银屑病患者中趋化素与皮损、肥胖、糖脂代谢及炎症因子的相关性

doi:10.3877/cma.j.issn.1674-0785.2022.06.009

目的

分析趋化素（Chemerin）水平与银屑病（PS）患者皮损严重程度、肥胖、糖脂的代谢紊乱、炎症因子的相关性。

方法

选择2019年1月至2020年1月于广西医科大学第一附属医院收治的150例PS患者，根据PS患者是否并发代谢综合征（MS）分为单纯PS组及PSMS组，同期选择于本院查体中心查体的健康人群40例为对照组。测量并记录各组受检者的身高、体重及腰围（WC），计算身体质量指数（BMI）。采用PS面积与严重程度指数（PASI）量表评估2组患者的皮损严重程度。采集所有受检者空腹静脉血5 ml，采用全自动生化分析仪检测血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG），采用放射免疫分析法检测血清空腹胰岛素（Fins）、超敏C反应蛋白（hs-CRP）、白介素6（IL-6），计算胰岛素抵抗指数（HOMA-IR），采用酶联免疫吸附法检测血清趋化素水平。

结果

单纯PS组及PSMS组患者血清趋化素水平明显高于对照组，PSMS组患者血清趋化素水平明显高于单纯PS组（P＜0.01）。单纯PS组及PSMS组患者血清hs-CRP、IL-6水平明显高于对照组，PSMS组患者血清hs-CRP、IL-6水平明显高于单纯PS组（P＜0.01）。单纯PS组及PSMS组患者BMI、WC、TG、TC、LDL-C、Fins及HOMA-IR水平明显高于对照组，PSMS组患者BMI、WC、TG、TC、LDL-C、Fins及HOMA-IR水平明显高于单纯PS组，HDL-C水平明显低于对照组及单纯PS组（P＜0.01）。单纯PS组患者Fins及HOMA-IR水平明显高于对照组，PSMS组患者PASI水平明显高于单纯PS组（P＜0.01）。Pearson线性相关分析得知，趋化素与PASI、BMI、WC、TG、LDL-C、hs-CRP、IL-6均呈明显正相关（P均＜0.05或＜0.01）。进一步以血清趋化素为因变量，将与因变量具有线性关系的PASI、BMI、WC、TG、LDL-C、hs-CRP、IL-6为自变量进行多元逐步回归分析得知，WC、TG、hs-CRP、IL-6对趋化素存在影响（P均＜0.05或＜0.01）。

结论

趋化素参与PS的发生及发展过程，其水平的变化与PS患者的病情严重程度、肥胖、糖脂代谢紊乱及炎症反应存在密切联系，为评估PS病情发展及有效治疗PS提供新的思路。

关键词: 趋化素, 银屑病, 皮损严重程度, 肥胖, 脂的代谢紊乱, 炎症, 相关性

Objective

To analyze the correlation between serum chemerin and the severity of psoriasis (PS), obesity, lipid metabolism disorder, and inflammation in patients with PS.

Methods

One hundred and fifty patients with PS admitted to the First Affiliated Hospital of Guangxi Medical University from January 2019 to January 2020 were divided into either a simple PS group or a PS with metabolic syndrome (MS) group according to whether they were complicated with MS or not. Meanwhile, 40 healthy people who underwent physical examination at our hospital were selected as a control group. Height, weight, and waist circumference (WC) were measured and recorded, and body mass index (BMI) was calculated. PS area and severity index (PASI) was used to evaluate the severity of lesions in the two groups. Fasting venous blood (5 ml) was collected from all subjects. Serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FPG) were detected using an automatic biochemical analyzer. Serum fasting insulin (FINS), high sensitivity C-reactive protein (hs-CRP), and interleukin-6 were detected by radioimmunoassay. Insulin resistance index (HOMA-IR) was calculated. Serum chemerin level was detected by enzyme-linked immunosorbent assay.

