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Original Article Analysis of Clinical Features in 499 Psoriasis Patients with Metabolic Syndrome

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Original Article Analysis of Clinical Features in 499 Psoriasis Patients with Metabolic Syndrome Int J Clin Exp Med 2020;13(4):2555-2564 www.ijcem.com /ISSN:1940-5901/IJCEM0106151 Original Article Analysis of clinical features in 499 psoriasis patients with metabolic syndrome Panhong Wu1, Xuefeng Guo2, Mengxiang Li3, Yongsheng Liu4, Lifang Guo4, Zhao Wei1, Aimin Liu1, Yuemin Wang7, Li Wang1, Buxin Zhang1, Yinglin Cui5, Shixiang Hu6 1Dermatological Department, Henan Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China; 2Derma- tological Department, Zhengzhou Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China; 3College of Information Engineering, Henan University of Science and Technology, Henan, China; 4Physical Examination, Henan Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China; 5Henan Hospital of Traditional Chi- nese Medicine, Zhengzhou, Henan, China; 6Surgical Department, Henan Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China; 7Zhengzhou Huiji District People’s Hospital, Henan, China Received December 9, 2019; Accepted December 29, 2019; Epub April 15, 2020; Published April 30, 2020 Abstract: Objective: To find the clinical features of psoriasis patients with metabolic syndrome (MS), its underly- ing etiology and pathogenesis, and the reaction between the severity of psoriasis and the onset of MS in patients with psoriasis. Method: Materials were obtained from 499 patients due to psoriasis vulgaris, 263 hospitalized patients due to allergic diseases and 340 individuals who received physical examination at the same stage from Sep. 1, 2011 to Dec. 31, 2017. Basic materials covered name, gender, age, body weight, height, BP, lipids, Glu and PASI score for patients with psoriasis. China Clinical Dermatology (2012, Zhao Bian) and diagnosis standards issued by the Diabetic Branch of Chinese Medical Association (2004) were referred to for diagnosis of psoriasis with MS respectively. Result: General materials were collected from 1102 individuals, of whom, 499 were patients with psoriasis, including 11 at mild (≤ 2% BSA), 353 at moderate (2-10%) and 135 at severe degree (> 10%); 603 were included in the control group, of whom, 263 had allergic diseases and 340 were healthy. The study showed a relationship between psoriasis and MS as compared with healthy individuals and patients with allergic diseases, which was stronger in skin damage due to psoriasis worsened. Meanwhile, compared with patients with psoriasis only, psoriasis patients with MS demonstrated a longer LOS and high medical expenses on an average basis, which indicated the rising difficulty to treat psoriasis if it is accompanied by MS to a certain degree. Conclusion: Effective management is necessary to prevent MS in patients with psoriasis, especially those who are mild, while regular scientific popularization and screening for metabolic diseases are required in most severe cases of psoriasis. Keywords: Clinical features, psoriasis patients, metabolic syndrome Introduction the difficulty of treatment and the probability of cardiovascular and cerebrovascular diseases in MS is defined as a pathological status under patients with psoriasis [4]. which metabolic disorder is observed in terms of protein, fat, and carbohydrate in human bo- Psoriasis is a common chronic and recurrent dy, a clustering of complicated metabolic disor- inflammatory dermatosis mediated by autoim- der syndromes, and a hazard leading to diabet- munity in dermatology, found in almost 1% of ic cardiovascular and cerebrovascular diseas- the global population [3] with an incidence es, and manifested in various metabolic di- between 0.47 and 3% worldwide [5]. Epide- sorders, including obesity, hyperglycemia, hy- miological evidences make clear that psoriasis pertension, and dyslipidemia which constitute is associated with frequent cardiovascular risk the pathological foundation of cardiovascular factors and adverse cardiovascular effects, and cerebrovascular diseases as well as diabe- including myocardial infarction, apoplexia and tes [1, 2]. At present, it is generally accepted cardiovascular death. Psoriasis, particularly that MS is related to IR and hyperinsulinemia those which are severe, may be a risk factor [3]. It may worsen the skin damage and increase leading to ASCVD beyond traditional risk factors Features of psoriasis patients with MS Table 1. General information of the 1102 study objects patients, 235 males and Observation Control Group 1 Control Group 104 females with aver- Classification Group Allergic Disease 2 Healthy age age of 37.58±9.35. Number of study objects 499 262 339 All patients provided com- PASI score plete information about BMI, Glu, BP and lipids Mild psoriasis ≤ 2% 11 (2.2%) N/A N/A (TG, TC, HDL and LDL) Moderate psoriasis 2-10% 353 (70.74%) N/A N/A which were comparable in Severe psoriasis > 10% 136 (27.25%) N/A N/A data analysis as varia- Gender bles. M 363 (72.75%) 125 (47.71%) 235 (69.32%) F 136 (27.25%) 137 (52.29%) 104 (30.68%) Inclusion criteria: All 