Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, China.
Br J Dermatol. 2011 Mar;164(3):514-20. doi: 10.1111/j.1365-2133.2010.10107.x. Epub 2011 Feb 3.
Psoriasis is associated with premature atherosclerosis although the underlying mechanism remains unclear.
We sought to investigate the relationship between disease activity and systemic inflammation in patients with psoriasis, and macrovascular and microvascular function.
Fifty-two patients with psoriasis (mean ± SD age 44 ± 8 years; 38 men) were compared with 50 age- and sex-matched controls. Baseline demographics and high-sensitivity C-reactive protein (hs-CRP) level were recorded for each subject. Psoriatic disease activity was assessed using the Psoriasis Area and Severity Index (PASI). Arterial stiffness and endothelial function were assessed using brachial to ankle pulse wave velocity (baPWV) and digital hyperaemic response measured using the peripheral arterial tonometry (PAT) index.
Patients with psoriasis had significantly higher hs-CRP (mean ± SD 5·3 ± 5·1 vs. 1·9 ± 1·6 mg L(-1), P < 0·01) and baPWV (mean ± SD 14·5 ± 2·5 vs. 13·2 ± 1·6 m s(-1) , P < 0·01) but not PAT index (mean ± SD 2·06 ± 0·59 vs. 2·10 ± 0·44, P = 0·70) than controls. There was significant correlation of hs-CRP with baPWV (r = 0·51, P < 0·01) and with PASI (r = 0·48, P < 0·01). Multiple linear regression analysis demonstrated that baPWV is independently correlated with age, fasting glucose and hs-CRP (P < 0·05), but does not predict PAT index. Each mg L(-1) increase in hs-CRP accounted for an increase in baPWV of +0·12 m s(-1) (95% confidence interval 0·01-0·22, P = 0·03).
Young patients with psoriasis have increased arterial stiffness but not microvascular dysfunction compared with healthy controls. More importantly, hs-CRP positively correlated with, and independently predicted, arterial stiffness. This suggests that systemic inflammation in patients with psoriasis is associated with premature atherosclerosis.
银屑病与动脉粥样硬化性疾病的发生密切相关，但其具体的发病机制尚未完全阐明。
本研究旨在探讨银屑病患者的疾病活动度与全身炎症反应、大血管及微血管功能之间的关系。
共纳入 52 例银屑病患者（平均年龄 44±8 岁，男性 38 例）和 50 例年龄、性别相匹配的健康对照者。记录所有受试者的基线特征及高敏 C 反应蛋白（hs-CRP）水平。采用银屑病面积和严重程度指数（PASI）评估银屑病患者的疾病活动度。采用臂踝脉搏波速度（baPWV）评估动脉僵硬度，采用外周动脉张力计（PAT）指数评估内皮功能。
与对照组相比，银屑病患者的 hs-CRP 水平显著升高[（5.3±5.1）mg/L 比（1.9±1.6）mg/L，P<0.01]，baPWV 亦显著升高[（14.5±2.5）m/s 比（13.2±1.6）m/s，P<0.01]，但 PAT 指数差异无统计学意义[（2.06±0.59）比（2.10±0.44），P=0.70]。hs-CRP 与 baPWV 呈显著正相关（r=0.51，P<0.01），与 PASI 呈显著正相关（r=0.48，P<0.01）。多元线性回归分析显示，baPWV 与年龄、空腹血糖和 hs-CRP 独立相关（P<0.05），但不能预测 PAT 指数。hs-CRP 每增加 1mg/L，baPWV 增加 0.12m/s[95%置信区间（CI）：0.01~0.22，P=0.03]。
与健康对照者相比，年轻的银屑病患者存在动脉僵硬度增加，但微血管功能正常。更为重要的是，hs-CRP 与动脉僵硬度呈正相关，并可独立预测动脉僵硬度。这提示银屑病患者的全身炎症与动脉粥样硬化的发生密切相关。
