非酒精性脂肪性肝病合并银屑病关节炎患者外周血淋巴细胞亚群和血脂水平变化

摘要/Abstract

摘要： 目的分析非酒精性脂肪性肝病(NAFLD)合并银屑病患者外周血淋巴细胞亚群和血脂水平变化,并分析它们对银屑病关节炎(PA)发生的影响。方法纳入2020年2月至2024年2月我院诊治的NAFLD合并银屑病患者105例,依据是否合并PA分为未合并PA组、合并PA组,比较两组一般资料、淋巴细胞亚群水平及血生化指标,并采用多因素logistic回归分析探讨影响NAFLD合并银屑病患者PA发生的因素。结果 105例NAFLD合并银屑病患者中,合并PA 14例(合并PA组)。未合并PA组BMI、糖尿病、FBG、HbA_1C、高脂血症、代谢综合征、脂肪肝、皮损面积评分及皮损严重程度评分分别为24.0 kg/m²、28例(30.8%)、6.5 mmol/L、6.1％、43例(47.2%)、37例(40.6%)、33例(36.3%)、4.7分及3.5分,与合并PA组[25.4 kg/m²、9例(64.3%)、7.7 mmol/L、6.9%、12例(85.7%)、11例(40.6%)、10例(71.4%)、6.7分及4.5分]比较,差异有统计学意义(P<0.05)。未合并PA组外周血CD4⁺细胞百分比和CD4⁺/CD8⁺细胞比值为35.4%、1.3,均显著高于合并PA组(32.7%、1.1,均P<0.05)。将上述差异性指标代入多因素分析发现,高脂血症、代谢综合征、脂肪肝及CD4⁺/CD8⁺细胞比值是影响NAFLD合并银屑病患者PA发生的独立危险因素(P<0.05),而HDL则是保护性因素(P<0.05)。结论 PA发生受多重因素影响,NAFLD可能通过促进炎症反应和免疫失调增加银屑病中PA的发生风险。高脂血症、代谢综合征、脂肪肝及CD4⁺/CD8⁺细胞比值是影响NAFLD合并银屑病患者PA发生的独立危险因素,而HDL则是保护性因素。

关键词: 非酒精性脂肪性肝病, 银屑病关节炎, 外周血淋巴细胞亚群, CD4⁺T细胞亚群, 血脂异常

Abstract: Objective To analyze the changes of peripheral blood lymphocyte subsets and blood lipid levels in patients with nonalcoholic fatty liver disease (NAFLD) complicated with psoriasis, and to analyze their influence on the occurrence of psoriatic arthritis (PA). Methods Between February 2020 and February 2024, 105 patients with NAFLD complicated with psoriasis in our hospital were divided into non-PA group and PA group according to whether they were complicated with PA. The general data, lymphocyte subsets and blood biochemical indexes, of the two groups were compared, and the factors affecting PA in NAFLD complicated with psoriasis were analyzed by multivariate logistic regression. Results Among 105 patients with NAFLD complicated with psoriasis, 14 patients were complicated with PA (PA group). The scores of BMI, diabetes, FBG, HbA_1C, hyperlipidemia, metabolic syndrome, fatty liver, lesion area and lesion severity in patients with non-PA group were 24.0 kg/m², 28 cases (30.8%), 6.5 mmol/L, 6.1%, 43 cases (47.2%), 37 cases (40.6%), 33 cases (36.3%), 4.7 points and 3.5 points, compared with PA group [25.4 kg/m², 9 cases (64.3%), 7.7 mmol/L, 6.9%, 12 cases (85.7%), 11 cases (40.7%) , 10 cases (71.4%), 6.7points and 4.5points], the difference was statistically significant (P<0.05). The percentage of CD4⁺ cells and CD4⁺/CD8⁺ cells in peripheral blood of patients with non-PA were 35.4 % and 1.3,), which were significantly higher than those of patients with PA (32.7% and 1.1, P<0.05). Substituting these differences into multivariate analysis, hyperlipidemia, metabolic syndrome, fatty liver and CD4⁺/CD8⁺ are independent risk factors for PA in patients with NAFLD complicated with psoriasis (P<0.05), while HDL is a protective factor (P<0.05). Conclusion The occurrence of PA is influenced by multiple factors, and the existence of NAFLD may increase the risk of PA in psoriasis by promoting inflammatory response and immune disorder. The changes of blood lymphocyte subsets and blood lipid indexes further reveal the complex interaction between metabolism and immune system. Hyperlipidemia, metabolic syndrome, fatty liver and LDL are independent risk factors for PA in patients with NAFLD complicated with psoriasis, while HDL is a protective factor.

Key words: Nonalcoholic fatty liver disease, Psoriatic arthritis, Peripheral blood lymphocyte subsets, CD4⁺ T cell subsets, Dyslipidemia

沈琰, 张莉, 周慧敏. 非酒精性脂肪性肝病合并银屑病关节炎患者外周血淋巴细胞亚群和血脂水平变化[J]. 肝脏, 2025, 30(12): 1706-1709.

SHEN Yan, ZHANG Li, ZHOU Hui-min. Changes of peripheral blood lymphocyte and CD4⁺T cell subsets in patients with nonalcoholic fatty liver disease and psoriatic arthritis and their relationship with dyslipidemia[J]. Chinese Hepatolgy, 2025, 30(12): 1706-1709.

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