Study On The Relationship Between Psoriasis And Various Components Of The Metabolic Syndrome In Children And Mechanism Discussion

Objective Psoriasis is a chronic inflammatory disease,the risk of complications like metabolic syndrome and cardiovascular disease will increase in adult patients.However,the incidence and pathogenesis of the metabolic syndrome andits independent diseases in the syndrome in children with psoriasis are unknown.In this study,we investigated the clinical manifestations and general features of psoriasis in children for investigating the incidence of various components of the metabolic syndrome in psoriasis group and healthy control group as well as thedifference of Th17 related cytokines and Th17/Treg levels between the psoriasis children with and without metabolic abnormality.So as to determine whether the risk of overweight and obesity and different components ofmetabolic syndrome will increase in children with psoriasis and confirm whether Th17 cells involved in the occurrence of metabolic abnormalities in metabolic syndrome.Methods Children in the outpatient department of Dermatology and diagnosed with psoriasis from January 2016 to January 2017 in our hospitalwere collected.The clinical characteristics and general conditions of psoriasis children were investigated by questionnaire form.Children of 7~17 that with psoriasis vulgaris served as the object in this study and a case-control study was conducted based on gender and age paired with 1:1,respectively.The incidences of various components of the metabolic syndrome were compared betweenplaque psoriasis group and healthy control group.Similarly the differences betweenpsoriasis guttategroup and control group were compared.Focused on children with plaque psoriasis,the serum levels of IL-6 and TNF-were measured by chemiluminescence method and the serum IL-17 levels were measured by ELISA.The ratio of Thl7 and Tregcell subgroup in peripheral blood was detected by flow cytometry.Then the levels of serum cytokines(TNF-?,IL-6,IL-17)and the ratio of Thl7 and Treg in the peripheral blood of psoriasis patients without metabolic abnormalities(hereinafter referred to as pure psoriasis group)and patients with abnormal metabolism were compared.Result1.Analysis of clinical manifestations and general characteristics of children with psoriasis showed a total of 104 children with psoriasis aged1~15 years old were enrolled in the study.Among themthere were 44 boys(42.3%)and 60 girls(57.7%),the ratio of boy to girl was 1: 1.36.There were 79 cases of psoriasis guttate(76%),23 cases of plaque psoriasis(22.1%)and 2 cases of pustular psoriasis(1.9%).And 26 cases a family history of genetic psoriasis(25%).The most vulnerable part was the scalp.The infection rate of Streptococcus mutans inpsoriasis vulgaris(72.2%)was significantly higher than in plaque type(43.5%).2.Study on the relationship between psoriasis vulgaris and metabolic syndrome including its components demonstrated the BMI of plaque psoriasis group increased significantly(P < 0.01)while HDL-C was obviously lower(P< 0.01)when compared with the normal control group,while there was no significant difference in waist circumference,blood pressure,triglyceride(TG)level,fasting plasma glucose(FPG)level,fasting insulin(FPI)and insulin resistance index(HOMA-IR)(P >0.05).The psoriasis group showed a increased BMI than the normal control group(P< 0.05),while waist circumference,blood pressure,TG,HDL-C,FPG,FPI and HOMA-IR showed no significant difference than the normal control group(P > 0.05).3.Study on the mechanism of Th17 cell subsets in children with plaque psoriasis and metabolic abnormalities demonstrated the differences of Th17/CD4+T(%),Treg/CD4+T(%)and Th17/Treg levels in peripheral blood among pure psoriasis group,psoriasis with abnormal metabolism group,normal control group(P <0.05).The Th17/CD4+T(%)in pure psoriasis and psoriasis with abnormal metabolism group was significantly higher than that in control group.Treg/CD4+T(%)of pure psoriasis group was higher than that of normal control group.Treg/CD4+T(%)of psoriasis with abnormal metabolism group was lower than that of control group and pure psoriasis group(P < 0.05).The ratio of Th17 to Treg was higher in psoriasis with abnormal metabolic group when compare with that in pure psoriasis group(P <0.05).The levels of serum TNF-?,IL-6 were significantly higher in the psoriasis group than in the normal control group(P < 0.05).The detection rate of IL-17 in psoriasis group was higher than that in normal control group(P < 0.05).The serum TNF-? and IL-17 levels were higher in the patients with metabolic abnormalities than in pure psoriasis group while the difference of serum IL-6 between the two groups was not significant(P > 0.05).Conclusion In our study the psoriasis guttate was the most common type of psoriasis vulgaris in children and plaque psoriasisranked second.Plaque psoriasis in children is associated with abnormal lipid metabolism in metabolic syndrome.However psoriasis vulgaris in children has little relationship with the above disease.Plaque psoriasis and psoriasis guttate are all associated with overweight and obesity,which may berisk factors for psoriasis vulgaris in children.Tumor necrosis factor-?(TNF-?),IL-17 and Th17 /Treg imbalance are involved in related components ofmetabolic syndromein children with plaque psoriasis.