Clinical Analysis of typeⅠand typeⅡ psoriasis vulgaris

目的:探讨寻常性银屑病早发型和晚发型与家族史、发病季节、病情严重度、性别和发病部位的关系.方法:采用调查问卷形式对307例寻常性银屑病患者进行调查.结果:①早发型患者阳性家族史率(33.18%)高于晚发型(12.90%),有家族史者的初发病年龄[(28.16±11.98)岁]早于无家族史者[(34.96±16.04)岁](P < 0.01).②早发型的高发季节是冬春季,夏季最低;晚发型为春季,其次是夏季和秋季,冬季最少,差异有统计学意义(P < 0.05).③平均银屑病皮损面积和严重度指数(PASI)评分:早发型高于晚发型(P < 0.05),且男低于女(P < 0.05),晚发型男女差别无统计学意义(P > 0.05);有家族史者高于无家族史者(P < 0.05),早发型家族史者高于晚发型家族史者(P < 0.01).④头皮、小腿、前臂和肘部等为最常见的初发部位,好发部位则以头部、四肢伸侧、背部、胸腹部等为多,尤其是外耳部(72.31%)、胫前(71.66%)和头顶(71.01%),而外生殖器、手掌、舌、跖部等处则较少有皮损发生.⑤初发部位为臀、踝关节和腹股沟的频率为晚发型高于早发型(P < 0.01),肘部为早发型高于晚发型(P < 0.05);外耳部、胫前、背部、前发际、腹部、面部、颈部、甲、舌等处的皮损发生率是早发型高于晚发型(P < 0.05或0.01),而足背和踝关节则是晚发型高于早发型(P < 0.01),其他部位两型差异无统计学意义.结论:寻常性银屑病早发型和晚发型在家族史、发病季节、病情严重度以及皮损初发和好发部位等方面存在差异,早发型患者女性重于男性,有家族史者重于无家族史者.     

银屑病早发型与晚发型临床差异的横断面调查

骆志成,Email: luozhc@lzu.edu.cn [摘要] 目的：调查早发型银屑病（发病年龄< 40岁）与晚发型银屑病（发病年龄≥40岁）之间的临床差异。方法：对患者实行调查问卷研究,内容包括性别、年龄、发病年龄、身高、体重、家族史、既往史、加重因素、甲损害、舌改变、瘙痒情况、合并症等。结果：共纳入了352名银屑病患者,其中早发型279例,晚发型73例。5.73%早发型和15.07%晚发型患者中出现掌跖损害,差异有统计学意义（χ2=7.170,P=0.007）。9.32%早发型和23.29%晚发型患者中出现合并症,差异有统计学意义（χ2=10.528,P=0.001）。73.13%早发型患者和44.83%晚发型患者在冬季复发加重,差异具有统计学意义(χ2=12.207,P＜0.01）。两组皮损PASI评分、SF-36量表总分、皮肤病生活质量评分（DLQI）方面,差异无统计学意义（P>0.05）。结论：早发型银屑病和晚发型银屑病存在临床差异。     

TNF-α启动子区单核苷酸多态性与中国维吾尔族白癜风的相关性

目的：明确TNF-α启动子区基因多态性与中国维吾尔族白癜风发病机制的相关性。方法： PCR扩增316例维吾尔族白癜风患者和330例健康对照组外周血目的片段DNA,DNA 全自动测序仪对TNF-α启动子区基因rs1799964、rs1800630、rs1799724 三个位点单核苷酸基因多态性进行测序。结果：白癜风患者TNF-αrs1799964、rs1800630、rs1799724基因型和等位基因频率与对照组比较均无统计学意义（P＞0.05）。TNF-α rs1799724 基因型及T等位基因频率在白癜风早发型与迟发型间、有无家族史间比较,差异均有统计学意义（均P＜0.05)。结论：TNF-α 启动子区rs1799724位点单核苷酸多态性可能参与中国维吾尔族白癜风的发生和发展。     

