银屑病并发代谢异常的临床分析

Clinical analysis of metabolic abnormalities associated with psoriasis

目的:分析银屑病及其4种类型并发代谢综合征(MS)和代谢异常因素的关系。方法:收集446例银屑病患者(银屑病组)和424例带状疱疹患者(对照组)的临床及实验室资料,比较两组并发MS及代谢相关因素的差异,同时比较4种类型银屑病患者间上述差异。结果:银屑病组并发MS与对照组比较结果为χ~2=12.781,P=0.000,寻常性银屑病(寻常性组)与脓疱性银屑病组(脓疱性组)并发MS的比例与对照组比较分别为χ~2=9.253,P=0.002;χ~2=13.973,P=0.000,脓疱性组中并发MS的比例与寻常性组比较为χ~2=4.426,P=0.035。银屑病组吸烟率、BP升高、三酰甘油(TG)升高、低密度脂蛋白(LDL-C)升高、高密度脂蛋白(HDL-C)降低及脂肪肝患病率与对照组比较结果分别为χ~2=17.887,P=0.000;χ~2=23.035,P=0.000;χ~2=649.269,P=0.000;χ~2=4.269,P=0.039;χ~2=67.160,P=0.000;χ~2=39.676,P=0.000;寻常性组LDL-C升高发生率与红皮病性银屑病(红皮病性组)比较为χ~2=6.323,P=0.012,与脓疱性组比较为χ~2=13.688,P=0.00,与关节病性银屑病(关节病性组)比较为χ~2=17.059,P=0.00;在空腹血糖(FBG)升高方面,脓疱性组发生率与寻常性组比较为χ~2=8.542,P=0.003;与红皮病性组比较为χ~2=3.962,P=0.047;脂肪肝患病率比较,寻常性组与红皮病性组和关节病性组比较结果分别为χ~2=8.173,P=0.004;χ~2=14.153,P=0.00,而脓疱性组与关节病性组比较结果为χ~2=4.898,P=0.027。结论:银屑病组并发MS及代谢异常明显高于对照组,脓疱性组高于其他3型。银屑病组吸烟及患脂肪肝的比例更高,BP、TG、LDLC3项指标升高及HDL-C降低概率高于对照组;寻常性组LDL-C升高概率明显高于其他3型,脓疱性组发生FBG升高概率高于寻常性组与红皮病性组;寻常性组脂肪肝患病率明显高于红皮病性组与关节病性组,而脓疱性组又明显高于关节病性组。

Objective： To analyze four types of psoriasis and its relationship with metabolic syndrome（MS） and the risk factors of abnormal metabolism. Methods： Clinical and laboratory data were compared between 446 psoriatic patients and 424 cases of her- pes zoster （as control group） regarding the occurrence of metabolic syndrome and its related factors, and the difference among the four types of psoriasis Results： Compared with the controls, the incidence of psoriasis complicated with MS was higher （X2=12.781, P=0.000）, particularly in patients with vulgaris and pustular types （X2=253, P=0.002 for vulgaris; X2=13.973, P=0.000 for pustnlar psoria- sis）. The incidence of pustular psoriasis complicated with MS was higher than that of psoriasis vulgaris （X2=4.426, P=0.035）. There were significant differences between psoriasis and controls in the rates of smoking, high BP, elevated TG, high LDL-C, low HDL-C and the incidence of fatty liver （smoking： X2=17.887, P=0.000; high BP： X2=23.035, P=0.000; elevated TG： X2=649269, P=0.000; high LDL-C： X2=4269,P=0.039; low HDL-C： X2=67.160, P=0.000; fatty liver： X2=-39.676, P=00）. The incidence of elevated LDL-C in pa- tients with psoriasis vulgaris significantly differed from that with erythrodet^nic （X2=6.323, P=0.012）, pustular X2=-13.688, P=0.00） and arthritic types（X2=17.059, P=0.00）; The incidence of high fast plasma glucose levels in patients with pustular psoriasis significantly dif- fered from that with either psoriasis vulgaris （X2=8.542, P=0.003） or erythrodermie psoriasis （X2=3.962, P=0.047）; Complication of fatty liver in patients with psoriasis vulgaris was more often than that with erythrodermie （X2=8.173, P=0.004） or arthritic types （X2=14.153, P=0.000）. Moreover, the incidence of fatty liver was different between pustular and arthritic types （X2=4.898, P=0.027）. Conclusions： The incidence of MS in psoriatic patients was higher than that in the controls Patients with pustular psoriasis display the highest in- cidence of MS among the four types of psoriasis In comparison with the controls, more psoriatic patients smoke, or have fatty liver or a higher probability of having high BP, high TG, high LDL-C and low HDL-C; Patients with psoriasis vulgaris have a higher proba- bility of elevated LDL-C than that with the other three types of psoriasis The probability of high fast plasma glucose levels is higher in pustular psoriasis than in erythrodermic or vulgaris psoriasis; And the incidence of fatty liver in patients with psoriasis vulgaris is higher than that with erythrodermic and arthritic types, the latter of which exhibit low incidence of fatty liver than patients with pus- tular psoriasis.