Khalid Usman, Egeberg Alexander, Ahlehoff Ole, Smedegaard Laerke, Gislason Gunnar Hilmar, Hansen Peter Riis
From the Department of Cardiology (U.K., O.A., L.S., G.H.G., P.R.H.), Department of Dermatology (A.E.), Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark (O.A.); National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (G.H.G., P.R.H.); and Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.).
Arterioscler Thromb Vasc Biol. 2016 May;36(5):1043-8. doi: 10.1161/ATVBAHA.116.307449. Epub 2016 Apr 14.
Abdominal aortic aneurysm (AAA) is a complex multifactorial disease associated with a high morbidity and mortality. Increased inflammation including T-helper 17 cell-mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a T-helper 17-driven chronic inflammatory disease and in view of potentially overlapping inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a nationwide cohort.
The study comprised all Danish residents aged ≥18 years followed up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AAA were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications, socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5 495 203 subjects were eligible for analysis. During the study period, we identified 59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis. The overall incidence rates of AAA were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The corresponding adjusted incidence rate ratios for AAA were increased in patients with psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.03-1.39) and 1.67 (confidence interval, 1.21-2.32) for subjects with mild and severe disease, respectively.
In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AAA. The mechanisms and consequences of this novel finding require further investigation.
腹主动脉瘤（AAA）是一种复杂的多因素疾病，发病率和死亡率都很高。包括辅助性T细胞17（Th17）细胞介导的效应在内的炎症增加与AAA的发病机制有关。银屑病被认为是一种由Th17驱动的慢性炎症性疾病，鉴于可能存在重叠的炎症机制，我们在一个全国性队列中研究了银屑病患者发生AAA的风险。
该研究纳入了所有年龄≥18岁的丹麦居民，随访时间从1997年1月1日至2011年12月31日，随访终点为AAA诊断、移民或死亡。通过行政登记册的个体层面链接确定合并症、伴随用药和社会经济状况信息。计算AAA的发病率，并在泊松回归模型中估计调整了年龄、性别、合并症、用药、社会经济状况和吸烟因素后的发病率比。共有5495203名受试者符合分析条件。在研究期间，我们确定了59423例轻度银屑病患者和11566例重度银屑病患者。参考人群（23696例）、轻度银屑病（240例）和重度银屑病（50例）的AAA总体发病率分别为每10000人年3.72例、7.30例和9.87例。银屑病患者AAA的相应调整发病率比增加，轻度和重度疾病患者的发病率比分别为1.20（95%置信区间，1.03 - 1.39）和1.67（置信区间，1.21 - 2.32）。
在一个全国性队列中，银屑病与疾病严重程度相关的AAA风险增加有关。这一新发现的机制和后果需要进一步研究。
