Analysis Sleep Quality And Study Of Th17 And Treg Correlation In Patients With Psoriasis Vulgaris

Psoriasis is a clinical common chronic recurrence skin diseases. Because of affecting the appearance and often failing to recover,it brings patients both mental and economic burden. At same time seriously damage the patients quality of life and the ability to adapt society. It is a typical psychosomatic dermatosis. In China, according to incomplete statistics it's estimated that more than four million people are suffering from this disease, and the mobility still exhibits a increasing tendency. The World Health Organization has considered it an important impact on human health diseases. The definition of health from the simple absence of disease and weakness expand to the physical, mental and social adaptation. Medical model from a simple biomedical model developed into biological-psychological-social medical model. Our study focused on disease-related patient's characteristics, sleep quality and correlation between Th17 and Treg during psoriasis progression. We try to discover a number of new clues associated with disease. Part 1 Epidemiological investigation carried on psoriasis vulgaris and to analysis disease-related characteristics.Objective: Analysis from the group perspective of the patient's disease-related characteristics and to explore the possible reasons for illness.Methods: Firstly epidemiological surveys were made on 693 cases of psoriasis vulgaris patients with self-designed questionair by using random sampling method. Then make rash examination and estimate the severity of the illness. At last, set up logistic regression model to analyze the impact of illness-related factors.Results: There are 363 cases of male(52.4%)and 330 cases of female(47.6%)in this survey. By logistic regression correlation analysis there were 5 terms had signification differences. Sex, occupation, education, body mass index, initial or recurrence psoriasis are the major risk factors. Men is risk factors Compares women, women have the possibility of a serious illness only 0.723 times that of men; mental is the protection factors to non-mental, mental decrease the possibility illness exacerbations; recurrence compared with the initial is the risk factors; primary school and below the relative level of education is the risk factors contrast to university education and above, the possibility is 1.725 times; the normal body mass index is protective factors for obesity, with normal body weight the possibility in a serious condition is only 0.340 of obesity. Analysis showed: female in the early onset and light condition than men. The peak of initial onset age in male is 20-25 and in female is 10-20.The number of female is was much higher than male in onset age group 5-10 years old group, different is significan(tP<0.01). Meanwhile, 10-15 years old group, compared with men and women are different(P< 0.05). 28.7% of patients have family history, genetic history of those who have early-onset more likely. Body mass index and lesion area was positively correlated (r = 0.128, p = 0.001). Male patients were often overweight and obesity. Male patients in different BMI groups no difference in the severity of skin rash (r = 0.071, p = 0.175), between different groups of female with significant differences (r = 0.167, p = 0.002).Conclusion: Social and psychological factors in the occurrence and development of psoriasis plays a very important role. Psoriasis is a psychosomatic diseases. Social psychological factors should be attention in psoriasis treatment.Part 2 Survey of sleeping quality and sleep structure research on psoriasis vulgarisObjective: This study aimed at examinging the sleep quality in patients with Vulgaris Psoriasis. Its influencing factors were also investigated. Methods: Firstly, during the period ranging from Dec. 2007 to August 2008, 126 Vulgaris Psoriasis outpatients visiting the hospital clinics were measured with the Pittsburgh Sleep Quality Index (PSQI) (Buysse et al. 1989). At the same time, a Self-designed questionnaire was utilized in order to survey the factors that affect the quality of sleep in Psoriasis vulgaris. To compare the PSQI results, a control study was carried out among above psoriasis patients, 112 cases of normal adults and 45 insomnia patients(Liu Xian-chen et al. 1996). Secondly, from Jan. 2007 to Dec. 2008, 28 Vulgaris Psoriasis Volunteers for testing sleep by Micro Movement Sensitive Matress Sleep Monitoring System, then analysis of sleep structure. Results: There were 75 cases (59.5%) of Sleep Disorders in 126 psoriasis vulgaris. 69 patients (54.8%) considered themselves of poor quality of sleep. 