SYNE2基因多态性与汉族寻常性银屑病患者表型相关性研究北大核心CSCD

目的研究SYNE2基因多态性rs2781377与汉族人寻常性银屑病临床表型之间的相关性。方法基于本研究团队前期全外显子组芯片实验对16 786例银屑病患者及22 920例正常对照进行基因分型的结果,采用病例-对照、病例-病例研究,使用SPSS19.0统计软件分析银屑病患者与正常人基因型的分布频率,并比较该等位基因及基因型与临床表型之间的相关性。结果病例组与对照组之间SYNE2(rs2781377)等位基因及基因型频率分布差异均具有统计学意义(P均<0.05);分层分析结果表明rs2781377等位基因频率分布与早发型寻常性银屑病相关(P<0.05),家族史(阳性/阴性)、皮损临床类型(点滴型/斑块型)以及病情严重程度分级(轻/中/重度)几个临床表型与rs2781377无显著相关(P均>0.05)。结论 SYNE2(rs2781377)与汉族人寻常性银屑病发病易感性相关,与早发型寻常型银屑病显著相关,但与汉族人寻常性银屑病的家族史、皮损临床类型及病情严重程度无显著相关。     

SYNE2基因多态性与汉族寻常性银屑病患者表型相关性研究

目的研究SYNE2基因多态性rs2781377与汉族人寻常性银屑病临床表型之间的相关性。方法基于本研究团队前期全外显子组芯片实验对16 786例银屑病患者及22 920例正常对照进行基因分型的结果,采用病例-对照、病例-病例研究,使用SPSS19.0统计软件分析银屑病患者与正常人基因型的分布频率,并比较该等位基因及基因型与临床表型之间的相关性。结果病例组与对照组之间SYNE2(rs2781377)等位基因及基因型频率分布差异均具有统计学意义(P均0.05);分层分析结果表明rs2781377等位基因频率分布与早发型寻常性银屑病相关(P0.05),家族史(阳性/阴性)、皮损临床类型(点滴型/斑块型)以及病情严重程度分级(轻/中/重度)几个临床表型与rs2781377无显著相关(P均0.05)。结论 SYNE2(rs2781377)与汉族人寻常性银屑病发病易感性相关,与早发型寻常型银屑病显著相关,但与汉族人寻常性银屑病的家族史、皮损临床类型及病情严重程度无显著相关。     

内质网氨基肽酶1基因rs27044、rs30187和rs26653多态性与汉族寻常性银屑病相关性研究

目的 探讨内质网氨基肽酶1（ERAP1）基因多态性与汉族人寻常性银屑病的遗传关联性。 方法 收集寻常性银屑病患者289例,对照组292例,知情同意后采集外周静脉血5 ml。选择位于ERAP1基因编码区域的3个单核苷酸多态性（SNP）,利用连接酶检测反应进行基因分型（rs27044、rs30187和rs26653）。利用PLINK1.07软件进行统计分析,χ2检验比较患者组与对照组等位基因频率及基因型频率,计算等位基因的相对危险度估计值比值比（OR）及其95%可信区间（95% CI）。利用Haploview软件进行单倍型分析。 结果 rs30187等位基因C及rs26653等位基因G在患者组的频率（分别为0.460 2和0.430 8）、尤其是早发型组中的频率（0.448 5和0.422 7）均明显低于对照组（0.534 2和0.501 7）,差异均有统计学意义（均P < 0.05）。rs27044、rs30187及rs26653这3个SNP两两间均存在强连锁不平衡（r2 ≥ 0.717,D′ ≥ 0.962）。基因型分析结果显示,在隐性遗传模式下,rs30187在患者组及早发型组的基因型频率均显著低于对照组,差异均有统计学意义（P值分别 < 0.05和 < 0.016 7）。单倍型分析发现,单倍型（H4：CTC）在患者组的频率（0.050）、尤其是早发型组的频率（0.052）均明显高于对照组（0.022）,差异均有统计学意义（P值分别 < 0.05、 < 0.016 7）。 结论 ERAP1基因多态性与汉族人寻常性银屑病可能相关,特别是早发型患者。危险单倍型（H4：CTC）可能是寻常性银屑病一个重要的易感因素。     