1102 Age study objects with aver- Mean ± standard deviation 40.81±14.74 48.07±18.42 37.58±9.35 age age of 40.81±14.74 that were routinely exam- ined and delivered in the as patients with severe psoriasis generally die Dermatology of Henan Province Hospital of at an age 5 years younger than patients without TCM. The allergic disease group were con- psoriasis. Cardiovascular disease is the mostly formed with diagnose. commonly reported cause to the death of pa- tients with psoriasis [6], while fasting BSL and The exclusion criteria: The patient was diag- DBP are closely associated with the severity of nosed with liver and kidney dysfunction, rick- psoriasis (PASI) [7]. ets, and malnutrition, etc. Other examination data were incomplete. In this study, 499 psoriasis patients with MS were observed to understand their clinical fea- Basic materials covered name, gender, age, tures which were then analyzed to produce body weight, height, BP, lipids, Glu and PA. guiding suggestions for clinical prevention and treatment of psoriasis. SI score for patients with psoriasis. China Clinical Dermatology (2012, Zhao Bian) and Material and methods diagnosis standards issued by the Diabetic Branch of Chinese Medical Association (2004) General information were referred to for diagnosis of psoriasis with MS respectively. Materials were obtained from 1102 study objects admitted to the Department of Der- Methods matology of Henan Province Hospital of TCM due to psoriasis vulgaris from Sep. 1, 2011 to Body mass index is a simple calculation using a Dec. 31, 2017. Table 1 describes the general person’s height and weight. The formula is BMI information of 1102 study objects, of whom, = kg/m2 where kg is a person’s weight in kilo- 499 were included into the observation group, grams and m2 is their height in meters squared. 363 males and 136 females with average age To determine the blood GLU and lipid levels, a of 40.81±14.74. They were patients with pso- total of 3 ml fasting venous blood was collected riasis discharged from the Department of De- from the subjects into separation gel tubes and rmatology of Henan Province Hospital of TCM separated at 3,466 g for 10 min. The plasma from Sep. 13, 2011 to Jan. 16, 2016, of whom, was analyzed in a Hitachi 705/717 biochemical 11 (2%) suffered from mild psoriasis (≤ 2% instrument (Hitachi, Ltd., Tokyo, Japan) at 20°C. BSA), 353 (71%) from moderate psoriasis The fasting blood GLU, TG, TC, HDL and LDL lev- (3-10%), and 136 (27%) from severe psoriasis els were then determined. (> 10%). 2 control groups were set up, of which, the allergic disease group included 262 pa- Statistical analysis tients who were discharged at the Department of Dermatology of Henan Provincial Hospital of Statistical analysis was performed using SPSS TCM from Sep. 20, 2011 to Oct. 29, 2014, 125 23.0 software. T-test was used for the normal males and 127 females with average age of distribution of the measurement data. Wilcoxon 48.07±18.42; the healthy group contained 339 signed-rank test was used for the data that did 2556 Int J Clin Exp Med 2020;13(4):2555-2564 Features of psoriasis patients with MS Table 2. Describes the quartiles of various indices in the three groups Observation Group psoriasis Control Group 1 allergic disease Control Group 2 Healthy BMI 24.57 (15.56, 38.75) 23.39 (14.81, 34.60) 24.17 (15.24, 36.83) SBP (mmHg) 120 (80, 180) 120 (90, 168) 115 (88, 175) DBP (mmHg) 80 (50, 110) 75.5 (44, 108) 71 (51, 114) BSL (mmol/l) 4.99 (2.89, 19.31) 5.00 (3.34, 13.33) 5.19 (4.19, 15.26) TG (mmol/l) 1.34 (0.33, 15.03) 1.325 (0.10, 10.06) 1.28 (0.35, 18.78) TC (mmol/l) 4.63 (2.14, 8.78) 4.75 (2.08, 8.37) 4.35 (2.11, 7.97) HDL (mmol/l) 1.07 (0.48, 2.25) 1.22 (0.65, 2.05) 1.12 (0.58, 2.4) LDL (mmol/l) 2.68 (1.08, 6.32) 2.74 (0.88, 5.50) 2.51 (0.78, 4.84) MS (n, %) 58 (11.62%) 21 (8.02%) 25 (7.37%) not satisfy the normal distribution. The relation- strated an or value of BMI at 1.87 and 1.11 ship between the factors and psoriasis patients respectively, indicating that abnormally rising was analyzed using multivariate logistic regres- BMI, manifested as obesity, was more likely in sion analysis. The Spearman rank correlation patients with psoriasis as compared with analysis method was used. F test was used for patients with allergic disease and healthy indi- multiple sets of measurement data, and the viduals. Data of various populations from the post-test LSD method was used for comparison three groups indicated that psoriasis may be between groups. one of the possible risk factors leading to abnormal rise of BMI (as shown in Tables 2 and Results 3). Abnormally rising BMI was more likely in pa- Rising BP was more likely in patients with tients with psoriasis psoriasis Tables 2 and 3 indicate the quartile corre- Comparison of BP found that the observation sponding to each metabolic index of the 3 group had a minimum, maximum and median groups, the number of normal cases and abnor- SBP and DBP of 80 mmHg, 180 mmHg and mal cases as well as the or value by comparing 120 mmHg, 50 mmHg, 110 mmHg and 80 the indices of the observation group with the mmHg respectively; 404 patients reported a two control groups.
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