89 patients (70.6%) believed that the psoriasis patients' condition due to the bad quality of sleep. The mean score of PSQI was 7.35±2.29. Among the component items with a score≥2, the top one is Sleep Latency. Daytime Dysfunction and Sleep Disturbances were the second and third items, respectively. The global score and component scale scores were significantly different between psoriasis patients and the normal adult groups. There were no significantly difference between psoriasis patients and insomnia patients in Sleep Latency and Sleep Disturbances. Sleep test results showed that the prevalence of psoriasis patients with reduced REM sleep characteristics, accompanied by an increased NREM sleep and arousal. Between NREM light sleep increased and the deep sleep reduced.Conclusion:Poor sleep quality do exist in psoriasis vulgaris, therefore comprehensive measures should be taken to improve sleep quality of psoriasis vulgaris. Meanwhile it is necessary to promote mental health education, easing the patients pressure to improve the quality of sleep.Part 3 An correlation between Th17 and FoxP3+ Treg accumulation during psoriasis progressionBackground: Psoriasis is a chronic, relapsing, immune-mediated inflammatory skin disease, characterized by hyperplasia in the epidermis, infiltration of leukocytes, including monocytes, dendrites cells and T lymphocytes, into both the dermis and the epidermis, and dilatation and growth of blood vessels. Psoriasis was generally considered to be a Th1-associated disease with a principal role for IFN-γfor a long time. However, there are growing evidence that recently recognized two novel and unique subsets of CD4+ T cells, T-helper 17 cells and CD4+CD25+ regulatory T cells, may play important roles in the pathogenesis of psoriasis. Th17 are distinct from Th1 and Th2 cells by preferentially produce interleukin (IL)-17A and F, and require RORγt as a key transcription factor for their differentiation. IL-17 expression is detectable in biopsies from lesional psoriatic skin, but not in nonlesional skin, indicated that Th17 are involved in the pathogenesis of psoriasis. Treg, which are characterized by their constitutive expression of CD25 and FoxP3 and immunological suppression, have been considered to be another T cell subset relevant to immune-mediated diseases in humans. In psoriasis, the imbalance of Treg and effector T cells has recently described by several groups, and suggested that the numerically or functionally impaired Treg in blood and lesional tissue may be the reason which lead to reduced restraint and consequent hyperproliferation of psoriatic pathogenic T cells. Objective: To explore Th17 and Treg number and function changes during the process of disease progression of psoriasis.Methods: Blood samples were obtained from 54 psoriasis patients and 18 age- and gender-matched healthy donors. All psoriasis patients were divided into three groups according to the Psoriasis Area and Severity Index (PASI) score: 27 patients in group 1 (PASI score≤10), 18 patients in group 2 (10 25). Using flow cytometry, cell factor staining and culture Method detection the quantity of Th17 and Treg in peripheral blood and the inter-relationship between them. Paraffin-embodied lesional skin tissues from 24 psoriasis patients were employed for immunohistochemical staining. Results: In this study, we found that both Th17 and FoxP3+ Treg were increased in psoriasis patients both in circulating serum and lesional skin tissues and were positively correlated with disease progression. But the ratio of Th17 to Treg in lesional skin tissue obviously decreased along with disease progression,while it was significantly increased in circulating and positively correlated with PASI score. IL-17 secretion of CD4+ T cells was not regulated by Treg, even though Treg exhibited significant inhibition on CD4+ T cells proliferation and IFN-γproduction. Therefore, our data suggested that there is a feed back regulation in Th17 induced-inflammation, where increased Treg might exert a suppressive effect on the hyper-immune response. These findings represent new information about the association between Th17 and Treg, which furthers our understanding of pathogenesis of psoriasis. Conclusion:Both T-helper 17 cells (Th17) and CD4+CD25+ regulatory T cells (Treg) play important roles in the pathogenesis of psoriasis.Research Innovation:1. It is first time use no binding, low psychosocial, low physical Micro Movement Sensitive Matress Sleep Monitoring System to detect the sleep structure in psoriasis patients and found psoriasis patients with special REM sleep changes.2. It is first time to explore Th17 and Treg number of dynamic changes with disease progression and their mutual relations.