单核苷酸多态性rs2236313与汉族人寻常型白癜风临床表型的相关性研究

目的:确定染色体6q27区域内一个单核苷酸多态性(single nucleotide polymorphism,SNP)位点rs2236313与汉族人寻常型白癜风临床表型之间的相关性.方法:选取6458例寻常型白癜风患者和9766名正常对照的rs2236313的基因分型资料和临床资料,用χ2检验对各组间基因型和等位基因频率的分布进行比较.结果:rs2236313基因型频率和等位基因频率分布在病例组和对照组间存在统计学差异(P基因型=8.21×10-14,P等位基因=1.26×10-14).在早发和晚发患者、有伴发疾病和无伴发疾病患者之间,rs2236313等位基因频率分布存在统计学差异(P<0.05).在有和无家族史患者、轻与中重度患者之间其分布均无统计学差异(P>0.05).结论:rs2236313与汉族人寻常型白癜风发病易感性相关,且与发病年龄、伴发疾病相关,与家族史、病情严重程度无关.     

TNIP1基因多态性与中国北方汉族寻常性银屑病关联性分析

目的 探讨人肿瘤坏死因子α诱导蛋白3（TNFAIP3）相互作用蛋白1（TNIP1）基因多态性与中国北方汉族人寻常性银屑病的遗传关联性。 方法 收集寻常性银屑病患者465例,健康对照476例。受试者知情同意后采集外周静脉血5 ml。选择位于TNIP1基因区域的3个单核苷酸多态性（SNP）,即rs17728338、rs3762999和rs999556,利用连接酶检测反应基因分型。利用PLINK1.07软件进行统计分析,卡方检验比较病例组及对照组等位基因频率及基因型频率,计算等位基因的相对危险度估计值比值比OR及其95%可信区间（95% CI）。对 3个SNP间进行连锁不平衡检验,计算两两间的r2和D′值。 结果 位于TNIP1基因区域的3个SNP在病例组和对照组中等位基因频率分布存在差异,但rs3762999和rs999556未达到Bonferroni校正水平。在显性模式下,rs3762999、rs999556的基因型频率在病例组和对照组间差异有统计学意义,达到Bonferroni校正水平（P < 0.016 7）。分层分析发现,3个SNP的等位基因频率、基因型频率在有家族史寻常性银屑病患者与健康对照组间的差异均具有统计学意义（均P < 0.016 7）,rs17728338等位基因A的频率在寻常性银屑病组及各型（早发型、晚发型、有家族史、无家族史）病例组均显著高于对照组（均P < 0.0167）。rs3762999与 rs999556间存在强连锁不平衡（r2 = 0.910,D′ = 0.982）,rs17728338与rs3762999和rs999556之间有中等程度的连锁不平衡（r2分别为0.371和0.353,D′分别为0.989和1）。 结论 TNIP1基因多态性rs17728338、rs3762999及rs999556与汉族人寻常性银屑病具有相关性。     

ANXA6基因多态性与汉族人寻常型银屑病临床表型的相关性

目的:评价汉族人寻常型银屑病ANXA6基因多态性与临床表型的相关性.方法:选取7425例寻常型银屑病患者和11 208例正常对照的ANXA6基因多态性rs999556和rs3762999位点的基因分型资料和临床资料进行分析.结果:病例组与对照组间ANXA6基因多态性rs999556和rs3762999位点的基因型和等位基因分布频率均存在差异(P<0.05);在急性点滴状患者与慢性斑块状患者间,rs999556位点的基因型分布频率存在差异(P<0.05),等位基因分布频率无差异(P>0.05);在儿童期发病与成年发病患者间、有家族史与无家族史患者间,rs999556位点的基因型和等位基因分布频率均无差异(P>0.05).在上述临床表型间,rs3762999位点的基因型和等位基因分布频率均无差异(P>0.05).结论:ANXA6基因多态性rs999556和rs3762999与汉族人寻常型银屑病发病的易感性相关,rs999556与该病的临床类型相关,与发病年龄和家族史不相关;rs3762999与该病的发病年龄、家族史及临床类型均不相关.     

