Psoriasis and risk of diabetes-associated microvascular and macrovascular complications
Psoriasis and risk of diabetes-associated microvascular and macrovascular complications
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DOI：
10.1016/j.jaad.2015.02.1095
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发表时间：
2015-06-01
影响因子：
13.8
通讯作者：
Mulani, Parvez
中科院分区：
文献类型：
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作者：
Armstrong, April W.;Guerin, Annie;Mulani, Parvez
背景资料：银屑病对糖尿病发病的影响有很好的文献记载，但其对糖尿病病程的影响知之甚少。目的：我们试图比较糖尿病合并和不合并银屑病患者发生微血管和大血管并发症的风险。从MarketScan数据库中选择患有2种或以上糖尿病诊断的成年人（Truven Health Analytics Inc，安阿伯，MI）（2000 - 2006）的研究被分为2个群组：2个或更多个银屑病诊断和没有银屑病诊断。银屑病患者使用倾向评分进行匹配，并使用年龄，性别和糖尿病特征与非银屑病患者完全匹配。结果进行了比较队列之间使用考克斯回归models.Results：在所有，6164糖尿病患者银屑病（27%中度至重度）匹配6164糖尿病患者无银屑病。银屑病患者发生微血管事件的可能性显著高于非银屑病患者（总体风险比[HR] 1.14，P <0.001）和银屑病严重程度（轻度：HR 1.13，P = 0.004;中度至重度：HR 1.16，P = 0.038）。无银屑病的患者发生大血管事件的风险总体较高（HR 1.13，P =.001）和轻度银屑病患者（HR 1.15，P =.003），但不适用于中度至重度病例（HR 1.10，P =.210）。局限性：可能低估了糖尿病相关性。结论：在糖尿病患者中，银屑病通常与较高的微血管和大血管并发症发生率相关。银屑病的严重程度并不增加糖尿病并发症的风险。
Background: Psoriasis's effect on diabetes onset is well documented, but its effect on course of diabetes is poorly understood.Objective: We sought to compare risks of developing microvascular and macrovascular complications between diabetic patients with and without psoriasis.Methods: Adults with 2 or more diabetes diagnoses selected from MarketScan databases (Truven Health Analytics Inc, Ann Arbor, MI) (2000-2006) were classified into 2 cohorts: 2 or more psoriasis diagnoses and without psoriasis diagnosis. Patients with psoriasis were matched using propensity score, and exactly matched using age, sex, and diabetes characteristics with patients without psoriasis. Outcomes were compared between cohorts using Cox regression models.Results: In all, 6164 diabetic patients with psoriasis (27% moderate to severe) were matched to 6164 diabetic patients without psoriasis. Patients with psoriasis were significantly more likely to develop microvascular events than patients without psoriasis overall (hazard ratio [HR] 1.14, P < .001) and by psoriasis severity (mild: HR 1.13, P = .004; moderate to severe: HR 1.16, P = .038). Risk of macrovascular events was higher for patients without psoriasis overall (HR 1.13, P = .001) and those with mild psoriasis (HR 1.15, P = .003), but not for moderate to severe cases (HR 1.10, P = .210).Limitations: Psoriasis to diabetes association may be underestimated.Conclusion: Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications. Greater psoriasis severity did not increase risk of diabetic complications.