Results

Serum chemerin level was significantly higher in the PS group and PS with MS group than in the control group, and in the PS with MS group than in the PS group (P＜0.01). Serum levels of hs CRP and IL-6 were significantly higher in the PS group and PS with MS group than in the control group, and in the PS with MS group than in the PS group (P＜0.01). The levels of BMI, WC, TG, TC, LDL-C, FINS, and HOMA-IR were significantly higher in the PS group and PSMS group than in the control group, and in the PS with MS group than in the PS group. The level of HDL-C was significantly lower in the PS with MS group than in the PS group and control group (P＜0.01). The levels of FINS and HOMA-IR in the PS group were significantly higher than those in the control group, and PASI in the PSMS group was significantly higher than that in the PS group (P＜0.01). Pearson linear correlation analysis showed that serum chemerin was positively correlated with PASI, BMI, WC, TG, LDL-C, hs-CRP, and IL-6 (P＜0.05 or ＜0.01). Taking serum chemerin as the dependent variable, PASI, BMI, WC, TG, LDL-C, hs-CRP, and IL-6 (having a linear relationship with the dependent variable) were used as independent variables for multiple stepwise regression analysis. The results showed that WC, TG, hs-CRP, and IL-6 had influence on chemerin (P＜0.05 or ＜0.01).

Conclusion

Chemerin is involved in the occurrence and development of PS. Serum chemerin level is closely related to the severity of PS, obesity, disorder of glucose and lipid metabolism, and inflammatory reaction, which provides a new idea for evaluating the development of PS and effective treatment of PS.

Key words: Chemerin, Psoriasis, Severity of skin lesions, Obesity, Dyslipidemia, Inflammation, Correlation

表1 各组受检者血清趋化素水平比较（

x ˉ

±s）

组别	例数	趋化素（ng/ml）
对照组	40	63.19±16.58
单纯PS组	59	106.84±23.15^a
PSMS组	51	136.71±22.46^ab
F值		133.112
P值		＜0.001

表1 各组受检者血清趋化素水平比较（

x ˉ

±s）

组别	例数	趋化素（ng/ml）
对照组	40	63.19±16.58
单纯PS组	59	106.84±23.15^a
PSMS组	51	136.71±22.46^ab
F值		133.112
P值		＜0.001

表2 各组受检者血清炎症因子水平比较（

x ˉ

±s）

组别	例数	hs-CRP（mg/L）	IL-6（ng/L）
对照组	40	0.56±0.21	2.06±0.68
单纯PS组	59	1.89±0.67^a	3.29±1.25^a
PSMS组	51	3.16±1.26^ab	4.59±1.28^ab
F值		104.364	55.838
P值		＜0.001	＜0.001

表2 各组受检者血清炎症因子水平比较（

x ˉ

±s）

组别	例数	hs-CRP（mg/L）	IL-6（ng/L）
对照组	40	0.56±0.21	2.06±0.68
单纯PS组	59	1.89±0.67^a	3.29±1.25^a
PSMS组	51	3.16±1.26^ab	4.59±1.28^ab
F值		104.364	55.838
P值		＜0.001	＜0.001

表3 各组受检者肥胖相关因子水平比较（

x ˉ

±s）

组别	例数	BMI（kg/m²）	WC（cm）
对照组	40	22.16±1.89	75.49±7.15
单纯PS组	59	24.68±2.16^a	85.64±8.15^a
PSMS组	51	27.84±2.46^ab	99.84±7.16^ab
F值		76.237	120.004
P值		＜0.001	＜0.001

表3 各组受检者肥胖相关因子水平比较（

x ˉ

±s）

组别	例数	BMI（kg/m²）	WC（cm）
对照组	40	22.16±1.89	75.49±7.15
单纯PS组	59	24.68±2.16^a	85.64±8.15^a
PSMS组	51	27.84±2.46^ab	99.84±7.16^ab
F值		76.237	120.004
P值		＜0.001	＜0.001

表4 各组受检者脂代谢因子水平比较（

x ˉ

±s）

组别	例数	TG（mmol/L）	TC（mmol/L）	LDL-C（mmol/L）	HDL-C（mmol/L）
对照组	40	1.16±0.24	2.61±0.84	1.74±0.42	1.45±0.26
单纯PS组	59	1.56±0.69^a	3.46±0.87^a	2.49±0.58^a	1.35±0.25^a
PSMS组	51	2.86±1.45^ab	5.21±1.93^ab	4.06±0.85^ab	1.06±0.24^ab
F值		41.232	46.998	154.601	31.465
P值		＜0.001	＜0.001	＜0.001	＜0.001

