与对照组相比，轻度银屑病患者（0.375 VS 0.347）,中度银屑病患者（0.398 VS0.342）和重度银屑病患者（0.45 VS0.38，P<0.05 ）CCI评分明显升高。
就个体而言，银屑病患者最常伴发的内脏疾病为慢性肺部疾病（OR=1.08, 95%CI=1.02-1.15）,单纯糖尿病（OR=1.22, 95%CI=1.11-1.35）,糖尿病伴发系统疾病（OR=1.34, 95%CI=1.11-1.62）,轻度肝脏疾病（OR=1.41, 95%CI=1.12-1.76）。同时还可能出现心肌梗塞（OR=1.34, 95%CI=1.07-1.69）,消化系统溃疡（OR=1.27, 95%CI=1.03-1.58）,外周血管疾病（OR=1.38, 95%CI=1.07-1.77）,肾脏疾病（OR=1.28, 95%CI=1.11-1.48）以及风湿性疾病（OR=2.04, 95%CI=1.71-2.42）。另外银屑病患者伴发内脏疾病还与银屑病的严重程度有关。
Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity.
To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis.
Design, Setting, and Participants
Population-based cross-sectional study of patient data fromUnited Kingdom–based electronic medical records; analysis included9035 patients aged 25 to 64 years with psoriasis and 90 350 age- and practice-matched patients without psoriasis.
Main Outcomes and Measures
Prevalence of major medical comorbidity included in the Charlson comorbidity index.
Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05).
Conclusions and Relevance
The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.
Psoriasis is a common chronic inflammatory disease, mediated by type 1 and 17 helper T cells, which affects 2% to 3% of the general population.1- 2 Although conventionally considered a disease limited to the skin and joints, increasing evidence suggests that psoriasis has far-reaching systemic effects.3- 15 Research characterizing the risk of comorbidity in patients with psoriasis may advance our understanding of the natural history of psoriasis and improve clinical practice. In particular, the presence of comorbid diseases may affect psoriasis treatment choice and monitoring, as well as inform the provision of comprehensive care with proper health screening, evaluation, and management.16- 17
Multiple observational studies have demonstrated that patients with psoriasis, particularly those receiving systemic treatment or phototherapy, have higher incidences of myocardial infarction, stroke, diabetes mellitus, and cardiovascular mortality, independent of conventional risk factors for these outcomes.3- 12 Associations with other comorbid diseases, such as metabolic syndrome, chronic obstructive pulmonary disease, asthma, peptic ulcer disease, liver disease, renal failure, and rheumatoid arthritis, have also emerged.13- 15
Despite the growing literature on psoriasis comorbidity, there is a critical knowledge gap on the degree to which psoriasis severity may affect the prevalence of comorbid diseases. Previous studies have relied on indirect measures of psoriasis severity, such as treatment use patterns, rather than direct and objective measures. Moreover, few epidemiologic investigations have been conducted using a validated comorbidity index for a wide array of major medical comorbid diseases that may confer prognostic information on mortality.13 Therefore, our objective was to examine the prevalence of major medical comorbid diseases in patients with mild, moderate, or severe psoriasis as assessed by objective measures of body surface area (BSA) involvement compared with that in patients without psoriasis in a broadly representative patient population.
参考文献：Howa Yeung, BS. et al. Psoriasis Severity and the Prevalence of Major Medical Comorbidity. JAMA Dermatol. 2013.