El Safoury Omar Soliman, Ezzat Marwa, Abdelhamid Mahmoud F, Shoukry Nadia, Badawy Ehssan
Department of Dermatology, Cairo University, Cairo, Egypt.
Indian J Dermatol. 2013 Jul;58(4):326. doi: 10.4103/0019-5154.113947.
Skin tags (STs) are small, pedunculated skin-colored or brown papules that occur around any site where skin folds occur. The literature is short of comprehensive and controlled clinical studies aimed to evaluate the atherogenic risk factors in patients with STs.
The aim of this study is to evaluate the impact of age, STs, metabolic syndrome (METs), body mass index (BMI), and smoking on homocysteine (Hcy), endothelin-1 (ET-1), high-sensitive C-reactive protein (Hs-CRP), and on cardiovascular diseases.
This study included 30 cardiac patients with STs, 30 non-cardiac patients with STs, and 30 healthy controls with neither heart disease nor STs. History of smoking, measurement of height, weight, BMI, waist circumference (WC), blood pressure, STs number, color, acanthosis nigricans, estimation of serum level of fasting glucose, triglycerides (TGs), cholesterol, high-dense lipoproteins (HDL), Hcy, ET-1, Hs-CRP, and the presence of the METs were elicited in the three groups.
Regarding the Hcy, ET-1, and Hs-CRP, the cardiac-STs group showed the highest levels and the control group showed the least (P < 0.001). The percents of patients with METs were 56.7% in the cardiac-STs, 40% in the non-cardiac-STs, and 0% in the control group (P < 0.001). Mean BMI exceeded the limit of obesity in the cardiac-STs group (30.9 ± 3.9) and the non-cardiac-STs group (32.6 ± 6) and was normal in the control group (24.7 ± 2.8). Hyperpigmented STs were present in 66.7% of the cardiac-STs group. Multivariate regression analysis for the independent effectors on Hcy level were the presence of STs (P < 0.001), METs (P = 0.001), and BMI (P = 0.024). Regarding ET-1, the effectors were the presence of STs and METs (P = 0.032). For Hs-CRP, effectors were the presence of STs (P < 0.001) and smoking (P = 0.040). Multivariate logistic regression of the predictors of cardiac disease showed that the independent predictors of the occurrence of cardiac disease were BMI (P < 0.001), STs (P = 0.002), and METs (P = 0.037).
STs may act as a physical sign of underlying raised cardiac atherogenic factors. This may indicates an ongoing risk on coronary circulation which may indicate further corrective action, hopefully early enough. The association of ST with obesity and METs represents a Bermuda Triangle that act against the heart.
皮肤软纤维瘤（STs）是一种小的、带蒂的皮肤色或棕色丘疹，出现在任何有皮肤褶皱的部位。目前文献中缺乏旨在评估皮肤软纤维瘤患者动脉粥样硬化危险因素的全面且有对照的临床研究。
本研究旨在评估年龄、皮肤软纤维瘤、代谢综合征（METs）、体重指数（BMI）和吸烟对同型半胱氨酸（Hcy）、内皮素-1（ET-1）、高敏C反应蛋白（Hs-CRP）以及心血管疾病的影响。
本研究纳入30例患有皮肤软纤维瘤的心脏病患者、30例患有皮肤软纤维瘤的非心脏病患者以及30例既无心脏病也无皮肤软纤维瘤的健康对照者。收集三组患者的吸烟史、身高、体重、BMI、腰围（WC）、血压、皮肤软纤维瘤数量、颜色、黑棘皮病情况，测定空腹血糖、甘油三酯（TGs）、胆固醇、高密度脂蛋白（HDL）、Hcy、ET-1、Hs-CRP的血清水平以及是否存在代谢综合征。
关于Hcy、ET-1和Hs-CRP，心脏病合并皮肤软纤维瘤组水平最高，对照组最低（P < 0.001）。代谢综合征患者百分比在心脏病合并皮肤软纤维瘤组为56.7%，非心脏病合并皮肤软纤维瘤组为40%，对照组为0%（P < 0.001）。心脏病合并皮肤软纤维瘤组（30.9 ± 3.9）和非心脏病合并皮肤软纤维瘤组（32.6 ± 6）的平均BMI超过肥胖界限，对照组正常（24.7 ± 2.8）。66.7%的心脏病合并皮肤软纤维瘤组存在色素沉着的皮肤软纤维瘤。对影响Hcy水平的独立因素进行多变量回归分析，结果显示为皮肤软纤维瘤的存在（P < 0.001）、代谢综合征（P = 0.00）和BMI（P = 0.024）。对于ET-1，影响因素为皮肤软纤维瘤和代谢综合征的存在（P = 0.032）。对于Hs-CRP，影响因素为皮肤软纤维瘤的存在（P < 0.001）和吸烟（P = 0.040）。心脏病预测因素的多变量逻辑回归显示，心脏病发生的独立预测因素为BMI（P < 0.001）、皮肤软纤维瘤（P = 0.002）和代谢综合征（P = 0.037）。
皮肤软纤维瘤可能是潜在的心脏动脉粥样硬化因素升高的体征。这可能表明冠状动脉循环存在持续风险，这可能提示需要尽早采取进一步的纠正措施。皮肤软纤维瘤与肥胖和代谢综合征的关联构成了一个对心脏不利的“百慕大三角”。
