A Prospective Study On Psoriasis With Metabolic Syndrome And Its Related Factors

BackgroundPsoriasis is an immune-mediated, polygenic skin disease. The prevalence of psoriasis is different very much due to race, environment, geographic location and other factors, and some factors such as spirit, trauma, infection, cold, wet and drugs may be triggered factors for it. Large-scale epidemiological survey in the eighties in the twentieth century found that the prevalence of psoriasis is0.123%in china, but recent studies indicate that the prevalence of the disease is increasing. With the deepening studies of many researchers for the disease, psoriasis is not only a skin disorder but also a positive impact on many organ systems, and it has a close relationship with metabolic syndrome. As an abnormal metabolism of a variety of pathological conditions, metabolic syndrome (MS) is a risk factor for cardiovascular disease (CVD) and other metabolic diseases. And it has close links to many diseases related metabolism.The pathogenesis of psoriasis with metabolic syndrome is more complex, and the exact mechanism is still not clear. Some cytokines such as tumor necrosis factor-α(TNF--α), interleukin-1,2,6,8,18(IL-1,2,6,8,18), adiponectin play important roles in the pathogenesis of psoriasis with metabolic syndrome. Under the joint action of these pro-inflammatory cytokines, psoriasis combines with metabolic syndrome through a common mechanism associating with chronic inflammation. In addition, psoriasis and metabolic syndrome maybe have the same susceptible genes for example CDKAL1and so on.After the International Diabetes Federation (IDF) gave a new definition to metabolic syndrome in2005, more and more people studied the disease.In recent years, epidemiological and experimental studies have found that patients with psoriasis have increasing risks of obesity, hypertension, hyperglycemia, hyperlipidemia, and atherosclerotic CVD, so psoriasis with metabolic syndrome has become a hot topic in dermatology.Extensive epidemiological data show that the prevalence of metabolic syndrome is higher in patients with psoriasis than that in the general population. A survey to representative sample of the U.S. population revealed up to40%of the prevalence of metabolic syndrome in patients with psoriasis. Langan and his coworkers did epidemiological studies related to the correlation between psoriasis and metabolic syndrome in the United Kingdom, and their results showed that their correlation enhanced with increasing severity of every separate component of metabolic syndrome. Many scholars of Japan, India and Korea also did researches in psoriasis with metabolic syndrome, and found that the prevalence of psoriasis with metabolic syndrome were24.4%,44.1%and17.8%, respectively.Many successful studies have also been made in the epidemiology, risk factors, clinical features and some related cytokines of psoriasis with metabolic syndrome. Basic researches and clinical retrospective analyses are the vast majority studies in the correlation between psoriasis and metabolic syndrome. Prospective clinical studies are very rare in patients with psoriasis and metabolic syndrome, but they are very important and significant, because they not only provide more theoretical basis for the majority of the scientific research workers, but also provide more reasonable solutions for clinicians when they treat the patients with psoriasis.To further investigate the pathogenesis of psoriasis with metabolic syndrome, to clarify effect of gender, age, disease duration, smoking, alcohol consumption and other factors on psoriasis with metabolic syndrome, to explain effect of psoriasis patients with metabolic syndrome on hyperuricemia, levels of creatinine and blood urea nitrogen and renal function, We carried out a clinical prospective study on426cases of psoriasis who hospitalized in Shandong Provincial Hospital of Skin Disease Affiliated to Shandong University. The results of our study will have great significance to elucidate the prevalence of psoriasis with metabolic syndrome in Shandong Province, the pathogenesis of psoriasis with metabolic syndrome, and effect of psoriasis with metabolic syndrome on the patient’s physiology. And then, some measures will be taken to prevent or decrease the prevalence of psoriasis with metabolic syndrome in our area, to prevent or decrease the impairment or failure of renal function.Objective1. To research the prevalence of psoriasis with metabolic syndrome.2. To expound the pathogenesis of psoriasis with metabolic syndrome.3. To nvestigate factors Related to inducing psoriasis with metabolic syndrome.4. To analyze impact on patients’ health after psoriasis with metabolic syndrome.Methods1. Study objects:This study analyzed426cases of psoriasis who hospitalized in Shandong Provincial Hospital of Skin Disease Affiliated to Shandong University. While selecting453healthy subjects as control group from Health Management Center, Qianfoshan Hospital Affiliated to Shandong University in05/2013-05/2014.2. Diagnostic criteria for psoriasis and metabolic syndrome:Diagnostic criteria of psoriasis was made according to Chinese clinical dermatology; Diagnostic criteria of metabolic syndrome was made according to the definition of metabolic syndrome made by International Diabetes Federation (IDF) in2005.3. Exclusion criteria:(1) primary hypertension; primary diabetes (Ⅰ type); familial hyperlipidemia.(2) severe endocrine system diseases such as Cushing syndrome.(3) no systematically applied Vitamin A acid preparations, corticosteroids and immunosuppressants in the past three months.(4) patients with rheumatism, rheumatoid and immune system diseases.4. Measuring central obesity, blood pressure of patients who met the inclusion criteria for admission; recording the informations for patient’s gender, age, disease duration, smoking, alcohol consumption, and calculating PASI score of patients with psoriasis; Doing laboratory tests for levels of triglyceride, high-density lipoprotein-cholesterol, fasting plasma glucose, serum uric acid, creatinine and blood urea nitrogen. 5. Statistical analysis Data were analyzed using SPSS software (SPSS Inc, Chicago, version17,2008). Results were expressed as mean±SD for quantitative variables; Results were expressed as percentage for categorical variables. x2test was used for comparison between groups. P values less than0.05were accepted as the significance level.Results1. Central obesity, levels of triglyceride and fasting plasma glucose in psoriasis patients were higher than control group; Levels of high-density lipoprotein-cholesterol were lower than control; Systolic and diastolic blood pressure were higher than control group.2. Prevalences of psoriasis(vulgaris, joint disease, pustular and erythrodermic) with metabolic syndrome were37.53%,38.71%,33.33%and40.63%, respectively.3. Prevalence of metabolic syndrome in male patients with psoriasis is higher than that in female.4. The prevalence of psoriasis with metabolic syndrome is increasing with the raise of age and disease duration.5. Smoking, alcohol consumption of male patients with psoriasis can increase the prevalence of metabolic syndrome.6. PASI score is no difference in the different types of psoriasis, also in patients with psoriasis whether combining to metabolic syndrome or not.7. Patients with psoriasis have a higher prevalence of hyperuricemia.8. Psoriasis can lead to elevated creatinine levels.Conclusions1. Psoriasis patients with metabolic syndrome has a higher prevalence than normal population.2. Metabolic syndrome has not a close correlation to types of psoriasis.3. Gender, age, disease duration of patients with psoriasis play important roles in psoriasis with metabolic syndrome.4. Smoking, alcohol consumption are risk factors for male patients with psoriasis and metabolic syndrome. 5. PASI score is related to the area and severity of psoriatic lesions, but is not related to the types of psoriasis and psoriasis with metabolic syndrome.6. Psoriasis has a close relation with hyperuricemia.7. Psoriasis is a factor which lead to impaired renal function in the patients.