银屑病患者罹患冠心病的风险评估

Evaluation of coronary heart disease risks in patients with psoriasis

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、矿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。

Objective To estimate the 10-year risk of coronary heart disease in patients with psoriasis, and to determine whether the risk profile is affected by disease duration, family history and clinical types of psoriasis. Methods Data were pooled from 322 inpatients with psoriasis and 297 inpatients with other skin diseases （151 cases of acute urticaria, 33 drug eruption, 113 herpes zoster） from December 2008 to December 2010 in the Department of Dermatology, West China Hospital of Sichuan University. Risks of coronary heart disease were estimated by using the Framingham risk score algorithm. Wilcoxon rank test, Kruska1-Wallis test and chi-square tests were used to evaluate the differences in risks and risk factors between the patients with psoriasis and controls. Results As far as the Framingham 10-year risk score was concerned, the difference was statistically significant between the patients with psoriasis and the control population （6% vs. 4%, Z = 4.342, P = 0.000）, as well as between patients with different clinical types of psoriasis （6% for psoriasis vulgaris vs. 4% for pustular psoriasis vs. 7% for psoriasis arthropathica vs. 7% for erythroderma psoriaticnm, H = 8.484, P 〈 0.05）, but was insignificant between patients with familial and sporadic psoriasis （6% vs. 6%, Z = 0.406, P 〉 0.05）. No correlation was observed between the Framingham 10-year risk and psoriasis duration （P 〉 0.05）. Conclusions Increased risks of coronary heart disease exist in patients with psoriasis compared with those with acute urticaria, drug eruption or hepers zoster, and in patients with psoriasis arthropathica or erythroderma psoriaticum compared with those with pustular psoriasis. The Framingham lO-year risk of coronary heart disease is uncorrelated with disease duration and unaffected by family history of psoriasis.