中重度银屑病患者更易患肾脏疾病

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中重度银屑病患者更易患肾脏疾病,最新发表于BMJ杂志上的一篇研究论文表明中重度银屑病与发生慢性肾脏病的风险相关。

宾夕法尼亚大学的科学家比较了近 144,000 名银屑病患者(18 ~ 90 岁)与近 690,000 名对照者的数据。 最后研究发现银屑病患者发生中度到重度(3 ~5 级)慢性肾脏病的风险比健康人群高。 发展为慢性肾脏病的风险为后者两倍,发生终末期肾脏疾病的风险为后者四倍多。

医生分析了 8,700 例患者银屑病的严重程度,并与 87,000 名对照者的测量数据相比较。 轻度银屑病(影响小于体表面积的百分之二)与肾脏病没有关联,但中度(3 ~ 10%)和严重(超过 10%)者则存在明显相关性。

发生各种疾病的绝对风险随受试者的年龄增长而增加。 40 至~50 岁受试者中每 134 例银屑病患者有 1 例发生肾脏疾病,而其 50 ~60 岁受试者中每 62 人有 1 例。

作者建议有银屑病的患者应该检查肾脏损害的早期迹象。 有必要进一步研究以确定关联的类型并研究不同药物有什么样的影响。

以下是研究摘要

Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study

Objective

To determine the risk of chronic kidney disease in patients with psoriasis.

Design

Population based cohort study and nested cross sectional study.

Setting

Electronic medical records database based in United Kingdom.

Participants

Cohort study: patients with psoriasis aged 18-90 each matched to up to five patients without psoriasis based on age, practice, and time of visit. Nested study: patients with psoriasis aged 25-64 with confirmed data on psoriasis severity, each matched to up to 10 patients without psoriasis based on age and practice.

Main outcome measures

Cohort study: incident moderate to advanced (stage 3 through 5) chronic kidney disease. Nested study: baseline prevalence of chronic kidney disease.

Results

136 529 patients with mild psoriasis and 7354 patients with severe psoriasis based on treatment patterns were matched to 689 702 unaffected patients. The adjusted hazard ratios (95% confidence intervals) for incident chronic kidney disease were 1.05 (1.02 to 1.07), 0.99 (0.97 to 1.02), and 1.93 (1.79 to 2.08) in the overall, mild, and severe psoriasis groups, respectively. Age was a significant effect modifier in the severe psoriasis group, with age specific adjusted hazard ratios (95% confidence intervals) of 3.82 (3.15 to 4.64) and 2.00 (1.86 to 2.17) for patients aged 30 and 60, respectively. In the nested analysis of 8731 patients with psoriasis with measurements of affected body surface area matched to 87 310 patients without psoriasis, the adjusted odds ratios (95% confidence intervals) for chronic kidney disease were 0.89 (0.72 to 1.10), 1.36 (1.06 to 1.74), and 1.58 (1.07 to 2.34) in the mild, moderate, and severe psoriasis groups, respectively.

Conclusions

Moderate to severe psoriasis is associated with an increased risk of chronic kidney disease independent of traditional risk factors.

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