Study On The Clinical Characteristics And Potential Mechanisms Of Psoriasis Vulgaris With Overweight/Obesity

Objective1.To evaluate the prevalence of overweight/obesity in patients with psoriasis vulgaris(PV),analyze the clinical characteristics of PV patients with overweight/obesity,and explore the related factors of PV patients with overweight/obesity,so as to provide references for the prevention and personalized diagnosis and treatment program of Chinese and western medicine of PV patients with overweight/obesity.2.To explore the potential molecular regulatory mechanism of the interaction between psoriasis and obesity,so as to provide a theoretical basis and potential therapeutic targets for clinical and basic research on psoriasis combined with obesity.Methods1.A cross-sectional study was conducted.The study cases were from psoriasis vulgaris registered in the Psoriasis Chronic Disease Health Information Management System of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to December 2021.Data were collected including demographic indicators,anthropological parameters,living habits,comorbidities,psoriasis condition assessment,visual analogue scale,dermatology life quality index,psychological assessment,TCM syndrome and TCM constitution classification,etc.PV patients were divided into overweight/obesity group and non-overweight/obesity group according to body mass index(BMI)and abdominal circumference.The clinical data of the two groups were compared by t test,non-parametric test or χ2 test.Pearson or Spearman correlation test was used to analyze the correlation between BMI,abdominal circumference and the severity of psoriasis,etc.Logistic regression was used to analyze the related influencing factors of psoriasis vulgaris with overweight/obesity.2.Applying network pharmacological methods,the potential targets of psoriasis and obesity were obtained by searching CTD,DisGeNET,Drugbank,Genecards and OMIM disease target databases,and the relevant targets of each disease database were merged,and the repeated targets were eliminated to obtain the disease targets of the two diseases.The intersection targets of psoriasis and obesity were obtained by Venn diagram,and the intersection targets of the two were imported into the STRING platform to construct Protein Protein Interaction network,and GO biological process and KEGG enrichment analysis were performed.The CytoHubba plug-in of Cytoscape 3.8.1 software was used to calculate the top 30 core intersection target genes.Results1.The results of the cross-sectional study(1)A total of 1009 PV patients were included.According to the diagnostic criteria of BMI and abdominal circumference in China,524 PV patients(51.93%)were combined with overweight/obesity(including abdominal obesity).The prevalence of overweight and obesity were 32.51%and 10.80%,respectively,and the prevalence of abdominal obesity was 41.63%.(2)Compared with 485 non-overweight/obesity PV patients(48.07%),the proportion of men in PV patients with overweight/obesity was higher(76.15%vs 52.78%,P<0.05),the average age was older([41.59± 13.53]years vs[37.27±13.26]years,P<0.001),the proportion of middle-aged people(45～59 years old)was higher(24.24%vs 18.35%,P<0.05),the proportion of married people was higher(73.85%vs 60.41%,P<0.05),the proportion of students was lower(3.44%vs 7.63%,P<0.05),the proportion of occasional drinkers was higher(16.98%vs 11.96%,P<0.05),the median PASI score was higher(4.20[2.20,7.20]vs 3.50[1.80,5.60],P<0.001),the proportion of severe patients was higher(13.93%vs 8.66%,P<0.05),the median BSA score was higher(4.50[1.90,11.65]vs 3.80[1.60,8.40],P<0.05),and the median PGA score was higher(4.00[3.00,5.00]vs 3.00[2.00,5.00],P<0.01).There were no significant differences in the course of disease,stages of disease,VAS score,total DLQI score,SAS standard score,SDS standard score,level of anxiety and depression between the two groups(P>0.05).(3)Spearman correlation analysis showed that there was a positive correlation between BMI,abdominal circumference and PASI score([r=0.110,P<0.001]&[r=0.158,P<0.001]),BSA score([r=0.075,P<0.05]&[r=0.110,P<0.05])and PGA score([r=0.081,P<0.05]&[r=0.140,P<0.001])of PV patients;Pearson correlation analysis showed that there was no statistical correlation between BMI,abdominal circumference and VAS score,total DLQI score and SDS standard score(P>0.05),but there was a positive correlation between abdominal circumference and SAS standard score(r=0.063,P<0.05).