银屑病患者患有肺部疾病,心脏病,糖尿病及风湿病风险较高

1 星2 星3 星4 星5 星 (觉着不错就5星评价哦)

银屑病患者患有肺部疾病,心脏病,糖尿病及风湿病风险较高。银屑病常与其它内脏疾病伴发,包括肺部疾病,糖尿病,心梗,肝脏疾病以及风湿性疾病,而且随着银屑病的严重程度的增加,银屑病与内脏疾病伴发的情况更显著。

银屑病概述

银屑病俗称“牛皮癣”,它是一个古老的疾病,在很久以前就有银屑病,如古希腊认为银屑病是众神的诅咒。中医对银屑病很早以前就有记载,但是不叫银屑病,名字比较多,如“干癣”、“顽癣”、“松皮癣”、“白疕”、“白疕风”、“蛇风等名。我们常可见到电线杆上或墙壁上贴的小广告,贴的那是一重又一重,新的盖旧的,最后很难完全去除,我们把这些野广告称为“城市牛皮癣”。

这也形像的描述了银屑病较难完全去除的特点。但是使用“牛皮癣”一词来概括该病名称是不科学的,因为牛皮癣其实并不是癣。所谓的“癣”是指真菌感染引起的一种皮肤疾病,将这些癣局部的皮屑放在显微镜下常能发现真菌菌丝或真菌孢子,使用抗真菌药物进行治疗常能取得很好的疗效。而银屑病是一种常见的慢性皮肤病,并非真菌感染所引起的疾病。银屑病也并非传染病,接触银屑病不会导致自己发病。但是称其为“牛皮”,可能因为本病反复发作而且难以根治,其“韧性“有如牛皮。另外有些患者的皮疹时间长了可能变得肥厚,表面呈皮革状,好像牛身上的皮肤。学术界也认识到牛皮癣的名字不科学,于是在1956年全国皮肤病会议上,专家们一致通过以“银屑病”取代“牛皮癣”作为本病的正式学术术语。

银屑病是一种慢性疾病,本病的特征性损害是在红斑、丘疹和斑块上反复出现多层银白色干燥鳞屑。鳞屑与其下面的皮肤结合不甚牢固,容易脱落,所以常看到银屑病患者身上很容易掉皮。银屑病主要发于头皮和四肢多见。但是全身各处都可以发生,甚至龟头、指甲、趾甲也可以发生银屑病。大部分银屑病冬季和春节容易复发或加重,而夏季和秋季多缓解或消退。(更多银屑病基础知识参阅银屑病百科

银屑病常与其它内脏疾病伴发

最新的研究表明,银屑病不仅单纯的影响皮肤和关节,还可能与其它内脏疾病伴发,而且银屑病越严重,与内脏疾病的相关性越显著。

研究人员调查了9035名银屑病患者,平均年龄46岁,50.6%的为男性。对照组为9035名无银屑病人群,其中男性有47.1%。使用察尔森合并症严重度指标(Charlson comorbidity index,CCI)评价疾病的严重程度。根据患者体表面积累及为标准,51.8%的为轻度银屑病患者,35.8%的为中度银屑病患者,12.4%的为重度银屑病患者。

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。

研究还发现,银屑病肿瘤并无明显相关性。这点还好!

作者声称, 银屑病常伴发其它内脏系统疾病增加了银屑病患者的死亡风险,因此医师们应该知道银屑病与内脏疾病的相关性,为患者提供更多的治疗方法和护理方案。尤其是严重性银屑病患者更要注意内脏系统的情况,早发现,早治疗。而且尽量不要使用可能加重上述内脏系统负担的药物。

Importance

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.

Objective

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.

Results

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.

参考文献地址:http://archderm.jamanetwork.com/article.aspx?articleid=1724035

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