Pirro Matteo, Stingeni Luca, Vaudo Gaetano, Mannarino Massimo R, Ministrini Stefano, Vonella Marilisa, Hansel Katharina, Bagaglia Francesco, Alaeddin Abdalkader, Lisi Paolo, Mannarino Elmo
Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
Unit of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Italy.
Eur J Prev Cardiol. 2015 Aug;22(8):1027-35. doi: 10.1177/2047487314538858. Epub 2014 Jun 6.
Systemic inflammation and imbalance between endothelial injury and repair, the latter referred to as vascular incompetence, are associated with atherosclerosis and cardiovascular risk. Psoriasis, an inflammatory disease of the skin, has been associated with atherosclerosis. We investigated whether, in psoriasis, inflammation and vascular incompetence are associated with carotid intima-media thickness (cIMT) irrespective of metabolic syndrome and other established cardiovascular risk factors.
High sensitivity C-reactive protein (hsCRP), the ratio between endothelial microparticles (EMPs) and progenitors (EPCs), a marker of vascular incompetence, and cIMT were measured in 84 patients with psoriasis and 90 healthy controls, balanced for age, gender and the prevalence of metabolic syndrome.
Patients with psoriasis had higher hsCRP, EMP/EPC ratio and cIMT than controls. Patients with both psoriasis and metabolic syndrome had the highest hsCRP levels, psoriasis and metabolic syndrome being associated with a 3.1- and 2.6-fold increased risk of having high hsCRP levels, respectively. Logarithm transformed hsCRP and EMP/EPC ratio were predictors of high cIMT (odds ratio 3.8; 95% confidence interval 1.3-11.4; p = 0.02 and odds ratio 8.7; 95% confidence interval 2.7-27.5; p < 0.001, respectively) regardless of confounders. Patients with high hsCRP and EMP/EPC ratio had higher cIMT than those with none or at least one of risk variable.
Patients with psoriasis have an increased burden of cardiovascular risk, including inflammation, vascular incompetence and early atherosclerosis. Increased hsCRP levels, possibly sustained by the inflammatory nature of psoriasis and metabolic syndrome, and vascular incompetence are associated with early carotid atherosclerosis, regardless of metabolic syndrome and other established cardiovascular risk factors.
全身炎症以及内皮损伤与修复之间的失衡（后者称为血管功能不全）与动脉粥样硬化和心血管风险相关。银屑病是一种皮肤炎症性疾病，与动脉粥样硬化有关。我们研究了在银屑病患者中，炎症和血管功能不全是否与颈动脉内膜中层厚度（cIMT）相关，而不考虑代谢综合征和其他已确定的心血管危险因素。
在84例银屑病患者和90例健康对照者中测量了高敏C反应蛋白（hsCRP）、血管功能不全标志物内皮微粒（EMPs）与祖细胞（EPCs）的比率以及cIMT，在年龄、性别和代谢综合征患病率方面进行了平衡。
银屑病患者的hsCRP、EMP/EPC比率和cIMT均高于对照组。同时患有银屑病和代谢综合征的患者hsCRP水平最高，银屑病和代谢综合征分别使hsCRP水平升高的风险增加3.1倍和2.6倍。对数转换后的hsCRP和EMP/EPC比率是高cIMT的预测指标（优势比分别为3.8；95%置信区间1.3 - 11.4；p = 0.02和优势比8.7；95%置信区间2.7 - 27.5；p < 0.001），不受混杂因素影响。hsCRP和EMP/EPC比率高的患者比无风险变量或至少有一个风险变量的患者cIMT更高。
银屑病患者心血管风险负担增加，包括炎症、血管功能不全和早期动脉粥样硬化。hsCRP水平升高，可能由银屑病和代谢综合征的炎症性质所维持，以及血管功能不全与早期颈动脉粥样硬化相关，而不考虑代谢综合征和其他已确定的心血管危险因素。
