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Title: Selected parameters immune-inflammatory reaction and cardiovascular disorders in psoriatic patients


Background: Psoriasis is one of the most common skin diseases occurring in about 0.6-4.8% of the adult population in the world . The core feature of the disease is increased number of mitotic figures in the basal lamina of the epidermis and accelerated abnormal maturation of keratinocytes, coexistent with inflammatory cell infiltrates containing lymphocytes, monocytes and granulocytes in the dermis – which actively penetrate the epidermis. Enhanced localized inflammatory reaction may be a reflection of the systemic effect through release of various inflammation mediators such as proinflammatory cytokines. Based upon epidemiological studies some investigators demonstrate that psoriatic patients are significantly more frequently affected by cardiovascular disease. Psoriasis is most frequently associated with arterial hypertension, heart valve disease and atherosclerosis. The reasons for this relationship may be the inflammatory character of psoriasis and abnormal microcirculation on the one hand, and concomitant endocrine disorders, type 2 diabetes and oxidative stress on the other hand. Aim: To evaluate cardiovascular disorders in psoriatic patients. To define a correlation between the clinical manifestations of psoriasis (clinical type of psoriasis, severity of skin lesions, duration of the disease and recent eruption, frequency and reason of exacerbation), serum levels of some ; cytokines (with known stimulating and inhibiting effects in psoriasis such as TNFα, IL-6, IL-4, IL-10, and as yet unclear effects such as IL-12, IL-18) and cardiovascular disorders based upon echocardiography and arterial compliance. Material and Methods: The study population consist of 40 men with psoriasis, aged 25-55 years: 20 men at low cardiovascular risk (total risk cardiovascular death over 10 years according to the SCORE < 2%) no hyperlipidemia, no hypertension and non-smoking (Gpsa1=8 men with psoriatic arthritis, Gps2=12 men with psoriasis vulgaris) and 20 men at intermediate and high risk of cardiovascular death SCORE > 5% with various risk factors (hypertension, hyperlipidemia, smoking) (GPSA3=9 men with psoriatic arthritis, GPS4=11 men with psoriasis vulgaris). Age-matched 40 men without psoriasis divided into two subgroups:c5,C6 (20 men each) by cardiovascular risk level similar to psoriatic patients serve as the controls. Cardiovascular disorders have been evaluated by echocardiography (left ventricular systolic and diastolic function, left ventricular mass index (LVMI), atrial dimension (PL), ascending aorta width (AoD), aortic and mitral insufficiency (AR, MR)) using the Hewlett Packard Sonos 2000 machine. Arterial compliance have been measured from pulse wave velocity using the Complior ® device. Cytokine levels have been measured with the immunoenzymatic met ; hods (R&D England). Statistical analysis was performed with Statistica 6.0. Results: Both groups ie. psoriatic patients (37,4 ± 2,0 yrs.) and controls (36,4 ± 2,0 yrs.) had no age difference (p> 0,05). Mean body mass index was higher for psoriatic patients (26,2 ± 0,6 kg/m²) than for controls (23.95 ± 0.65 kg/m², p< 0.001). Heart rate, systolic and diastolic blood pressures were similar in both groups. Cholesterol and LDL cholesterol levels in psoriatic patients were higher than in controls. Mean concentration of white blood cells was on the same level in both psoriatic and control groups but percentage of lymphocytes in blood smear in psoriatic group was lower than in control group. Additionaly in psoriatic vulgaris group independently on SCORE rate the percentage of basophiles in blood smear was higher than in control group with SCORE rate below 2% and in psoriatic arthritis group with SCORE rate over 5%. When PWV values were compared patients with SCORE rate below 2% and psoriatic arthritis ( mean PWV = 9,38±0,54m/s) and psoriasis vulgaris (mean PWV = 9,0±0,44 m/s) had higher values than controls with the same SCORE rate ( mean PWV = 7,6±0,34 m/s), p< 0,001. ; The duration of psoriasis had a strong positive correlation with aortic PWV. Left ventricular diastolic diameter (LVIDd) in echocardiographic