Обследованы 432 больных вульгарным псориазом, мужчин -213 (49.3%), женщин -219 (50.7%). В зависимости от величины индекса PASI больные были разделены на две группы: с ограниченной формой (PASI -9.6±0,01 балла, n=60) и с распространенной формой заболевания (PASI -49.53±0.46 балла, n=372). 312 больных с распространенной формой псориаза имели признаки метаболического синдрома (МС) и составили основную группу, другая часть паци-ентов с распространенной формой заболевания, не имеющих признаков МС, -группу сравнения (n=60). У обследо-ванных пациентов проведено антропометрическое исследование и определение уровня лептина в крови. Показана ста-тистически значимая связь между распространенностью кожного процесса, уровнем лептина крови и присутствием МС, что свидетельствует о патогенетической роли метаболических нарушений при псориазе.Ключевые слова: псориаз, метаболический синдром, индекс массы тела, абдоминальное ожирение, лептин крови. PECULIARITIES OF BODY COMPOSITION AND LEPTIN LEVEL IN PATIENTS WITH PSORIASIS WITH METABOLIC SYNDROME Dontsova E.V. Department of Dermatovenereology of Voronezh State Medical University named after N.N. Burdenko, Voronezh432 patients (213 men (49.3%) and 219 women (50.7%)) with vulgar psoriasis were examined. Depending on the size of the PASI index, the patients were divided into two groups: with a limited form (PASI -9.6±0.01, n = 60) and with a common form of the disease (PASI -49.53±0.46, n = 372). 312 patients with a common form of psoriasis had signs of metabolic syndrome (MS) and made up the main group, another part of patients (n = 60) with a common form of the disease, without signs of MS -comparison group. Anthropometric examination and determination of leptin level in blood were carried out in the examined patients. A statistically significant relationship between the prevalence of the skin process, the level of blood leptin and the presence of MS is shown, which indicates the pathogenetic role of metabolic disturbances in psoriasis.
Objective. To evaluate the effectiveness of upadacitinib for improving the quality of life and correcting psycho-emotional disorders in patients with eczema.Material and methods. The study included 64 patients with eczema (mean age 58.5 ± 3.4 years, men – 43, women – 21), randomized into two groups. Patients of group 1 (n = 33) received basic drug therapy (BDT), group 2 (n = 31) – in addition to BDT, the Janus kinase 1 inhibitor upadacitinib (UPA) 15 mg per day for 2 months. The values of the patients' dermatological symptom scale index (DISS), Dermatology Life Quality Index (DLQI), anxiety, depression, functional state of patients on the WAM (wellbeing, activity, mood) scale were evaluated in dynamics after 2 months after the start of treatment.Results. In the BDT group, the value of DISS in patients after 2 months from the start of treatment decreased by 1.33 times, while in the UPA + BMT group it decreased by 2.17 times. In the BDT group, the DLQI index decreased by 1.26 times, while in the UPA + BDT group – by 1.66 times. The level of anxiety in patients in the BDT group decreased by 1.34 times, in the UPA + BDT group – by 1.64 times. The level of depression in the BDT group decreased by 1.22 times, in the UPA + BDT group – by 1.67 times. Indicators of the functional state of the WAN scale in patients with BMT increased only by 1.06, 1.03, 1.05 times, and in the UPA + BMT group, respectively, 1.4, 1.5, 1.6 times.Conclusions. BDT, while improving the clinical status of patients, at the same time has an insufficient corrective effect on the severity of anxiety, depression, WAM indicators and a reduced quality of life. Additional appointment of upadacitinib to patients was accompanied by a more pronounced positive effect on the levels of anxiety, depression, indicators of the functional state of patients, which contributed to an improvement in the quality of life compared to the results of BDT.
Background: Eczema is one of the most common skin diseases. Despite the success of systemic and local pharmacotherapy, effective treatment of patients with eczema is hampered by the lack of clear ideas about the etiology and the multifactorial nature of the disease pathogenesis. The research results available to date indicate that it is possible to increase the effectiveness of treatment of eczema patients using phototherapy methods. Aim: To evaluate the possibilities of narrow-band phototherapy with a wavelength of 311 nm (UVB-311 nm) in increasing the effectiveness of drug therapy in patients with eczema. Methods: The dermatological index of the symptom scale (DISS) was used to assess the clinical manifestations of eczema. Serum levels of cytokines – interleukins (IL) -1β, -2, -6, -10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α) were determined by solid-phase enzyme immunoassay. UVB-311 nm therapy procedures (25 sessions) were performed with the Dermalight®1000 device (Germany). The results of the treatment were evaluated after 2 and 4 months from the beginning of treatment. Results: The study included 66 patients with eczema (mean age 58.6±3.4 years, 44 males, 22 females), randomized into 2 groups. Group 1 included 33 patients who received only basic drug therapy (BDT). In the 2nd group, there were 33 patients who, in addition to BDT, received narrow-band phototherapy UVB-311 nm (РT+BDT). In the BDT group, the indicators of DISS after 2 months decreased by 1.33 times (p=0.01), while in the РT+BDT group - by 1.95 times (p<0.001). The level of cytokines in the BDT group did not change significantly (p>0.05) after 2 months. In the РT+BDT group, after 2 months, the level of IL-1ß decreased by 1.25 times (p=0.001), IL-2 - by 1.44 times (p<0.001), IL-6 - by 1.69 times (p=0.001), INF-γ – by 1.28 times (p=0.001), TNF-α – by 1.29 times (p=0.002);the level of IL-10 increased by 1.22 times (p=0.002). Conclusions: Basic drug therapy contributes to a moderate decrease in the DISS by 1.33 times, but does not provide a significant decline in the pro-inflammatory cytokine potential of the blood. The use of UVB-311 nm phototherapy contributes to a more significant decrease in the levels of the complex of proinflammatory cytokines (IL-1β, -2, -6, TNF-α, INF-γ) and an increase in anti-inflammatory IL-10, which favorably affects the clinical course of dermatosis, manifesting by a decrease in the DISS by 1.95 times.
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