血清PON1及1,25(OH)_(2)D_(3)对银屑病患者并发心血管疾病的预测价值

Predictive value of serum PON1 and 1,25(OH)_(2)D_(3) in psoriasis patients with concomitant cardiovascular disease

目的检测血清氧磷酯酶1(PON1)及1,25二羟基维生素D 3[1,25(OH)_(2)D_(3)]水平及其对银屑病患者并发心血管疾病(CVD)的预测价值。方法选取2018年2月—2022年2月中国人民解放军联勤保障部队第九八〇医院皮肤科收治银屑病患者88例为银屑病组,根据疾病严重程度,再分为轻度亚组(n=34)、中度亚组(n=26)和重度亚组(n=28);根据是否合并CVD分为非CVD亚组63例和CVD亚组25例。选取医院同期体检健康者70例为健康对照组。酶联免疫吸附实验检测血清PON1及1,25(OH)_(2)D_(3)水平;比较不同病情程度银屑病患者血清PON1及1,25(OH)_(2)D_(3)水平差异;多因素Logistic回归分析影响银屑病患者并发CVD的因素;受试者工作特征曲线分析血清PON1及1,25(OH)_(2)D_(3)对银屑病患者并发CVD的预测价值。结果银屑病组血清PON1及1,25(OH)_(2)D_(3)水平低于健康对照组(t=51.008,25.088,P均<0.001)。血清PON1及1,25(OH)_(2)D_(3)水平比较,轻度亚组>中度亚组>重度亚组(F=207.130、54.240,P均<0.001);Framingham风险评分(FRS评分)高是影响银屑病患者并发CVD的独立危险因素,血清PON1及1,25(OH)_(2)D_(3)升高是保护因素[OR(95%CI)=1.791(1.294~2.480),0.623(0.493~0.786),0.630(0.495~0.802)];血清PON1、1,25(OH)_(2)D_(3)及两项联合预测银屑病患者并发CVD的AUC分别为0.815、0.784、0.878,两项联合的AUC高于血清PON1及1,25(OH)_(2)D_(3)单独诊断,差异具有统计学意义(Z/P=3.124/0.002、3.349/0.001)。结论银屑病患者血清PON1及1,25(OH)_(2)D_(3)水平与银屑病患者病情严重程度有关,有望作为评估银屑病患者CVD发生的新指标。

Objective To detect the levels of serum phosphorus oxysterase 1(PON1)and 1,25 dihydroxyvitamin D 3[1,25(OH)_(2)D_(3)]and their predictive value of predictive value of concomitant cardiovascular disease(CVD)in patients with psoriasis.Methods Eighty eight patients with psoriasis admitted to the Department of Dermatology,980 Hospital of the Joint Logistic Support Force of Chinese People's Liberation Army,from February 2018 to February 2022 were selected as the psoriasis group,which was subdivided into a mild subgroup according to the severity of the disease(n=34),a moderate subgroup(n=26)and severe subgroup(n=28);according to whether combined CVD was divided into non-CVD subgroup 63 cases and CVD subgroup 25 cases.Seventy cases of healthy people who underwent medical examination in the same period in the hospital were selected as the healthy control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum PON1 and 1,25(OH)_(2)D_(3) levels;differences in serum PON1 and 1,25(OH)_(2)D_(3) levels were compared among psoriasis patients with different degrees of disease;multifactorial Logistic Regression analysis of the factors affecting the complication of CVD in patients with psoriasis;analysis of the predictive value of serum PON1 and 1,25(OH)_(2)D_(3) on the complication of CVD in patients with psoriasis by working characteristic curve of the subjects.Results The serum PON1 and 1,25(OH)_(2)D_(3) levels in the psoriasis group were lower than those in the healthy control group(t=51.008,25.088,P<0.001).Comparison of serum PON1 and 1,25(OH)_(2)D_(3) levels showed that mild subgroup>moderate subgroup>severe subgroup(F=207.130,54.240,P<0.001);high Framingham risk score(FRS score)was an independent risk factor affecting patients with psoriasis complicating CVD,and elevated serum PON1 and 1,25(OH)_(2)D_(3) were protective factors[OR(95%CI)=1.791(1.294-2.480),0.623(0.493-0.786),0.630(0.495-0.802)];serum PON1,1,25(OH)_(2)D_(3) and the combination of the two predicted the AUC of concurrent CVD in psoriasis patients to be 0.815,0.784,and 0.878,respectively,and the AUC of the two combinations was higher than that of serum PON1 and 1,25(OH)_(2)D_(3) diagnosed alone,and the difference was statistically significant(Z/P=3.124/0.002,3.349/0.001).Conclusion The serum PON1 and 1,25(OH)_(2)D_(3) levels in psoriasis patients are related to the severity of the disease in psoriasis patients,which is expected to be used as a new indicator to evaluate the occurrence of CVD in psoriasis patients.