Späh F
HELIOS Klinikum Krefeld, Medizinische Klinik I, Lutherplatz 40, D-47805 Krefeld, Germany.
Br J Dermatol. 2008 Aug;159 Suppl 2:10-7. doi: 10.1111/j.1365-2133.2008.08780.x.
Inflammation plays a key role in the pathogenesis of a number of chronic inflammatory systemic diseases (CISDs), including psoriasis, rheumatoid arthritis, systemic lupus erythematosus and Crohn's disease, and also in the pathogenesis of atherosclerosis. CISDs and cardiovascular diseases, such as atherosclerosis, share common pathogenic features, and cardiovascular disease is an important cause of morbidity and mortality in patients with CISDs. Activated inflammatory cells and pro-inflammatory cytokines contribute to the development of psoriatic lesions and play an important role in the breakdown of atherosclerotic plaques. Psoriasis and atherosclerosis also have similar histological characteristics involving T cells, macrophages and monocytes. In particular, the extravasation of T cells through the epithelium is characteristic of both psoriatic and atherosclerotic plaques. Cardiovascular disease is an important cause of morbidity and mortality in patients with psoriasis, which is associated with an increased cardiovascular risk profile compared with the general population. Patients with psoriasis are at increased risk of arterial hypertension, coronary heart disease, hyperlipidaemia, obesity and type II diabetes, which are more prevalent than in control patients. This increased risk could be due to the effects of chronic inflammatory changes, particularly the infiltration of T cells and subsequent secretion of pro-inflammatory cytokines. Some drugs used in the treatment of cardiovascular disease, such as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have anti-inflammatory activity. In addition, systemic treatments for psoriasis may, by decreasing inflammation, reduce the risk of cardiovascular disease. It is suggested, therefore, that an integrated approach to the treatment of the inflammatory processes underlying both psoriasis and atherosclerosis may be beneficial in reducing cardiovascular risk in patients with psoriasis. The newer targeted biological therapies, such as efalizumab and infliximab, which offer the potential for long-term disease control in psoriasis, may be of particular use in this setting.
炎症在多种慢性炎症性全身性疾病（CISDs）的发病机制中起关键作用，这些疾病包括银屑病、类风湿性关节炎、系统性红斑狼疮和克罗恩病，炎症在动脉粥样硬化的发病机制中也起作用。CISDs和心血管疾病，如动脉粥样硬化，具有共同的致病特征，心血管疾病是CISDs患者发病和死亡的重要原因。活化的炎症细胞和促炎细胞因子促成银屑病皮损的发展，并在动脉粥样硬化斑块破裂中起重要作用。银屑病和动脉粥样硬化还具有涉及T细胞、巨噬细胞和单核细胞的相似组织学特征。特别是，T细胞通过上皮的外渗是银屑病斑块和动脉粥样硬化斑块的特征。心血管疾病是银屑病患者发病和死亡的重要原因，与普通人群相比，银屑病患者的心血管风险增加。银屑病患者患动脉高血压、冠心病、高脂血症、肥胖症和II型糖尿病的风险增加，这些疾病在银屑病患者中比在对照患者中更普遍。这种风险增加可能是由于慢性炎症变化的影响，特别是T细胞的浸润和随后促炎细胞因子的分泌。一些用于治疗心血管疾病的药物，如3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）和血管紧张素转换酶抑制剂具有抗炎活性。此外，银屑病的全身治疗可能通过减轻炎症来降低心血管疾病的风险。因此，建议采用综合方法治疗银屑病和动脉粥样硬化潜在的炎症过程，这可能有助于降低银屑病患者的心血管风险。新型靶向生物疗法，如依法利珠单抗和英夫利昔单抗，有望长期控制银屑病病情，在这种情况下可能特别有用。