表4 各组受检者脂代谢因子水平比较（

x ˉ

±s）

组别	例数	TG（mmol/L）	TC（mmol/L）	LDL-C（mmol/L）	HDL-C（mmol/L）
对照组	40	1.16±0.24	2.61±0.84	1.74±0.42	1.45±0.26
单纯PS组	59	1.56±0.69^a	3.46±0.87^a	2.49±0.58^a	1.35±0.25^a
PSMS组	51	2.86±1.45^ab	5.21±1.93^ab	4.06±0.85^ab	1.06±0.24^ab
F值		41.232	46.998	154.601	31.465
P值		＜0.001	＜0.001	＜0.001	＜0.001

表5 各组受检者糖代谢因子水平比较（

x ˉ

±s）

组别	例数	FPG	Fins	HOMA-IR
对照组	40	5.12±0.69	11.89±7.15	2.86±1.84
单纯PS组	59	5.29±0.71	15.33±5.46^a	3.58±1.24^a
PSMS组	51	5.78±1.16^ab	19.64±6.78^ab	5.03±2.06^ab
F值		7.154	16.797	19.405
P值		＜0.001	＜0.001	＜0.001

表5 各组受检者糖代谢因子水平比较（

x ˉ

±s）

组别	例数	FPG	Fins	HOMA-IR
对照组	40	5.12±0.69	11.89±7.15	2.86±1.84
单纯PS组	59	5.29±0.71	15.33±5.46^a	3.58±1.24^a
PSMS组	51	5.78±1.16^ab	19.64±6.78^ab	5.03±2.06^ab
F值		7.154	16.797	19.405
P值		＜0.001	＜0.001	＜0.001

表6 各组受检者PASI水平比较（

x ˉ

±s）

分组	例数	PASI
单纯PS组	59	14.52±7.46
PSMS组	51	19.36±7.84^a
t值		3.314
P值		0.001

表6 各组受检者PASI水平比较（

x ˉ

±s）

分组	例数	PASI
单纯PS组	59	14.52±7.46
PSMS组	51	19.36±7.84^a
t值		3.314
P值		0.001

表7 趋化素与各因子相关性分析

指标	趋化素
指标	r值	P值
PASI	0.365	0.027
BMI	0.398	0.041
WC	0.546	0.017
TG	0.387	0.006
TC	0.269	0.247
LDL-C	0.471	0.045
HDL-C	-0.518	0.849
HOMA-IR	0.369	0.516
hs-CRP	0.441	0.025
IL-6	0.385	0.001

表7 趋化素与各因子相关性分析

指标	趋化素
指标	r值	P值
PASI	0.365	0.027
BMI	0.398	0.041
WC	0.546	0.017
TG	0.387	0.006
TC	0.269	0.247
LDL-C	0.471	0.045
HDL-C	-0.518	0.849
HOMA-IR	0.369	0.516
hs-CRP	0.441	0.025
IL-6	0.385	0.001

表8 趋化素与各因子多元线性回归分析

指标	趋化素
指标	β值	r值	P值
PASI	0.158	0.365	0.127
BMI	-0.089	-0.081	0.416
WC	0.225	2.016	0.045
TG	0.256	2.389	0.011
LDL-C	0.089	1.054	0.316
hs-CRP	0.306	3.445	0.005
IL-6	0.356	3.894	0.001

表8 趋化素与各因子多元线性回归分析

指标	趋化素
指标	β值	r值	P值
PASI	0.158	0.365	0.127
BMI	-0.089	-0.081	0.416
WC	0.225	2.016	0.045
TG	0.256	2.389	0.011
LDL-C	0.089	1.054	0.316
hs-CRP	0.306	3.445	0.005
IL-6	0.356	3.894	0.001

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Correlation between chemokine and skin lesions, obesity, glucose lipid metabolism and inflammatory factors in patients with psoriasis

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Correlation between chemokine and skin lesions, obesity, glucose lipid metabolism and inflammatory factors in patients with psoriasis