| Summary: | 博士 === 國立中興大學 === 生命科學系所 === 97 === Psoriasis is one of the most common chronic inflammatory diseases and affects 2-3% of general population in western countries. It is believed to be less frequent in some African and Asian countries, but we have not found reliable epidemiological data to support this. In addition to skin disease, psoriasis may be complicated with psoriatic arthritis, other autoimmune diseases, depression and multiple cardiovascular comorbidities. We conducted a population-based cohort study utilizing Taiwanese National Health Insurance Research Database to estimate the prevalences of psoriasis and its associated cardiovascular comorbidities in Taiwanese population. An estimated prevalence of 0.5% and annual incidence 0.06% of psoriasis was found in Taiwanese population. Psoriasis bears a higher risk of development of multiple risk factors of first diagnosed cardiovascular disease and metabolic dysregulation, such as hypertension, diabetes mellitus, and hyperlipidemia and hazardous ischemic vascular events including myocardial infarction and strokes than general population. In addition, the systemic medications used in moderate to severe psoriasis may not add the risks of developing these diseases. We next conducted case-control studies comparing the circulating levels of leptin, an adipokine derived from adipose tissue and inflammatory cells; and osteopontin, a pro-inflammatory cytokine, between psoriasis and control subjects. These two biomarkers were both elevated in psoriasis patients compared to control groups. Circulating leptin level was positively correlated body mass index, female gender and psoriasis disease. Adjusting for age, gender and body mass index, psoriasis is independently associated with hyperlipidemia. The high circulating leptin levels in psoriasis is associated with the development of metabolic syndrome. Elevated expression of tissue and circulating osteopontin level were noted in psoriasis patients. An elevation of circulating osteopontin level was associated with hypertension, diabetes mellitus and psoriasis. Adjusting for age, gender and concomitant cardiovascular diseases, high plasma osteopontin was independently associated with psoriasis. Among psoriasis patients, high circulating osteopontin value is associated with the development of hypertension and cardiovascular disease. Finally, we conducted a genotyping study focusing on the promoter and the 3’-untranslated region of osteopontin gene by direct sequencing. No significantly different allelic distributions of osteopontin genes were found between psoriasis and control groups.
This study firstly provides evidences of relative risks of development of new diagnosed cardiovascular diseases and metabolic dysregulation in psoriasis in Taiwanese population. Proinflammatory biomarkers such as leptin and osteopontin may help us identify the subgroups of patients who were at risks for developing metabolic syndrome and cardiovascular diseases. Future researches targeting leptin and osteopontin in the pathogenesis of psoriasis are mandatory.
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