本帖最後由 lsc0019 於 2009-5-12 01:11 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
April 27, 2009 — 根據四月號皮膚醫學檔案期刊上一篇美國女性護士的前溯研究結果，乾癬與糖尿病及高血壓風險增加獨立相關。
波士頓哈佛醫學院、布萊根婦女醫院的Abrar A. Qureshi醫師等人寫道，最近的研究指出，乾癬與增加共病症風險及死亡率有關。乾癬的全身性發炎和不健康之生活型態因素，與肥胖、胰島素阻抗、心血管風險增加有獨立相關。
研究目標是檢視乾癬與糖尿病及高血壓風險之間的獨立關係。護士健康研究II從1991至2005年追蹤116,671名美國女性護士，她們在1991年時的年紀介於27至44歲。
此次分析的世代包括78,061名於2005年回覆一個有關醫師診斷乾癬病史問卷的婦女，分析時排除於開始時有糖尿病或高血壓診斷的婦女；研究的初級終點是新的糖尿病或高血壓診斷，如在那兩年一次的問卷所示。
78,061名婦女中有1,813人(2.3%)報告有乾癬診斷；在14年追蹤期間，發生有1560 件(2%)糖尿病案例，15,724件(20%)高血壓案例。相較於沒有乾癬的婦女，乾癬婦女的糖尿病累積校正相對風險為1.63 (95%信心區間[CI]，1.25 - 2.12)、發生高血壓的風險也增加(多變項相對風險1.17； 95% CI，1.06 - 1.30)。
年紀、身體質量指數、抽菸狀態對於乾癬和糖尿病或高血壓風險的關係並無顯著影響(交互作用P值 = .07)。
研究作者寫道，在這項前溯分析中，乾癬與糖尿病及高血壓風險增加有獨立關係。需要後續研究以釐清治療乾癬是否可降低糖尿病和高血壓風險。
研究限制包括缺乏乾癬相關治療的資訊，以及缺乏運用到男性或非白人種族的一般性。
研究作者寫道，這些資料顯示將乾癬視為全身性異常而不只是皮膚病的重要性；需要後續研究，以對這些關聯的機轉有更多的瞭解，進而釐清治療乾癬是否可降低糖尿病和高血壓風險。
國家癌症研究中心部份支持本研究。Qureshi醫師擔任Abbott、Amgen以及Genentech的顧問與發言人。
Psoriasis Linked to Increased Risk for Diabetes and Hypertension
By Laurie Barclay, MD
Medscape Medical News
April 27, 2009 — Psoriasis is independently linked to an increased risk for diabetes and hypertension, according to the results of a prospective study of US female nurses reported in the April issue of the Archives of Dermatology.
"Recent studies indicate that psoriasis is associated with an increased risk of comorbidity and mortality," write Abrar A. Qureshi, MD, MPH, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues. "Systemic inflammation in psoriasis and an increased prevalence of unhealthy lifestyle factors have been independently associated with obesity, insulin resistance, and an unfavorable cardiovascular risk profile."
The goal of this study was to examine the independent association between psoriasis and the risk for diabetes and hypertension. From 1991 to 2005, the Nurses' Health Study II followed up a cohort of 116,671 US female nurses aged 27 to 44 years in 1991.
The cohort for this analysis included 78,061 women who responded to a question about a lifetime history of clinician-diagnosed psoriasis in 2005. The analysis excluded women who reported a diagnosis of diabetes or hypertension at baseline. The primary endpoint of the study was a new diagnosis of diabetes or hypertension, as reported on biennial questionnaires.
A diagnosis of psoriasis was reported by 1813 (2.3%) of the 78,061 women. During the 14 years of follow-up, there were 1560 incident cases (2%) of diabetes and 15,724 incident cases (20%) of hypertension. Compared with women without psoriasis, women with psoriasis had a multivariate-adjusted relative risk for diabetes of 1.63 (95% confidence interval [CI], 1.25 - 2.12), and the risk for the development of hypertension was also increased (multivariate relative risk, 1.17; 95% CI, 1.06 - 1.30).
The association between psoriasis and the risk for diabetes or hypertension was not significantly affected by age, body mass index, or smoking status (P values for interaction = .07).
"In this prospective analysis, psoriasis was independently associated with an increased risk of diabetes and hypertension," the study authors write. "Future studies are needed to find out whether psoriasis treatment will reduce the risk of diabetes and hypertension."
Limitations of this study include lack of information on psoriasis-related therapy and lack of generalizability to men or to nonwhite racial groups.
"These data illustrate the importance of considering psoriasis a systemic disorder rather than simply a skin disease," the study authors write. "Further research is needed to better understand the mechanisms underlying these associations and to find out whether psoriasis therapy can reduce the risk for diabetes and hypertension."
The National Cancer Institute partly supported this study. Dr. Qureshi has been a consultant and speaker for Abbott, Amgen, and Genentech.
Arch Dermatol. 2009;145:379-382, 467-469. |
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