Оценка уровней индикаторов системного воспаления и функции гепатобилиарной системы у больных тяжелыми формами псориаза

Цель исследования - оценить влияние различных факторов на показатели аминотрансфераз у больных тяжелыми формами псориаза. Основные группы составили пациенты, страдающих тяжелыми формами псориаза, псориатического артрита и хроническими дерматозами, находившихся на стационарном лечении в «Филиале Короленко» МНПЦДК за период 2017 г. Для статистического анализа проводился расчет M, σ, ±m, χ-квадрат. У больных кожной формой псориаза, длительно получавших метотрексат, показатели АСТ были 35,0±13,3, показатели АЛТ - 16,5±6,3. У пациентов с ПсА, которые длительно получали метотрексат показатели АСТ составили 36,2±15,9, а показатели АЛТ - 32,3±16,8. У больных кожной формой псориаза, злоупотребляющих алкоголем, показатели АЛТ составили 34,3±16,8, а показатели АСТ - 30,9±17,9. У пациентов с ПсА, которые злоупотребляли алкоголем, показатели АЛТ имели значение 43,5±13,7, показатели АСТ - 43,5±30,1. По результатам проведенного исследования мы выявили значительное повышение аминотрансфераз у пациентов с тяжелыми формами псориаза. Большое влияние на повышение печеночных ферментов оказывает длительный прием метотрексата, употребление алкоголя.

Objectives: Compare leukogram indices in patients and to evaluate the effect of different factors on the indices of liver function in patients with severe forms of psoriasis (Ps) and psoriasis arthritis (PsA). Material and methods: 164 (100%) patients with Ps (92 male (56.8%)/72 female (44.4%)). Only skin manifestations of Ps were in 137 (83.5%) out of 164 patients, PsA was registered in 27 (16.4%) out of 164 patients. Mean age of Ps patients was 42.3±14.6 years, with PsA - 54.0±14.0 years, mean PASI>10. All patients were divided into age groups, according to the World Health Organization's standard. M±m, t-test, (%) were calculated. The indices of liver function in patients with severe forms of psoriasis (Ps) and psoriasis arthritis (PsA) were calculated. All p<0.05 were considered to indicate statistical significance. Results: The mean level of leukocytes in patients with PsA was 7.8±2.4x10⁹/1; erythrocyte sedimentation rate (ESR) - 14.3±10.5; neutrophils - 60.0±10.2x10⁹/1; lymphocytes - 28.5±8.9x10⁹/1. The mean value of the level of leukocytes in patients with Ps was 6.7±2.3x10⁹/1, ESR -14.4±10.6; neutrophils -60.8±10.4x10⁹/1; lymphocytes - 28.1±8.8x10⁹/1. No significant differences were found in the leukogram and ESR in patients with Ps and PsA in all age groups. The level of the ESR were more in 2 times in significantly more cases in PsA compare Ps patients in age group 44-60 years. In patients with cutaneous psoriasis who used methotrexate for a long time, AST values were 35.0±13.3, ALT (alanine aminotransferase) scores were 16.5±6.3. In patients with PsA who received long-treatment with methotrexate, the AST (aspartate aminotransferase) values were 36.2±15.9, and the ALT scores were 32.3±16.8. In patients with cutaneous psoriasis who abused alcohol, ALT scores were 34.3±16.8, while AST scores were 30.9±17.9. In patients with PsA who abused alcohol, the ALT values were 43.5±13.7, the AST values were 43.5±30.1. Conclusion: Leukogram indicators don't reflect the severity of the skin process and do not depend on age and sex. The highest indices of inflammatory markers (ESR) were found in patients with PsA in the age group of 44-60 years. According to the results of the study, we found a significant increase in aminotransferases in patients with severe forms of psoriasis. Long-term use of methotrexate and alcohol consumption have a great effect on the increase in liver enzymes.