北方汉族寻常型银屑病与HLA-DRB1及DQB1等位基因相关性研究

目的:探讨HLA-DRB1及DQB1等位基因与北方汉族寻常型银屑病相关性。方法:利用序列特异性引物-聚合酶链反应(PCR-SSP)分型技术,对63例寻常型银屑病患者和102例健康人的HIA-DRB!及DQB1等位基因进行检测。结果:(1)HLA-DRB1*070x、DRB1*1001及DOB`*020x等位基因与北方汉族寻常型银屑病呈正相关(P分别为0.001,0.005,0.009);HLA-DRB1*120x等位基因与北方汉族寻常型银屑病呈负相关(P=0.007)。(2)HLA-DRB1*070x及DQB1*020x等位基因仅与家族史阳性的早发型(Ⅰ型)银屑病发病相关(P<0.001)。(3)HLA-DRBq*1001等位基因频率在Ⅰ型及无家族史的晚发型(Ⅱ型)银屑病均显著性增高(P<0.05)。结论:(1)HLA-DRB1*070x、DRB1*1001及DQB1*020x等位基因可能是北方汉族寻常型银屑病的易感基因或与易感基因相连锁;HLA-DRB1*120x等位基因可能是阻止北方汉族人发生银屑病的保护基因。(2)Ⅰ型及Ⅱ型银屑病的遗传背景存在差异。     

The angiotensin-converting enzyme insertion/deletion and the endothelin -134 3A/4A gene polymorphisms in patients with chronic plaque psoriasis

BACKGROUND: Psoriasis is a common chronic inflammatory skin disease. Vasoactive peptides such as endothelin-1 (ET-1) and bradykinin have previously been implicated in the pathogenesis of chronic plaque psoriasis. The angiotensin-converting enzyme (ACE) gene carries a 287-base pair insertion/deletion (I/D) gene polymorphism, which is associated with plasma concentrations of bradykinin-degrading ACE. A functional polymorphism (EDN1 -134 3A/4A) in the gene encoding ET-1 has been shown to affect ET-1 expression. The purpose of the present study was thus to investigate a hypothesized association between these gene polymorphisms and the presence of chronic plaque psoriasis. METHODS: The present case-control study comprised 207 patients with chronic plaque psoriasis (136 with early onset and 71 with late onset disease) and 182 control subjects. Genotypes of EDN1 and ACE were determined by a 5' exonuclease assay (Taqman). RESULTS: The prevalence of the homozygous ACE II genotype was significantly higher in patients with early-onset psoriasis than among control subjects (30.9% vs 19.2%, P = 0.016), yielding an odds ratio of 1.88 [95% confidence interval (CI): 1.12-3.15] for early-onset disease. For late-onset psoriasis, presence of the ACE II genotype was associated with a non-significant odds ratio 1.54 (95% CI: 0.81-2.92). As for the EDN1 -134 3A/4A gene polymorphism, no significant differences in genotype distributions were found between patients with either early- or late-onset psoriasis and control subjects (EDN1 -134 4A/4A: 9.6% in early-onset and 5.6% late-onset psoriasis vs 7.7% in controls; P > 0.05). CONCLUSIONS: Our data suggest that homozygosity for the ACE I allele may affect susceptibility to early-onset psoriasis.     

白介素12B基因rs6887695多态性与汉族人寻常性银屑病临床表型的相关性

目的 探讨白介素12B（IL-12B）基因多态性位点rs6887695与汉族人寻常性银屑病临床表型（发病年龄、家族史、临床类型、性别）的相关性。 方法　采用ABI Taqman探针荧光PCR技术,对575例寻常性银屑病患者和1403例健康对照的DNA样本进行IL-12B基因多态位点rs6887695的基因分型。使用SPSS14.0分析软件,χ2检验比较患者组和健康对照组间、不同临床表型组间的基因型和等位基因频率分布的差异性。 结果 IL-12B基因多态性位点rs6887695三种基因型（GG、GC、CC）频率在寻常性银屑病患者组分别为42.61%、45.39%和12.0%,健康对照组分别为34.42%、47.83%和17.75%;等位基因频率（G、C）患者组分别为65.30%和34.70%,健康对照组分别为58.34%和41.66%,基因型和等位基因频率分布在患者组和健康对照组间差异均有统计学意义（χ2值分别为16.31和16.54,P值均 < 0.01）,在慢性斑块状（543例）和急性滴状银屑病患者（32例）组间的差异均有统计学意义（χ2值分别为18.11和12.19,P值均 < 0.01）。等位基因G和基因型GG在患者组中的频率明显高于健康对照组,等位基因G和基因型GG在斑块状患者中的频率高于滴状患者。少儿发病组（35例）与成人发病组（540例）、家族史阳性组（102例）与家族史阴性组（440例）、男性患者组（341例）与女性患者组（234例）的基因型和等位基因频率分布差异均无统计学意义（P值均 > 0.05）。 结论 IL-12B（rs6887695）基因多态性与汉族人寻常性银屑病易感性相关联,特别是与斑块状银屑病相关,但与患者的发病年龄、家族史及性别可能无关联。     

