Chan Alfred A, Li Houmin, Li Wendy, Pan Kathy, Yee Jennifer K, Chlebowski Rowan T, Lee Delphine J
Division of Dermatology, The Lundquist Institute, 1124 West Carson Street, Torrance, CA, 90503, USA.
Division of Dermatology, Peking University People's Hospital, Xicheng District, Beijing, China.
Arch Dermatol Res. 2022 Nov;314(9):869-880. doi: 10.1007/s00403-021-02298-9. Epub 2021 Nov 24.
Small-scale studies offer conflicting evidence regarding the relationship/association between psoriasis and insulin resistance by HOMA-IR (homeostasis model assessment of insulin resistance). The purpose of this study was to assess the association between baseline HOMA-IR and psoriasis incidence in a large-scale longitudinal cohort of postmenopausal women. The analysis included 21,789 postmenopausal women from the Women's Health Initiative. Psoriasis diagnosis was defined by fee-for-service Medicare ICD-9-CM codes assigned by dermatologists or rheumatologists, and a 2-year lookback period to exclude prevalent cases. Baseline HOMA-IR was calculated using the updated HOMA2 model. Hazard rates from the Cox regression models were stratified by age (10-year intervals), on WHI component (Clinical Trial or Observational Study), and on randomization status within each of the WHI clinical trials. The complete model also adjusted for ethnicity, waist-hip-ratio, and smoking and alcohol habits. Among participants free of psoriasis at entry, those with high baseline HOMA-IR (≥ 2) compared to low (< 1.4) had significantly higher risk for psoriasis over 21-year cumulative follow-up (HR: 1.39, 95% CI 1.08-1.79, P-trend: 0.011). In postmenopausal women, higher baseline HOMA-IR levels were significantly associated with higher incidence of psoriasis over 21-year cumulative follow-up. Results from this time-to-event analysis indicate that insulin resistance can precede and is associated with an increased risk of psoriasis. Study is limited by Medicare diagnostic code accuracy and cohort age.
小规模研究提供了关于银屑病与通过稳态模型评估胰岛素抵抗（HOMA-IR）得出的胰岛素抵抗之间关系/关联的相互矛盾的证据。本研究的目的是评估绝经后女性大规模纵向队列中基线HOMA-IR与银屑病发病率之间的关联。分析纳入了来自女性健康倡议组织的21789名绝经后女性。银屑病诊断由皮肤科医生或风湿病学家指定的按服务收费的医疗保险ICD-9-CM编码确定，并采用2年回顾期以排除现患病例。使用更新后的HOMA2模型计算基线HOMA-IR。Cox回归模型的风险率按年龄（10年间隔）、女性健康倡议组织的组成部分（临床试验或观察性研究）以及每个女性健康倡议组织临床试验中的随机分组状态进行分层。完整模型还对种族、腰臀比以及吸烟和饮酒习惯进行了调整。在入组时无银屑病的参与者中，与低基线HOMA-IR（<1.4）者相比，高基线HOMA-IR（≥2）者在21年的累积随访中患银屑病的风险显著更高（风险比：1.39，95%置信区间1.08 - 1.79，P趋势：0.011）。在绝经后女性中，较高的基线HOMA-IR水平与21年累积随访中银屑病的较高发病率显著相关。这项事件发生时间分析的结果表明，胰岛素抵抗可能先于银屑病出现并与其风险增加相关。研究受到医疗保险诊断编码准确性和队列年龄的限制。