examination for whole psoriatic group was significantly higher than in contr ; ol group (52,8±1,06mm vs 50,0±1,04mm, p<0,01). LVIDd in psoriatic arthritis patients with SCORE rate over 5% and patients with psoriasis vulgaris with SCORE rate below 2% was higher than in control groups with the same SCORE rates. The values of left ventricular ejection fraction (EF) for all patients in psoriatic and control groups were in normal range and on the same mean level. Mean value of left ventricular mass index (LVMI) in whole psoriatic group was higher than in control group (111,82±7,16 g/m² vs. 92,8±7,07 g/m², p<0.01), but for all patients it was not over the normal range. Mean value of left atrium systolic diameter (PL) view was significantly higher in whole psoriatic group than in control group (41,8±1,7 mm vs. 33,9±1,7mm, p < 0,0001). Mean values of PL for psoriatic subgroups were over normal range (40 mm). Among parameters describing left ventricle diastolic function only E/A ratio was lower in psoriatic group than in control group (1,16±0,1 vs. 1,41±0,1, p<0,01).The lowest values of E/A were observed in psoriatic arthritis group with SCORE rate over 5%. Psoriatic patients (whole group) had wider ascending aorta ( AoD) than control group (34,37±0,91mm vs 29,95± 0,9mm, p<0,001). The prevalence of mitral regurgitation (MR) in psoriatic patients was higher than in control group (67 % vs. 17 % , p< 0,05). The highest prevalence of MR characterized the group of pati ; ents with psoriatic arthritis with SCORE rate over 5%. Serum level of IL(interleukin)-18 among psoriatic patients was higher than in control group (219,63±10,25 pg/mL vs. 164,25±10,25 pg/mL). For psoriatic patients significant positive correlations between IL-18 level and interventricular septum ( IVSd) and left ventricle posterior wall diastolic diameter (LVPWd) were observed. Significant negative correlations in this group were observed between IL-18 level and EF as well as E/A ratio. Plasma concentration of tumor necrosis factor α (TNFα) in psoriatic patients was higher than in control group (2,5±0,12 pg/mL vs. 2,05±0,12 pg/mL). Among patients with psoriasis and AR serum level of TNFα was significantly higher. For whole psoriatic group serum level of IL-6 was higher than in controls (2,44±0,32 pg/mL vs.1,11±0,32 pg/mL). Among psoriatic patients significant negative correlation between IL-6 level and E/A was observed. IL-12 among psoriatic patients was lower than in control group (0,85±0,16 pg/mL vs.1,52±0,16 pg/mL). IL-12 level correlated negatively with AoD in psoriatic patients. Serum levels of interleukin 4 and 10 were decreased in psoriatic patients but not significantly. IL-10 level correlates positively with LVPWd and negatively E/A ratio. Conclusions: 1. When considering typical parameters used in cardiovascular risk stratification i.e age, gender, blood pressure, smo ; king; psoriatic patients did not differ from non psoriatic, although they have higher plasma levels of total and LDL cholesterol. 2. Aortic pulse wave velocity and left ventricular mass index parameters related with increased cardiovascular risk were higher among psoriatic than in non psoriatic patients. Moreover studied psoriatic group was characterized by wider ascending aorta diameter, worse left ventricle diastolic function, enlarged left atrium and higher prevalence of mitral regurgitation. 3. Higher levels of interleukin 18, TNFα and interleukin 6 in the psoriatic than in the control group should be considered as a markers of increased inflammatory activity. This observation confirms prevalence of Th1 type cytokines activity in psoriatic process. Decreased lymphocytosis and inceased number of basophiles in the blood smear among patients with psoriasis vulgaris complete the immunological characteristic of studied group. 4. Increased levels of IL-18 and TNFα amon.

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2 - studia doktoranckie

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Wydział Lekarski


Wojas-Pelc, Anna

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Mar 10, 2023

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Nov 21, 2012

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ZB-106067 Mar 10, 2023


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