Study On The Correlation Between Three Syndrome Types Of Psoriasis Vulgaris And Serum YKL-40, RBP-4 And TNF-?

Psoriasis is an inflammation related,immune-mediated refractory skin disease,which can be accompanied by multi system diseases.Modern medicine divides psoriasis into four types:vulgaris,pustular,erythroderma and joint type.Psoriasis vulgaris is the most common disease,with a incidence rate of over 90%.At present,TCM has widely recognized "treatment based on blood syndrome differentiation".Psoriasis vulgaris is divided into blood heat syndrome,blood stasis syndrome and blood dryness syndrome,and the clinical effect is remarkable.However,the specific diagnosis and treatment of psoriasis vulgaris is still based on the subjective experience of various doctors and lacks the support of objective indicators.Psoriasis is a complex multi system disease-related inflammatory disease,its pathogenesis of Western medicine and TCM syndrome differentiation and transformation rules are not clear.Studies have confirmed that YKL-40 and RBP-4 are abnormally expressed in the serum of patients with psoriasis,and are closely related to a variety of inflammatory and tumor diseases.Therefore,it is of certain significance to explore the correlation between the three syndrome types of psoriasis vulgaris and the expression levels of serum YKL-40 and RBP-4.Objective:Compare the difference of serum YKL-40,RBP-4 and TNF-? expression levels between psoriasis vulgaris patients with blood heat syndrome,blood stasis syndrome and blood dryness syndrome,and normal control group,and compare the difference of expression level among three syndrome types,in order to explore the potential objective indicators for the accurate syndrome differentiation of psoriasis vulgaris.Meanwhile,serum YKL-40,RBP-4 and TNF-? of patients with psoriasis were analyzed,in order to explore the possible inflammatory mechanism of YKL-40 and RBP-4 in psoriasis and their relationship with the severity of lesions.Compare the difference of serum YKL-40,RBP-4 and TNF-? expression levels between obese and non obese patients with psoriasis,in order to explore the possible inflammatory factors related to obesity patients with psoriasis.Methods:We selected 90 patients with psoriasis vulgaris(30 cases of blood heat syndrome,30 cases of blood dryness syndrome and 30 cases of blood stasis syndrome)from December 2020 to March 2021,as the case group,and 30 healthy people in the physical examination clinic at the same period were selected as the control group.The clinical data of the case group were collected by questionnaire,including gender,age,height,weight,BMI,PASI score,personal history,family history,TCM syndrome,etc.Then the serum YKL-40,RBP-4 and TNF-? levels of all subjects were detected by ELISA.Result:1.The expression levels of serum YKL-40,RBP-4 and TNF-? of psoriasis patients with blood heat syndrome and blood stasis syndrome were higher than those of healthy control group(P<0.05);the expression levels of serum YKL-40 and TNF-? of psoriasis patients with blood dryness syndrome were higher than those of healthy control group(P<0.05).There was no significant difference in the RBP-4 expression of between patients with blood dryness syndrome and healthy control group(P>0.05);2.In psoriasis vulgaris group,the difference of expression level of serum YKL-40,RBP-4 and TNF-? between psoriasis patients with blood heat syndrome and blood dryness syndrome was statistically significant(P<0.05);there was no significant difference in the expression level of serum YKL-40,RBP-4 and TNF-? of between psoriasis patients with blood stasis syndrome and blood heat syndrome(P>0.05);the difference of expression level of serum YKL-40,RBP-4 and TNF-? of between psoriasis patients with blood stasis syndrome and blood dryness syndrome was statistically significant(P<0.05);the expression level of serum YKL-40,RBP-4 and TNF-? in three types of psoriasis showed a decreasing change:blood heat syndrome,blood stasis syndrome>blood dryness syndrome;3.The expression level of serum YKL-40 and TNF-? of obese patients in psoriasis vulgaris group was significantly higher than those of non obese patients(P<0.05);there was no significant difference in expression of serum RBP-4 between obese patients and non obese patients(P>0.05);4.The expression level of serum YKL-40 and TNF-?,in psoriasis vulgaris patients positively correlated,spearman correlation coefficient r=0.636,P=0.00<0.01;the expression level of serum RBP-4 and TNF-? in psoriasis vulgaris patients positively correlated,spearman correlation coefficient r=0.392,P=0.00<0.01;5.The expression level of serum YKL-40 was positively correlated with PASI score,spearman correlation coefficient r=0.583,P=0.00<0.01;the expression of serum RBP-4 was positively correlated with PASI score,spearman correlation coefficient r=0.394,P=0.00<0.01;the expression level of serum TNF-? was positively correlated with PASI score,spearman correlation coefficient r=0.692,P=0.00<0.01;6.The expression level of serum YKL-40 was positively correlated with BMI score,Spearman coefficient r=0.292,P=0.01<0.05;There was no significant correlation between the expression level of serum RBP-4 and TNF-?,and BMI score(P>0.05).Conclusion1.The expression levels of serum YKL-40,RBP-4 and TNF-? of between psoriasis patients with blood heat syndrome,blood stasis syndrome and blood dryness syndrome,and those of healthy controls was statistically significant.In addition to the expression of RBP-4 of psoriasis patients with blood dryness syndrome,the expression level of serum YKL-40,RBP-4 and TNF-a in three syndromes of psoriasis was significantly higher than that in healthy control group,suggesting that the expression level of YKL-40,RBP-4 and TNF-? increased in the three syndromes of psoriasis;2.There were significant differences in expression leve of serum YKL-40,RBP-4 and TNF-? of psoriasis vulgaris patients between blood dryness syndrome and blood heat syndrome,blood dryness syndrome;there was no significant difference in the levels of YKL-40,RBP-4 and TNF-? between blood heat syndrome and blood stasis syndrome;the expression level showed decreasing change:blood heat syndrome,blood stasis syndrom>blood dryness syndrome;3.There were significant differences in expression leve of serum YKL-40,and TNF-? of between obese patients and non obese patients with psoriasis.The expression levels of serum YKL-40,and TNF-? of obese patients with psoriasis were significantly higher than those of non obese patients,suggesting that YKL-40 and TNF-? may play an inflammatory role in obese patients with psoriasis;4.The expression level of serum YKL-40 and RBP-4 were positively correlated with TNF-? expression and PASI scores,considering that YKL-40 and RBP-4 may participate in inflammatory reaction and reflect the severity of psoriasis;5.The expression level of serum YKL-40 was positively correlated with BMI score,suggesting that the expression level of YKL-40 may be related to the degree of obesity in patients with psoriasis vulgaris.