持续性和非持续性银屑病患者代谢指标的比较研究

Comparative analysis of metabolic indicators in patients with persistent and non-persistent psoriasis

目的调查影响银屑病复发的诱因,探究银屑病复发与代谢相关标志物间的关联。方法回顾性调查2016年1月至2023年4月于北京大学第三医院皮肤科就诊的寻常型银屑病患者的复发情况,将复发间隔时间>3个月的患者纳入非快速复发即非持续性银屑病组,≤3个月的患者纳入快速复发即持续性银屑病组。分析2组患者的一般情况和复发诱因,收集代谢相关检查结果及部分患者的血清脂肪酸结合蛋白(FABP)4和FABP5水平检查结果,并分析其与复发的关系。组间比较采用t检验、非参数检验或χ^(2)检验;对FABP的可能影响因素采用线性回归分析,对复发的诱因采用多因素Logistic回归分析。结果共纳入255例患者,非持续性银屑病194例,持续性银屑病61例。两组患者的性别、年龄(每30岁分层)、银屑病病程(每10年分层)、银屑病家族史、主要治疗方法的差异均无统计学意义(均P>0.05)。非持续性银屑病组患者更易受季节影响出现复发(χ^(2)=18.98,P<0.001)。持续性银屑病组中血脂异常的患者比例显著高于非持续性银屑病组(χ^(2)=54.44,P<0.001),持续性银屑病组患者的体质指数、甘油三酯、尿酸、C反应蛋白水平均显著高于非持续性银屑病组(均P<0.05),高密度脂蛋白胆固醇水平显著低于非持续性银屑病组(U=3348.00,P<0.001)。持续性银屑病组患者的FABP4、FABP5水平显著高于非持续性银屑病组(均P<0.05)。线性回归模型校正体质指数和血脂异常后,FABP4水平与持续性银屑病和非持续性银屑病分组存在关联(P<0.001)。多因素Logistic回归分析显示,血脂异常与持续性银屑病存在显著的关联性(P<0.001)。结论复发间隔时间≤3个月的银屑病患者可能更易合并血脂异常等代谢性疾病,血脂异常及FABP4升高可能与银屑病复发存在关联。

Objective To identify factors influencing the recurrence of psoriasis,and to explore the association between the recurrence of psoriasis and metabolism-related markers.Methods A retrospective investigation was conducted on the recurrence status of patients with psoriasis vulgaris,who visited the Department of Dermatology,Peking University Third Hospital from January 2016 to April 2023.Patients with recurrence intervals>3 months were included in the non-rapid recurrence group(non-persistent psoriasis group),while patients with recurrence intervals≤3 months were included in the rapid recurrence group(persistent psoriasis group).General conditions and relapse triggers were analyzed between the two groups.Metabolism-related laboratory data,as well as detection results of serum fatty acid-binding protein 4(FABP4)and FABP5 in some patients,were collected,and relationships between these indicators and psoriasis recurrence were analyzed.Comparisons between groups were performed using t test,non-parametric test or chi-square test;linear regression analysis was performed to identify possible factors influencing the FABP levels,and multivariate logistic regression analysis to identify relapse triggers.Results A total of 255 patients were collected,including 194 with non-persistent psoriasis and 61 with persistent psoriasis.There were no significant differences in gender,age(stratified every 30 years),course of psoriasis(stratified every 10 years),family history of psoriasis,and main therapies between the two groups(all P>0.05).The patients in the non-persistent psoriasis group were more prone to recurrence due to seasonal effects(χ^(2)=18.98,P<0.001).The proportion of patients with dyslipidemia was significantly higher in the persistent psoriasis group than in the non-persistent psoriasis group(χ^(2)=54.44,P<0.001).Compared with the non-persistent psoriasis group,the persistent psoriasis group showed significantly increased body mass index and levels of triglycerides,uric acid,and C-reactive protein(all P<0.05),but significantly decreased high-density lipoprotein cholesterol levels(U=3348.00,P<0.001).The levels of FABP4 and FABP5 were significantly higher in the persistent psoriasis group than in the non-persistent psoriasis group(both P<0.05).In the linear regression model adjusted for body mass index and dyslipidemia,FABP4 levels were associated with recurrence status of psoriasis(P<0.001).Multivariate logistic regression analysis revealed a significant correlation between dyslipidemia and persistent psoriasis(P<0.001).Conclusion The psoriasis patients with recurrence intervals≤3 months may be more prone to develop metabolic diseases such as dyslipidemia,and dyslipidemia and elevated FABP4 levels may be associated with the recurrence of psoriasis.