Clinical Characteristics And TCM Syndromes Of Psoriasis Vulgaris Combined With Obesity And Discussion On Its Pathogenesi

BackgroundResearch has shown that psoriasis is not only a chronic inflammatory skin disease,but also a chronic inflammatory systemic disease.Psoriasis is often accompanied by cardiovascular disease,obesity,diabetes,non-alcoholic fatty liver and other multi system diseases.Among them,obesity has been proven to be an independent risk factor for the onset of psoriasis vulgaris.Obesity not only reduces the clinical efficacy of psoriasis,but also increases the probability of adverse events after drug treatment.After weight loss,psoriasis patients can significantly improve their skin lesions and quality of life.At present,clinical studies on obesity and psoriasis are mainly concentrated in developed countries such as Europe and the United States,focusing on epidemiological surveys.Among them,there are few epidemiological studies on the incidence rate of obesity among Chinese people with psoriasis,especially on the etiology and pathogenesis of TCM,the distribution of TCM syndrome,and the pathogenesis,which greatly hinders the prevention,management,diagnosis and treatment progress of psoriasis vulgaris combined with obesity in China.ObjectiveExplore the correlation and pathogenesis between psoriasis vulgaris and obesity,clarify the prevalence of obesity in adult psoriasis vulgaris patients in China,describe the clinical characteristics of psoriasis vulgaris patients with overweight/obesity,and analyze the distribution pattern of TCM syndrome in psoriasis vulgaris patients with obesity;Exploring the common inflammatory factor pathway of psoriasis vulgaris combined with obesity,search for the connection mechanism between psoriasis vulgaris and obesity,and provide a basis for in-depth understanding of the pathogenesis of psoriasis vulgaris combined with obesity from multiple perspectives and improving clinical diagnosis and treatment.MethodsUsing a dual center observational cross-sectional study method,we analyzed the differences in obesity prevalence between Chinese adult psoriasis vulgaris patients and healthy controls.Collect basic information and clinical data of psoriasis vulgaris patients,and divide them into two groups based on BMI values:overweight/obese psoriasis patients group and normal weight psoriasis patients group.Compare the basic information and clinical characteristics of the two groups of patients,and summarize the clinical characteristics of psoriasis vulgaris patients with combined overweight/obesity.Investigate the TCM symptoms,pulse manifestation and coated tongue of patients with psoriasis vulgaris combined with obesity,and analyze the characteristics of TCM syndrome of patients with psoriasis vulgaris combined with obesity through frequency calculation and cluster analysis.Collect blood from patients with psoriasis vulgaris and healthy individuals,and compare the differences in inflammatory factor levels among obese psoriasis patients,simple psoriasis patient group,and healthy control groups through experimental methods.Clarify the correlation between the inflammatory factor levels and BMI,as well as the severity of psoriasis skin lesions,and explore new pathways for the pathogenesis of psoriasis vulgaris combined with obesity.Results1.A total of 829 patients with psoriasis vulgaris were included in this study,including 619 males(74.67%)and 210 females(25.33%).There are a total of 1136 healthy control group cases,including 881 males(77.55%)and 255 females(22.45%).There was no significant difference in gender and age distribution between the two groups of patients(P>0.05).Among 829 patients with psoriasis vulgaris,124 cases were obese,and the obesity incidence rate was 15.08%.Among the healthy control group,102 cases were obese,and the obesity incidence rate was 8.98%.There was a significant difference in the obesity incidence rate between the two groups through statistical analysis(P<0.001),that is,the obesity incidence rate of psoriasis vulgaris patients was significantly higher than that of healthy control group.2.The basic information and clinical data of 618 adult patients with psoriasis vulgaris were collected,and they were divided into overweight/obesity psoriasis patients group(333 cases)and normal weight psoriasis patients group(285 cases)according to BMI value.There were no significant differences between the two groups in age,gender,disease course distribution,family history of psoriasis,smoking history and drinking history(P>0.05).In terms of the distribution of skin lesions,overweight/obese psoriasis patients are more likely to have skin lesions in the palmar and plantar areas(P<0.05),and are more prone to changes in psoriasis nails(P<0.05).By comparing the BSA and PASI scores of two groups of patients,and analyzing the correlation between BMI values and BSA,PASI score,it was found that the BSA(P<0.05)and PASI score of overweight/obese psoriasis patients were higher than those of normal weight psoriasis