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目的:总结银屑病合并冠心病患者的临床特点。方法:选取2010年1月至2015年8月本院收治的银屑病合并冠心病患者25例,对照组选自2015年1月至2015年6月本院收治的单纯冠心病患者218例。对两组的冠心病传统危险因素和冠状动脉造影结果进行对比分析;对25例银屑病患者皮损情况进行银屑病面积与严重指数(PASI)评分,并进行临床随访。结果:与单纯冠心病组比较,银屑病合并冠心病组初发冠心病时年龄较小[(56.12±10.85)岁,对照组(66.16±10.43)岁,P<0.001],但血脂异常较为多见(P=0.032);血生化指标中,银屑病合并冠心病组总胆固醇、低密度脂蛋白胆固醇、甘油三酯水平均较单纯冠心病组高(P<0.05),而高密度脂蛋白胆固醇较对照组低(P=0.022)。银屑病合并冠心病组急性心肌梗死起病比例较高(P=0.042),且冠状动脉造影结果提示银屑病合并冠心病患者冠状动脉病变严重,三支病变比例较高(P=0.049)。25例患者平均随访(16.46±8.74)个月,4例患者随访期间有再发心绞痛,其中3例再次入院行经皮冠状动脉介入(PCI)治疗。25例患者经加用他汀类药物治疗后,银屑病病情也有所好转,最后一次随访时的PASI评分较入院时明显降低(12.60±4.12比8.73±5.05,P<0.01)。结论:银屑病患者初发冠心病时年龄较轻,冠状动脉病变程度往往较重,且起病急、预后较差,需要尽早干预,尽量延缓疾病进展,从而改善患者预后;此外,他汀类药物的早期应用对银屑病本身的病情也有着一定程度的改善作用。
Objective: To summarize the clinical features of patients with psoriasis complicated with coronary heart disease. Methods: Twenty-five patients with coronary heart disease were selected from January 2010 to August 2015 in our hospital. The control group was selected from 218 patients with simple coronary heart disease admitted from January 2015 to June 2015 in our hospital. The traditional risk factors of coronary heart disease and coronary angiography were compared between the two groups. Psoriasis area and severity index (PASI) scores were evaluated in 25 cases of psoriasis lesions and clinical follow-up. Results: Compared with simple coronary heart disease group, age at onset of coronary heart disease was lower in patients with psoriasis and coronary heart disease [(56.12 ± 10.85) years vs 66.16 ± 10.43 years (P <0.001], but dyslipidemia was (P = 0.032). The levels of total cholesterol, low density lipoprotein cholesterol and triglyceride in patients with psoriasis complicated with coronary heart disease were higher than those in patients with coronary heart disease only (P <0.05), while the high density lipids Protein cholesterol was lower in the control group (P = 0.022). The incidence of acute myocardial infarction was higher in patients with psoriasis and coronary heart disease (P = 0.042). Coronary angiography showed that patients with psoriasis and coronary heart disease had severe coronary artery disease and a high proportion of three lesions (P = 0.049) . Twenty-five patients were followed up for an average of (16.46 ± 8.74) months. Four patients had recurrent angina pectoris during follow-up. Three of them were re-admitted to the hospital with percutaneous coronary intervention (PCI). Psoriatic conditions also improved in 25 patients treated with statins. The PASI score at the last follow-up was significantly lower than that at admission (12.60 ± 4.12 vs. 8.73 ± 5.05, P <0.01). Conclusions: Patients with psoriasis are younger at the beginning of coronary heart disease, coronary lesions tend to be more severe, and their onset is acute and the prognosis is poor. Early intervention is needed to delay the progression of the disease so as to improve prognosis. In addition, statins The early application of drugs on the condition of psoriasis itself also has a certain degree of improvement.