Hagforsen Eva, Michaëlsson Karl, Lundgren Ewa, Olofsson Helena, Petersson Axel, Lagumdzija Alena, Hedstrand Håkan, Michaëlsson Gerd
Department of Medical Sciences/Dermatology, University Hospital, S-751 85 Uppsala, Sweden.
Acta Derm Venereol. 2005;85(3):225-32. doi: 10.1080/00015550510026587.
Palmoplantar pustulosis is characterized by pustule formation in the acrosyringium. Nearly 50% of palmoplantar pustulosis sera produce immunofluorescence of the palmar papillary endothelium from healthy subjects, but also of the endothelium of normal parathyroid gland. With a case-control design the levels of calcium and parathyroid hormone in serum were measured in 60 women with palmoplantar pustulosis and 154 randomly selected population-based control women. One-third of the controls had been smokers, whereas 95% of the cases were or had been smokers. Mean age-adjusted serum calcium was increased in the patients compared with the controls (2.43 vs 2.36 mmol/l; p<0.0001), whereas the parathyroid hormone concentration was suppressed (23.2 vs 31.1 ng/l; p<0.0001). The plasma levels of parathyroid hormone-related protein were normal in patients but there was a strong expression of this protein in the acrosyringium both in palmoplantar pustulosis and control skin. As even a marginal elevation of serum calcium is associated with an increased risk for diabetes, cardiovascular disease and psychiatric disease, we analysed the risk for these disorders in palmoplantar pustulosis patients compared with that in the control group. Both diabetes mellitus and psychiatric disorders were associated with palmoplantar pustulosis with an odds ratio of 8.7 (95% CI 3.3-22.8) and 5.6 (95% CI 2.2-14.4), respectively. Palmoplantar pustulosis is a complex disease with an increased risk for several non-dermatological disorders. The role of the mildly increased serum calcium for the high risk for diabetes and depression deserves to be studied.
掌跖脓疱病的特征是在汗腺末端形成脓疱。近50%的掌跖脓疱病患者血清可使健康受试者的掌部乳头内皮细胞产生免疫荧光，同时也可使正常甲状旁腺的内皮细胞产生免疫荧光。采用病例对照设计，对60例掌跖脓疱病女性患者和154例随机选取的基于人群的对照女性进行血清钙和甲状旁腺激素水平检测。三分之一的对照者曾是吸烟者，而95%的病例是或曾是吸烟者。与对照组相比，患者经年龄调整后的平均血清钙升高（2.43 vs 2.36 mmol/l；p<0.0001），而甲状旁腺激素浓度受到抑制（23.2 vs 31.1 ng/l；p<0.0001）。患者甲状旁腺激素相关蛋白的血浆水平正常，但在掌跖脓疱病皮肤和对照皮肤的汗腺末端均有该蛋白的强烈表达。由于即使血清钙的轻微升高也与糖尿病、心血管疾病和精神疾病的风险增加相关，我们分析了掌跖脓疱病患者与对照组相比患这些疾病的风险。糖尿病和精神疾病均与掌跖脓疱病相关，优势比分别为8.7（95%可信区间3.3 - 22.8）和5.6（95%可信区间2.2 - 14.4）。掌跖脓疱病是一种复杂疾病，患几种非皮肤病性疾病的风险增加。血清钙轻度升高在糖尿病和抑郁症高风险中的作用值得研究。
