Patients with psoriasis also had higher risks of incident myocardial infarction (HR 1·21; 95% CI 1·10–1·32), angina (HR 1·20; 95% CI 1·12–1·29), atherosclerosis (HR 1·28; 95% CI 1·10–1·48), peripheral vascular disease (HR 1·29; 95% CI 1·13–1·47) and stroke (HR 1·12; 95% CI 1·00–1·25). Conclusions Risk factors for cardiovascular disease as well as myocardial infarction and other vascular diseases occur with higher incidence in patients with psoriasis than in the general population. Further work is needed to investigate whether these associations involve causal factors related to psoriasis or its treatment.     

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.     

Cowden's disease (multiple hamartoma syndrome) An underdiagnosed syndrome with increased risk of malignant development

Cowden's disease is so often followed by malignant diseases, such as cancer of the breast and thyroid, and different forms of gynaecological cancer, that surgeons should be made especially aware of those changes in skin and mucous membranes which, if multiple are pathognomic. It remains, however, an underdiagnosed syndrome. We believe a number of other conditions are also associated with Cowden's disease.     

Relationship between androgenetic alopecia and cardiovascular risk factors according to BASP classification in Koreans

There have been many studies on the relationship between androgenetic alopecia (AGA) and cardiovascular risk factors, but the study results were inconsistent and research on AGA in Asians remains insufficient. This study investigated the relationship between Korean AGA and various cardiovascular risk factors, considering life habits, type of hair loss and sex. We investigated subjects who visited a hospital for public or industrial health medical examinations between October 2012 and December 2014. A questionnaire as well as anthropometric measurements and a blood test were performed. Among the 1884 total subjects, 52.6% had AGA. AGA patients displayed a significantly higher prevalence rate of cardiovascular diseases, smoking rate, fasting glucose and triglyceride, and a significantly lower high‐density lipoprotein cholesterol level than did the non‐AGA group. The results of the subgroup analysis showed higher prevalence rates of hypertension, stroke, metabolic syndrome and smoking in male AGA patients. The more severe the AGA, the higher the incidences of hypertension, diabetes and smoking were observed. According to the analysis results by BASP classification, the F‐type AGA patients displayed a higher body mass index, waist circumference and diastolic blood pressure, and had a significantly higher prevalence rate of hypertension. As a result of the large population‐based study, modifications in lifestyle and early screening for cardiovascular disease, as well as hypertension and diabetes, are suggested.