Department of Internal Medicine, Clinic of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Arch Dermatol Res. 2011 Aug;303(6):381-8. doi: 10.1007/s00403-010-1108-6. Epub 2010 Dec 18.
Severe psoriasis is associated with significant cardiovascular mortality. We therefore investigated the effects of systemic therapy on the cardiovascular risk of psoriasis patients. Thirteen consecutive patients receiving fumaric acid esters were included and followed for 24 weeks both clinically and by means of laboratory monitoring, 10 completed the study. Eight of ten patients showed a PASI-50 response. Two of three patients with clinical insulin resistance (Homeostasis Model Assessment of insulin resistance >2.5) showed normal insulin responsiveness at the end of the study. Clinical improvement was paralleled by a reduction of high-sensitive CRP serum levels (median -25%). There was a trend toward reduced serum levels for the vascular endothelial growth factor (median -10%) and resistin (median -4%), while the potentially cardio-protective adiponectin showed a trend toward increased serum levels under therapy (median +19%). Systemic endothelial function assessed by venous occlusion plethysmography revealed an improvement of endothelial vasodilator function after 24 weeks of treatment (p < 0.02). This is the first prospective study documenting an amelioration of endothelial cell function in patients with moderate-to-severe plaque-type psoriasis under effective continuous systemic therapy. Future studies need to compare the cardioprotective effects of different treatment modalities, based on hard end points such as the rate of myocardial infarction.
严重的银屑病与显著的心血管死亡率相关。因此，我们研究了全身治疗对银屑病患者心血管风险的影响。纳入了 13 例连续接受菝葜酸酯治疗的患者，并进行了 24 周的临床和实验室监测随访，10 例完成了研究。10 例患者中有 8 例达到 PASI-50 应答。3 例有临床胰岛素抵抗（稳态模型评估的胰岛素抵抗>2.5）的患者中，有 2 例在研究结束时胰岛素反应正常。临床改善与高敏 CRP 血清水平的降低（中位数-25%）平行。血管内皮生长因子（中位数-10%）和抵抗素（中位数-4%）的血清水平呈下降趋势，而潜在的心脏保护作用的脂联素在治疗过程中呈上升趋势（中位数+19%）。通过静脉闭塞容积描记法评估的全身内皮功能显示，治疗 24 周后内皮血管舒张功能得到改善（p<0.02）。这是第一项前瞻性研究，证明了在有效的连续全身治疗下，中重度斑块型银屑病患者的内皮细胞功能得到改善。未来的研究需要根据心肌梗死等硬终点来比较不同治疗方式的心脏保护作用。