IL-12B和IL-23R基因多态性与中国汉族人银屑病易感性关联研究

目的 探讨中国汉族人群中IL-12B和IL-23R基因多态性与银屑病易感性的关系。方法 在217例银屑病患者和288例正常人对照中,采用DNA直接测序法对IL-12B和IL-23R基因的多态性位点进行基因分型,并将阳性结果在一个更大的包括578例银屑病患者和1422例正常人对照的整合样本群中,使用Taqman探针荧光PCR技术进行重复检验。实验数据进行Hardy-Weinberg平衡检验、卡方检验、单倍型分析和Logistic回归模型分析。结果 IL-12B rs6887695位点等位基因频率在病例组与对照组之间差异有统计学意义,OR = 1.33（95% CI 1.03 ~ 1.73）,P = 0.028;IL-23R rs11465817和rs1343152位点等位基因频率在病例组与对照组之间差异无统计学意义（P > 0.05）。连锁不平衡分析发现,rs11465817和rs1343152位点之间有一定的连锁不平衡（D′ = 0.744,r2 = 0.281）。对2个位点进行单倍型分析发现,A-A ∶ OR = 2.890,P = 0.0018,提示这一单倍型具有显著的发病风险。结论 IL-12B基因rs6887695多态性与中国汉族人群银屑病易感性相关;IL-23R基因rs11465817、IL-23R基因rs1343152位点多态性与中国汉族人群银屑病易感性无显著相关性,但是,IL-23R基因rs11465817-rs1343152位点A-A单倍型的中国汉族人具有更高的银屑病发病风险。     

Association of the interleukin-10 distal promoter (-2763A/C) polymorphism with late-onset psoriasis

Polymorphisms of the IL-10 promoter have been implicated in the genetic susceptibility to many autoimmune diseases, including psoriasis. Four putative functional single-nucleotide polymorphisms (SNPs) within the interleukin-10 promoter region (-3575T/A, -2763A/C, -1082G/A and -592C/A) were analysed in 139 patients with chronic plaque psoriasis and in 155 unrelated healthy controls from Thailand. There were no significant differences in the allele frequencies of any of the four SNPs between patients with psoriasis and controls. However, the frequency of the -2763A allele was increased in patients with late-onset psoriasis compared with controls and patients with early-onset psoriasis [OR=2.94, 95% CI 1.16-7.39, corrected P value (Pc)=0.04 and OR=3.26, 95% CI 1.13-9.51, Pc=0.048, respectively]. The AAGC (-3575/-2763/-1082/-592) haplotype frequency was higher in late-onset compared with early onset psoriasis (OR=4.37, 95% CI 1.24-15.97, Pc=0.027). This study suggests that the -2763A allele and the extended AAGC haplotype can be used as a genetic marker for susceptibility to late-onset psoriasis in a Thai population.     

Psoriasis vulgaris in Chinese individuals is associated with PSORS1C3 and CDSN genes

