银屑病合并冠心病临床特点分析

Clinical characteristics of patients with psoriasis and coronary artery disease

目的:总结银屑病合并冠心病患者的临床特点。方法:选取2010年1月至2015年8月本院收治的银屑病合并冠心病患者25例,对照组选自2015年1月至2015年6月本院收治的单纯冠心病患者218例。对两组的冠心病传统危险因素和冠状动脉造影结果进行对比分析;对25例银屑病患者皮损情况进行银屑病面积与严重指数(PASI)评分,并进行临床随访。结果:与单纯冠心病组比较,银屑病合并冠心病组初发冠心病时年龄较小[(56.12±10.85)岁,对照组(66.16±10.43)岁,P<0.001],但血脂异常较为多见(P=0.032);血生化指标中,银屑病合并冠心病组总胆固醇、低密度脂蛋白胆固醇、甘油三酯水平均较单纯冠心病组高(P<0.05),而高密度脂蛋白胆固醇较对照组低(P=0.022)。银屑病合并冠心病组急性心肌梗死起病比例较高(P=0.042),且冠状动脉造影结果提示银屑病合并冠心病患者冠状动脉病变严重,三支病变比例较高(P=0.049)。25例患者平均随访(16.46±8.74)个月,4例患者随访期间有再发心绞痛,其中3例再次入院行经皮冠状动脉介入(PCI)治疗。25例患者经加用他汀类药物治疗后,银屑病病情也有所好转,最后一次随访时的PASI评分较入院时明显降低(12.60±4.12比8.73±5.05,P<0.01)。结论:银屑病患者初发冠心病时年龄较轻,冠状动脉病变程度往往较重,且起病急、预后较差,需要尽早干预,尽量延缓疾病进展,从而改善患者预后;此外,他汀类药物的早期应用对银屑病本身的病情也有着一定程度的改善作用。

Objective：To summarize the clinical characteristics of patients with psoriasis and coronary artery disease （CAD）. Methods： We retrospectively recruited 25 CAD patients with psoriasis and 218 without psoriasis in Nanjing Drum Tower Hospital. The number of well-established risk factors for CAD, coronary angiographic properties and blood biochemistry index were compared. The psoriasis area and severity index （PASI） score of the 25 patients were recorded at the first time of hospitalization and the end of follow-up, guided by experienced dermatologist. All the psoriasis patients were followed up. Results：Compared with CAD patients without psoriasis, those with psoriasis had a younger age of onset of CAD （56. 12 ±10. 85 vs 66. 16 ± 10. 43 years, P 〈 0. 001 ） ,higher levels of total cholesterol （ TC ）, low- density lipoprotein cholesterol （ LDL- C ）, and triglycerides （TG） （P 〈 0. 05 ）, and lower level of high- density lipoprotein cholesterol （ HDL- C, P = 0. 022 ）. Higher rates of myocardial infarction and coronary artery triple vessel lesion were also observed in CAD patients with psoriasis （P 〈 0.05）. During a mean follow-up of 16.46 months, 3 patients with psoriasis were re-hospitalized for second percutaneous coronary intervention treatment due to repeated angina recurrence. An improvement of psoriasis symptoms was achieved following statin use, showing substantially reduced PASI score at the end of follow- up when compared with the initial value （P 〈 0.01 ）. Conclusion： CAD patients with psoriasis have an earlier age of symptom onset, severe lesions of the coronary artery and poor prognosis. Timely treatment delays the progression of CAD and improves the prognosis. Moreover, statin may also help improve the symptoms of psoriasis.