老年寻常型银屑病患者外周血PGE2、ApoM、Hcy水平变化及与心理健康状态相关性分析

张妍 杨艳涛 孙士芳 玛依努尔·玉努斯 张帆 黄金叶 刘晓猛 侯韶轩 常海霞

[摘要]目的：探究老年寻常型银屑病患者外周血前列腺素E2（PGE2）、载脂蛋白M（ApoM）、同型半胱氨酸（Hcy）水平变化及与心理健康状态相关性。方法：选取笔者医院2019年12月-2020年6月老年寻常型银屑病患者106例作为研究对象，比较不同病情患者外周血PGE2、ApoM、Hcy水平，根据一般健康量表（CHQ-12）评分分为伴心理障碍组与不伴心理障碍组，比较不同心理健康状态患者外周血PGE2、ApoM、Hcy水平，分析各指标与CHQ-12评分相关性，并采用多元线性逐步回归分析外周血指标与心理状态的关系。结果：活动期患者外周血PGE2、Hcy水平高于静止期，ApoM低于静止期，差异有统计学意义（P<0.05）;外周血PGE2、Hcy水平随皮损严重程度增加呈升高趋势，ApoM随皮损严重程度呈降低趋势（P<0.05）。Spearman相关性分析，外周血PGE2、Hcy与疾病分期、皮损严重程度呈正相关（P<0.05）;ApoM与疾病分期、皮损严重程度呈负相关（P<0.05）。伴心理障碍组与不伴心理障礙组外周血ApoM水平相比，差异无统计学意义（P>0.05）;伴心理障碍组外周血PGE2、Hcy水平高于不伴心理障碍组（P<0.05）。Pearson相关性分析，外周血PGE2（r=0.767）、Hcy（r=0.593）与CHQ-12评分呈正相关（P<0.05）;外周血ApoM（r=0.142）与CHQ-12评分无明显相关性（P>0.05）。多元线性逐步回归分析，将病程、疾病分期、皮损严重程度等其他因素控制后，外周血PGE2、Hcy仍与心理健康状态显著相关（P<0.05）。结论：老年寻常型银屑病患者外周血PGE2、ApoM、Hcy与病情密切相关，且PGE2、Hcy水平与患者心理健康状态显著相关，临床需给予重视。

[关键词]寻常型银屑病;老年患者;前列腺素E2;载脂蛋白M;同型半胱氨酸;心理健康状态

[中图分类号]R758.63    [文献标志码]A    [文章编号]1008-6455（2021）07-0103-04

Changes of Peripheral Blood PGE2， ApoM， Hcy Levels in Elderly Patients with Psoriasis Vulgaris and Their Correlation with Mental Health State

ZHANG Yan，YANG Yan-tao，SUN Shi-fang，Maynur YUNUS，ZHANG Fan，HUANG Jin-ye，LIU Xiao-meng，HOU Shao-xuan，CHANG Hai-xia

（Department of Dermatology，the Fifth Affiliated Hospital of Xinjiang Medical University，Urumqi 830011，Xinjiang，China）

Abstract： Objective  To explore the changes in peripheral blood prostaglandin E2 （PGE2）， apolipoprotein M （ApoM） and homocysteine （Hcy） levels in elderly patients with psoriasis vulgaris and their correlation with mental health state. Methods  A total of 106 elderly patients with psoriasis vulgaris from December 2019 to June 2020 in our hospital were selected as the research subjects. Compared the levels of PGE2， ApoM， and Hcy in the peripheral blood of patients with different conditions， and dividing them into groups with and without psychological disorders according to the Chinese health questionnaire （CHQ-12） score of the observation group. Analyzed the correlation between each index and CHQ-12 score， and used multiple linear stepwise regression to analyze the relationship between peripheral blood index and mental state. Results  The levels of PGE2 and Hcy in active phase were higher than those in quiescent phase， and ApoM was lower than that in quiescent phase，the differences were statistically significant （P<0.05）. The levels of PGE2 and Hcy in peripheral blood showed an increasing trend with the severity of skin lesions， and ApoM showed a decreasing trend with the severity of skin lesions （P<0.05）. Spearman correlation analysis showed that PGE2 and Hcy in peripheral blood were positively correlated with disease stage and the severity of skin lesions （P<0.05）. ApoM was negatively correlated with disease stage and the severity of skin lesions （P<0.05）. There was no statistically significant difference in peripheral blood ApoM levels between the group with psychological disorders and the group without psychological disorders （P>0.05）. The peripheral blood PGE2 and Hcy levels in the group with psychological disorders were higher than those without psychological disorders （P<0.05）. Pearson correlation analysis showed that PGE2 （r=0.767） and Hcy （r=0.593） in peripheral blood were positively correlated with CHQ-12 score （P<0.05）. Peripheral blood ApoM （r=0.142） was not significantly correlated with CHQ-12 score （P>0.05）. Multivariate linear stepwise regression analysis， after controlling other factors such as disease course， disease stage， and severity of skin lesions， peripheral blood PGE2 and Hcy were still significantly correlated with mental health status （P<0.05）. Conclusion  Peripheral blood PGE2， ApoM， and Hcy of elderly patients with psoriasis vulgaris are closely related to the condition， and the levels of PGE2 and Hcy are significantly related to the mental health state of patients， and clinical attention should be paid.

Key words： psoriasis vulgaris; elderly patients; prostaglandin E2; apolipoprotein M; homocysteine; mental health status

寻常型银屑病是临床常见慢性炎症性皮肤病，发病与免疫异常、炎症反应密切相关[1]。前列腺素E2（Prostaglandin E2，PGE2）是机体炎症与免疫反应的重要参与因子之一，异常表达可引发免疫异常、加重炎症反应程度[2]。同时，有文献指出，银屑病患者通常伴有代谢紊乱[3]。而载脂蛋白M（Apolipoprotein M，ApoM）可调控血脂轉运，参与机体脂质代谢与蛋白质代谢[4];同型半胱氨酸（Homocysteine，Hcy）属于机体代谢过程中的中间产物，具有多种病理作用和生理功能[5]。因此，推测上述指标在寻常型银屑病发病发展过程发挥重要作用，但具体作用机制仍有待研究。……