BACKGROUND: Besides the HLA-Cw*0602 allele, the psoriasis susceptibility 1 candidate 3 (PSORS1C3) and corneodesmosin (CDSN) genes are two probable psoriasis susceptibility genes in the PSORS1 locus. The -79C, -26C and +246A alleles of the PSORS1C3 gene, the CDSN*971T allele, CDSN*TTC (619T-1236T-1243C) and CDSN*5 (619T-1240G-1243C) are strongly associated with psoriasis in the caucasian population. Until now, no haplotype study of the PSORS1C3 and CDSN genes has been documented in Chinese patients with psoriasis vulgaris. OBJECTIVES: We aimed to determine whether genetic polymorphisms of the PSORS1C3 and CDSN genes were associated with an increased risk of psoriasis vulgaris in Chinese patients in Taiwan. METHODS: We investigated the PSORS1C3 and CDSN genes for disease association by direct sequencing in 178 patients with psoriasis vulgaris and 203 control subjects. Genotyping for HLA-Cw*0602, alpha-helix coiled-coil rod homologue (HCR) gene and single nucleotide polymorphism (SNP) n.9 was also carried out using a sequence-based typing method. RESULTS: The PSORS1C3*582A allele, an SNP in the 3'-untranslated region of the PSORS1C3 gene, was a major psoriasis vulgaris susceptibility allele in the Chinese population, and the association was much stronger in patients with early-onset psoriasis vulgaris (22.3% vs. 6.9%, odds ratio = 3.87, P(c) =0.0000072). The frequencies of CDSN*TTC and CDSN*971T were also significantly increased in patients with early-onset psoriasis vulgaris. Moreover, PSORS1C3*582A, SNP n.9*C, Cw*0602 and HCR*WWCC were in near complete linkage disequilibrium (LD) with each other; in contrast, the LD with the CDSN gene was not so strong. SNP n.9*C-Cw*0602-PSORS1C3*582A-HCR*WWCC was a major susceptibility haplotype in patients with early-onset psoriasis vulgaris (P < 10(-7)) and this risk haplotype also carried CDSN*TTC and CDSN*971T. CONCLUSIONS: The PSORS1C3 and CDSN genes are important psoriasis susceptibility genes in Chinese patients with psoriasis vulgaris.     

The major psoriasis susceptibility locus PSORS1 is not a risk factor for late-onset psoriasis

PSORS1 is the major susceptibility locus for psoriasis vulgaris (PV) and lies within an approximately 200 kb segment of the major histocompatibility complex on chromosome 6p21.3. Alleles of candidate genes in this region including human leukocyte antigen (HLA)-C, alpha-helical coiled coil rod (HCR), and corneodesmosin (CDSN) show association with early-onset PV. Late-onset psoriasis (LOP) is defined as a disease with onset after 40 y of age and is typically sporadic. We assessed the role of PSORS1 in genetic susceptibility to LOP. Genotyping for HLA-C alleles and seven single nucleotide polymorphisms (SNP) within the genes HCR and CDSN was performed in LOP (n=145) and normal controls (n=309). Statistical analysis of allelic frequencies included calculation of odds ratio and chi2 comparisons. LOP demonstrated only a weak association to PSORS1 alleles HLA-Cw*6 (p=0.037), CDSN*5 (p=0.041), HCR*WC (p=0.013), and HCR SNP +325 (p=0.038). Patients with age of onset for psoriasis of 50 y or above provided no evidence of association with any of these alleles. These data suggest that the study cohort may include a number of subjects who harbor PSORS1 predisposition to early-onset psoriasis and yet do not present with disease by the age of 40 y. Thus this study demonstrates that PSORS1 is not a major inherited risk factor in the pathogenesis of LOP. These data suggest that the exclusion of LOP subjects from case-control studies will aid further delineation of the PSORS1 locus. Future genome-wide studies will be required to identify loci conferring risk for late-onset disease.     

山东汉族寻常性银屑病患者eIF4E、MMP-9基因多态性研究

目的 探讨真核细胞翻译起始因子（eIF4E ）、基质金属蛋白酶-9（MMP-9）基因内的单核苷酸多态性与山东汉族寻常性银屑病的关系。方法 基于群体的病例对照关联分析方法,利用Taqman分型方法对188例银屑病患者及280例正常对照人群MMP-9基因内的2个位点以及eIF4E基因内的1个位点进行分析,对基因型频率及等位基因频率采用PLINK软件进行统计学分析。结果 位于MMP-9基因上游调控区域的 rs4810482等位基因T在银屑病组中的频率显著低于对照组（OR = 1.49,95% CI = 1.12 ~ 1.99,P < 0.01）,在隐性与显性遗传模型分析中,差异具有统计学意义。生物信息学分析表明,该位点可能改变了转录因子的结合位点。在研究中分析的其余两个位点rs3918254和rs11723037与银屑病无相关性。结论 位于MMP-9基因上游调控区域的rs4810482与银屑病具有显著相关性,可能是银屑病的一个易感基因。