Br J Dermatol:银屑病合并静脉血栓栓塞症患者的癌症风险增加

2022-02-15 医路坦克 MedSci原创

银屑病是一种常见的炎症性皮肤病,它与多种疾病有关,包括癌症和心脏代谢综合征。有研究怀疑银屑病患者的静脉血栓栓塞可能是隐匿性癌症的第一个表现。本文研究了其相互之间的联系。

     银屑病是一种常见的炎症性皮肤病,影响全球超过1亿成人和儿童。它与多种疾病有关,包括癌症和心脏代谢综合征。有研究怀疑银屑病患者的全身炎症和高凝状态与心血管疾病发病风险增加有关,包括静脉血栓栓塞(VTE)(深静脉血栓形成和肺栓塞)。

     癌症和静脉血栓栓塞之间的联系早在1865年特鲁索报告这一发现时就已为人所知。此后积累了强有力的流行病学证据,表明静脉血栓栓塞可能是隐匿性癌症的第一个表现。

     我们使用了1996-2017年间覆盖所有丹麦医院的丹麦健康登记系统来识别所有住院或门诊诊断为静脉血栓栓塞症合并银屑病或有银屑病病史的患者。为了估计相对癌症风险的可能增加,我们使用丹麦国家癌症率计算年龄,性别和日历期间(1996-2018)标准化发病率(SIR)和相关的95%置信区间(CI),以比较观察到的银屑病和VTE患者的癌症发病率与预期发病率。

     我们确定了887名患有静脉血栓栓塞的患者(54%为女性),并诊断为银屑病。在这些患者中,79%的患者年龄超过50岁,22%的患者在诊断VTE之前的三个月内有诱发因素(怀孕、创伤/骨折或手术)。在研究期间,共观察到145种癌症。在第一年的随访中,总体癌症的绝对风险为4.7%(95%可信区间:3.5-6.3。对应的SIR为3.0(95%CI:2.2-4.1)。在随后几年的随访中,总体SIR降至1.5(95%CI:1.2-1.8)。肺癌、结直肠癌和非霍奇金淋巴瘤的相关性最强。

     在静脉血栓栓塞时或之后的第一年,我们发现银屑病患者的癌症风险明显增加

     癌症血栓形成的发病机制涉及肿瘤细胞之间复杂的相互作用、急性时相反应等凝血功能的激活、副蛋白的产生、炎症、坏死和血流动力学紊乱。恶性细胞可以通过释放促炎症和促血管生成的细胞因子,以及通过与血管和血细胞相互作用来激活凝血功能。

    人们一直认为,特发性或原发性静脉血栓栓塞的患者比继发于诱发因素的静脉血栓事件的患者患隐匿性癌症的风险更高。然而,几项研究表明,像银屑病这样的慢性病患者的静脉血栓栓塞也可能是隐匿性癌症的标志。

      综合研究表明,在静脉血栓栓塞患者中广泛筛查隐匿性癌症一般会提高的癌症检出率,但这些策略并不能改善与癌症相关死亡率。现有文献尚不清楚某些亚类患者是否可以从癌症的广泛诊断检查中受益。因此,患有静脉血栓栓塞的银屑病患者应该遵循与其他静脉血栓栓塞患者相同的隐匿性癌症筛查指南,直到有更多证据可用。

文献来源:Sørensen ST,  Nagy D,  Lindahl LM, Risk of Cancer in Patients with Psoriasis and Venous Thromboembolism: a Danish Population-based Cohort study 1996-2018.Br J Dermatol 2022 Jan 18

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    2022-08-02 xue8602
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    2022-07-04 fusion
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    2022-02-16 578830034

    学习了

    0

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    2022-02-15 医者仁者

    #静脉血栓##癌症风险##银屑病#这三者关联起来,真不容易

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