银屑病患者慢性应激相关神经活动、生理失调与冠状动脉疾病的关系：一项纵向观察队列研究的结果。
Relationship between chronic stress-related neural activity, physiological dysregulation and coronary artery disease in psoriasis: Findings from a longitudinal observational cohort study.
机构信息
Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
Atherosclerosis. 2020 Oct;310:37-44. doi: 10.1016/j.atherosclerosis.2020.07.012. Epub 2020 Jul 29.
BACKGROUND AND AIMS
Amygdalar 18F-fluorodeoxyglucose (FDG) uptake represents chronic stress-related neural activity and associates with coronary artery disease by coronary computed tomography angiography (CCTA). Allostatic load score is a multidimensional measure related to chronic physiological stress which incorporates cardiovascular, metabolic and inflammatory indices. To better understand the relationship between chronic stress-related neural activity, physiological dysregulation and coronary artery disease, we studied the association between amygdalar FDG uptake, allostatic load score and subclinical non-calcified coronary artery burden (NCB) in psoriasis.
METHODS
Consecutive psoriasis patients (n = 275 at baseline and n = 205 at one-year follow-up) underwent CCTA for assessment of NCB (QAngio, Medis). Amygdalar FDG uptake and allostatic load score were determined using established methods.
RESULTS
Psoriasis patients were middle-aged, predominantly male and white, with low cardiovascular risk by Framingham risk score and moderate-severe psoriasis severity. Allostatic load score associated with psoriasis severity (β = 0.17, p = 0.01), GlycA (a systemic marker of inflammation, β = 0.49, p < 0.001), amygdalar activity (β = 0.30, p < 0.001), and NCB (β = 0.39; p < 0.001). Moreover, NCB associated with amygdalar activity in participants with high allostatic load score (β = 0.27; p < 0.001) but not in those with low allostatic load score (β = 0.07; p = 0.34). Finally, in patients with an improvement in allostatic load score at one year, there was an 8% reduction in amygdalar FDG uptake (p < 0.001) and a 6% reduction in NCB (p = 0.02).
CONCLUSIONS
In psoriasis, allostatic load score represents physiological dysregulation and may capture pathways by which chronic stress-related neural activity associates with coronary artery disease, emphasizing the need to further study stress-induced physiological dysregulation in inflammatory disease states.
背景和目的
杏仁核 18F-氟脱氧葡萄糖（FDG）摄取代表与冠状动脉疾病相关的慢性应激相关神经活动，通过冠状动脉计算机断层扫描血管造影术（CCTA）进行评估。全身性应激负荷评分是一种与慢性生理应激相关的多维测量方法，包含心血管、代谢和炎症指标。为了更好地理解慢性应激相关神经活动、生理失调与冠状动脉疾病之间的关系，我们研究了银屑病患者杏仁核 FDG 摄取、全身性应激负荷评分与亚临床非钙化性冠状动脉负荷（NCB）之间的关系。
方法
连续的银屑病患者（基线时 n=275，一年随访时 n=205）接受 CCTA 评估 NCB（QAngio，Medis）。使用既定方法测定杏仁核 FDG 摄取和全身性应激负荷评分。
结果
银屑病患者为中年，主要为男性和白人，根据 Framingham 风险评分，心血管风险低，银屑病严重程度为中重度。全身性应激负荷评分与银屑病严重程度相关（β=0.17，p=0.01），与 GlycA（一种全身性炎症标志物，β=0.49，p<0.001）、杏仁核活性（β=0.30，p<0.001）和 NCB（β=0.39；p<0.001）相关。此外，在全身性应激负荷评分高的参与者中，NCB 与杏仁核活性相关（β=0.27；p<0.001），而在全身性应激负荷评分低的参与者中，两者不相关（β=0.07；p=0.34）。最后，在一年时全身性应激负荷评分改善的患者中，杏仁核 FDG 摄取减少 8%（p<0.001），NCB 减少 6%（p=0.02）。
结论
在银屑病中，全身性应激负荷评分代表生理失调，可能揭示了慢性应激相关神经活动与冠状动脉疾病相关的途径，强调了需要进一步研究炎症性疾病状态下应激引起的生理失调。
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