Josip Juraj Strossmayer University of Osijek. Faculty of Medicine.
Abstract
Cilj istraživanja: Ciljevi ovog istraživanja bili su istražiti povezanost metaboličkog sindroma (MetS) s kliničkom slikom vulgarne psorijaze (PV), uključujući analizu pojedinih sastavnica MetS i PV. Glavni cilj bio je evaluirati teže kliničke slike PV kao predstanja za razvoj inzulinske rezistencije (IR), neovisno o postojanju MetS. Nacrt studije: case control studija. Ispitanici: U istraživanje je uključeno 128 ispitanika po dvije skupine od 64 ispitanika. Jedna skupina imala je 64 ispitanika sa PV i MetS, a druga kontrolna 64 ispitanika sa PV bez MetS (odgovarajući po dobi i spolu). Materijali i metode: Opći podatci, klinički i laboratorijski podatci prikupljeni su za obje ispitivane skupine. Analizirana je težina kliničke slike PV i kvaliteta života svih ispitanika putem PASI indeksa i DLQI indeksa. Utvrđivanje MetS provedeno je prema revidiranoj definiciji NCEP ATP III. Za uvid u metabolizam glukoze analizirani su GUK natašte, HbA1c, inzulin, C-peptid, indeks inzulinske rezistencije (HOMA-IR) i indeks beta stanične funkcije (HOMA-B). Rezultati: Ispitanici s PV imaju značajnu prisutnost MetS. Analizirajući prisustvo MetS, nalazimo statistički značajno prisustvo MetS u grupi oboljelih od srednje teškog oblika PV. Vrijednosti PASI indeksa značajno su više kod ispitanika s MetS u odnosu na ispitanike bez MetS. Izrazito je jaka povezanost PASI i HOMA-IR indeksa, koja perzistira i nakon isključivanja povišenog ITM. Nije nađena povezanost između ITM i opsega struka s težinom PV, što ukazuje na to da je IR povezana s težinom kliničke slike PV neovisno o većoj tjelesnoj težini. Visoke vrijednosti HOMA-IR kod ispitanika sa srednje teškim i teškim oblikom PV, a bez MetS i veće vrijednosti HOMA-B indeksa kod ispitanika bez MetS upućuju na to da je težina kliničke slike PV neovisan čimbenik IR, bez obzira na prisustvo MetS i na još očuvanu funkciju ß stanica. Zaključak: Težina PV je neovisni rizični faktor IR kod osoba s težim oblikom PV. Ne smiju se zanemariti oboljeli od PV, a bez MetS, a osobito oni sa srednje teškom PV. Nužan je probir na inzulinsku rezistenciju (HOMA-IR) jer kad jednom dođe do razvitka MetS tada više IR ne služi kao neovisni pretkazatelj težine PV.Objectives: The aim of this study was to investigate correlation between metabolic syndrome (MetS) and clinical presentation of vulgar psoriasis (PV), including the analysis of the metabolic syndrome components and PV. The primary outcome was to evaluate more severe clinical forms of psoriasis as preconditions for insulin resistance development (IR), irrespective of the MetS presence. Study Design: case control study. Participants: The study included a total of 128 patients divided into two groups of 64 patients. One group consisted of 64 patients with both PV and MetS and the other, control group had 64 patients suffering from PV but without presence of MetS. The two groups were matched in terms of age and gender. Material and methods: For both groups the following data were obtained: demographic, clinical and laboratory data. Severity of the PV and quality of life of all patients were assessed by PASI and DLQI index. The presence of MetS was determined by revised NCEP ATP III definition. For glucose metabolism evaluation, fasting blood glucose, HbA1c, insulin, C-peptide, HOMA-IR and HOMA-B were analysed. Results: Significant presence of MetS was found in patients suffering from PV. Statistically significant MetS presence was found in the group of patients suffering from moderate form of PV. PASI index values were significantly higher in patients with MetS compared to the patients without MetS. Correlation between PASI and HOMA-IR index was extremely strong, persisting even after adjustment for BMI. Correlation between BMI and waist circumference with PV severity was not found, confirming correlation between IR and PV severity form irrespective of obesity. Based on higher HOMA-IR values found in patients suffering from moderate and severe form of PV but without presence of MetS and higher level of HOMA-B index found in patients without MetS, the results indicate that the severity of PV is an independent risk factor for IR, irrespective of the MetS presence and preserved beta-cell function. Conclusion: Severity of PV is the independent IR risk factor in patients suffering from a severe form of PV. One should not ignore patients suffering from PV but without MetS, especially not those suffering from moderate form of PV. It is necessary to perform insulin resistance screening (HOMA-IR) because once MetS has developed, HOMA-IR cannot be considered as an independent predictor of psoriasis severity
