Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA Dermatol. 2013 Oct;149(10):1173-9. doi: 10.1001/jamadermatol.2013.5015.
Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity.
To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study of patient data from United Kingdom-based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without psoriasis.
Prevalence of major medical comorbidity included in the Charlson comorbidity index.
Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05).
The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.
尽管关于银屑病合并症风险的文献不断增加，但仍存在一个关键的知识空白，即客观测量的银屑病严重程度在多大程度上会影响主要医疗合并症的患病率。
根据身体表面积受累情况，对轻度、中度或重度银屑病患者进行客观分类，并与无银屑病患者进行比较，以检查这些患者中主要医疗合并症的患病率。
设计、设置和参与者：这是一项基于英国电子病历的患者数据的人群横断面研究；分析纳入了 9035 名年龄在 25 至 64 岁之间的银屑病患者和 90350 名年龄和实践相匹配的无银屑病患者。
包括 Charlson 合并症指数在内的主要合并症的患病率。
在银屑病患者中，分别有 51.8%、35.8%和 12.4%的患者根据身体表面积标准患有轻度、中度或重度疾病。轻度（0.375 对 0.347）、中度（0.398 对 0.342）或重度（0.450 对 0.348）银屑病患者的平均 Charlson 合并症指数均逐渐升高（均 P<.05）。总体而言，银屑病与慢性肺部疾病（调整后的优势比，1.08；95%CI，1.02-1.15）、糖尿病（1.22；1.11-1.35）、糖尿病伴系统并发症（1.34；1.11-1.62）、轻度肝脏疾病（1.41；1.12-1.76）、心肌梗死（1.34；1.07-1.69）、消化性溃疡疾病（1.27；1.03-1.58）、外周血管疾病（1.38；1.07-1.77）、肾脏疾病（1.28；1.11-1.48）和风湿性疾病（2.04；1.71-2.42）的患病率更高。趋势分析显示，银屑病严重程度与上述每一种合并症均呈显著相关（均 P<.05）。
银屑病患者的总体医疗合并症负担以及特定合并症的负担随着疾病严重程度的增加而增加。医生在为银屑病患者提供全面护理时应注意到这些关联，尤其是那些患有更严重疾病的患者。