patients.At the same time,BMI value and PASI score were positively correlated(P<0.05),but not with BSA(P>0.05),The severity of skin lesions in psoriasis vulgaris patients with combined overweight/obesity aggravated with an increase in BMI value.3.In other system complications and laboratory examination indicators,the proportion of overweight/obese psoriasis patients with fatty liver(P<0.001),hyperlipidemia(P<0.001),hyperuricemia(P<0.001),hypertension(P=0.007),coronary heart disease(P=0.037),abnormal liver function(P<0.001),and liver cysts(P=0.013)was significantly higher than that of normal weight psoriasis patients.The level of uric acid(P<0.001),total cholesterol(P=0.048),triglycerides(P<0.001),low-density lipoprotein(P=0.034),fasting blood glucose(P<0.001)and other indicators in the overweight/obese psoriasis group were significantly higher than those in the normal weight psoriasis group,while the level of serum high-density lipoprotein(P=0.001)and complement 3(P=0.003)were relatively low.4.108 patients with psoriasis vulgaris combined with obesity(BMI≥30)were mainly divided into 5 types of TCM syndrome:spleen and kidney deficiency combined with phlegm dampness,liver depression and spleen deficiency,spleen deficiency and dampness excess,qi deficiency,internal dampness and heat accumulation combined with qi deficiency.The main syndrome differentiation of viscera is the multiple deficiencies of the liver,spleen,and kidney,with spleen deficiency being the main one,and damp heat,phlegm dampness,and qi deficiency coexisting,indicating a combination of deficiency and excess.5.The serum levels of leptin,resistin,and visfatin were ranked from high to low in the obese psoriasis patient group,simple psoriasis patient group,and healthy control group.There was a statistical difference among the three groups(P<0.05),while adiponectin levels were reduced in both the simple psoriasis patient group and the obese psoriasis patient group,especially in the obese psoriasis patient group.There was also a statistical difference among the three groups(P<0.05).The correlation analysis between adipose factor levels and BMI value and PASI score in patients with psoriasis vulgaris showed that serum leptin,resistin,and visfatin levels were positively correlated with BMI value(P<0.05),while serum adiponectin levels were negatively correlated with BMI value(P<0.05).The levels of serum leptin and resistin were positively correlated with PASI score(P<0.05),while the levels of serum adiponectin and visfatin were not correlated with PASI score(P>0.05).6.Compared to the healthy control group,serum LRG1 and TGF-β,IL-17 level increased in the group of simple psoriasis patient group,and the increase was more significant in the group of obese psoriasis patients(P<0.05).The correlation analysis was conducted between LRG1,TGF-β,IL-17 levels and BMI value,as well as PASI score,and the results showed that serum LRG1,TGF-β and IL-17 were positively correlated with BMI and PASI score(P<0.05).Conclusions1.Compared with healthy people,patients with psoriasis vulgaris have a higher incidence rate of obesity.2.Patients with psoriasis vulgaris who are overweight/obese often have more severe psoriasis skin lesions and are prone to combined with metabolic diseases and immune dysfunction.3.The TCM syndrome types of patients with psoriasis vulgaris include spleen and kidney deficiency combined with phlegm dampness,liver depression and spleen deficiency,spleen deficiency and dampness excess,qi deficiency,internal dampness and heat accumulation combined with qi deficiency.The key location of the disease is in the spleen,and the key pathogenesis is dampness and heat,which is also accompanied by the syndrome of liver and kidney deficiency.4.The serum levels of leptin,visfatin,and resistin in the obese psoriasis patients group were higher than those in the simple psoriasis patient group,while the serum adiponectin levels were lower than those in the simple psoriasis patient group,indicating that the expression of serum adipocytokines may be related to obesity.The levels of leptin and resistin in serum adipose factors are positively correlated with PASI score,indicating a close relationship between obesity and the onset of psoriasis vulgaris.Psoriasis and obesity may share a common inflammatory pathway,and adipose factors may be an important pathological mechanism linking obesity and psoriasis vulgaris,and can exacerbate the severity of skin lesions in psoriasis vulgaris.5.Serum LRG1,TGF-β and IL-17 in obese psoriasis patients were higher than those of simple psoriasis patient group,and LRG1,TGF-β,IL-17 level were positively correlated with BMI value and PASI score,indicating that the LRG1 signaling pathway may be involved in the occurrence and development of psoriasis vulgaris and obesity,and has certain reference value for evaluating the severity of psoriasis.The LRG1 signaling pathway is a new pathway with potential and research value in the study of the pathogenesis of psoriasis vulgaris combined with obesity.