(4)The concomitant diseases of PV patients with overweight/obesity were common in digestive system diseases(19.27%),respiratory system diseases(16.22%),metabolic diseases(12.21%)and cardiovascular and cerebrovascular diseases(10.11%);Compared with non-overweight/obesity PV patients,there was no significant difference in the composition of various concomitant diseases between the two groups(P>0.05).(5)The main TCM syndrom of PV patients with overweight/obesity were blood dryness syndrome(48.66%)and blood stasis syndrome(40.27%),of which the proportion of blood stasis syndrome was significantly higher than that of non-overweight/obesity PV patients(40.27%vs 28.04%,P<0.05),and median of the PASI score(5.10[2.90,9.10]vs 3.20[1.60,5.20],P<0.001),BSA score(5.50[2.10,13.00]vs 3.70[1.50,8.50],P<0.001)and PGA score(4.00[3.00,5.00]vs 3.00[2,00,4.00],P<0.001)of blood stasis syndrome were higher than those of blood dryness syndrome.(6)The main TCM constitution of PV patients with overweight/obesity were mainly biased(71.95%),and the proportion of biased constitution was damp-heat constitution(15.65%)>Qi-deficiency constitution(14.12%)>yang-deficiency constitution(10.50%)>phlegm-dampness constitution(8.78%)>yin-deficiency constitution(7.44%)>special constitution(5.73%)>blood-stasis constitution(4.96%)>Qi-stagnation constitution(4.77%);The proportion of yang-deficiency constitution(15.20%vs 9.02%,P<0.05),blood-stasis constitution(13.60%vs 2.26%,P<0.05)in women was higher than that in men,and the proportion of damp-heat constitution(8.78%vs 2.27%,P<0.05)in men was higher than that in women;And he proportion of phlegm-dampness constitution was significantly higher than that of non-overweight/obesity PV patients(8.78%vs 2.27%,P<0.05).(7)After adjusting for confounding factors such as age,occupation and disease severity,the results of multivariate Logistic regression analysis showed that the related influencing factors of overweight/obesity in PV patients included:Phlegm-dampness quality(OR:3.082,95%CI[1.456,6.521],P<0.05),male(OR:2.709,95%CI[1.987,3.692],P<0.001),married(OR:1.688,95%CI[1.193,2.389],P<0.01),occasional drinking(OR:1.628,95%CI[1.102,2.403],P<0.05).2.The results of the network pharmacologyA total of 694 intersection target genes common to psoriasis and obesity were screened from the related disease target databases.The key biological processes involved in the intersection target genes of psoriasis and obesity mainly included regulation of cell population proliferation,response to lipid,positive regulation of metabolic process,response to stimulus,response to external stimulus,cellular response to stimulus,cellular response to chemical stimulus,response to endogenous stimulus,and response to stress,etc;KEGG enrichment analysis showed that the common key signaling pathways were mainly involved in TNF signaling pathway,IL-17 signaling pathway,AGE-RAGE signaling pathway in diabetic complications,pathways in cancer,PI3K-Akt signaling pathway,MAPK signaling pathway,cytokine-cytokine receptor interaction,osteoclast differentiation,and insulin resistance,etc.The CytoHubba calculation results showed that the top 30 core intersection target genes with degrees were INS,GAPDH,IL6,AKT1,ALB,TNF,TP53,VEGFA,MAPK3,EGFR,STAT3,MYC,EGF,MAPK1,MAPK8,JUN,CXCL8,CASP3,FN1,IL1B,MMP9,IL10,CCL2,TLR4,IGF1,PTGS2,CCND1,IL4,ESR1,LEP.Conclusion1.The prevalence of overweight/obesity is high in PV patients,especially abdominal obesity.2.The severity of PV patients with overweight/obesity is significantly worse than that of non-overweight/obesity patients,and BMI,abdominal circumference are positively correlated with the severity of PV patients.3.The main types of TCM syndrome in PV patients with overweight/obesity are blood stasis syndrome and blood dryness syndrome.Compared with non-overweight/obesity PV patients,PV patients with overweight/obesity are more inclined to form blood stasis syndrome,and the severity of blood stasis syndrome is more serious than blood dryness syndrome.4.The TCM constitution of PV patients with overweight/obesity is mainly biased constitution,most commonly in damp-heat constitution,Qi-deficiency constitution,yang-deficiency constitution and phlegm-dampness constitution.The constitution distribution has differences in gender.5.Phlegm-dampness constitution,male,married and occasional drinking are the influencing factors of PV patients with overweight/obesity.6.Psoriasis and obesity share key signaling pathways.related to immune inflammation,endocrine and metabolism such as TNF signaling pathway,IL-17 signaling pathway and AGE-RAGE signaling pathway in diabetic complications;The overlapping core target genes mainly include inflammatory cytokines,chemokines and growth factors such as TNF,IL6,IL1B,CXCL8,CCL2,VEGFA and EGF.