Correlation Between Blood Cell-Derived Inflammatory Indexes And The Severity And Histopathology Of Psoriasis Vulgaris

BackgroundPsoriasis vulgaris(PsV)is a common immune-mediated inflammatory skin disease with chronic and recurrent clinical characteristics.It has been reported that patients with severe PsV are more likely to have nail damage,joint damage,and systemic complications,so the evaluation of the severity of PsV is the focus of clinical research.However,there are no reliable biomarkers to assess the severity of PsV disease.The pathogenesis of PsV is complex,and the interaction between innate immunity and adaptive immunity is one of the main pathogenesis of PsV,the role of immune-related cells such as neutrophil(NEU),monocyte(MON),lymphocyte(LYM),and platelet(PLT)in PsV has been paid more and more attention.Blood cell-derived inflammation indexes include neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),monocyte/lymphocyte ratio(MLR),systemic inflammatory response index(SIRI),systemic immune inflammatory index(SII),aggregate index of inflammation systemic(AISI),derived neutrophil/lymphocyte ratio(d NLR),the neutrophil/(lymphocyte×platelet)ratio(NLPR),previous studies have also confirmed that blood cell-derived inflammation indexes are important indicators to evaluate the severity and prognosis of cardiovascular diseases,respiratory diseases,malignant tumors and immune inflammatory diseases,therefore,blood cell-derived inflammatory indexes may also be biomarkers to measure the severity of PsV.The histopathological examination has very important application value in the diagnosis of PsV,and through the quantitative analysis of epidermis thickness,dermal inflammatory cell infiltration,and dermal neovascularization of PsV histopathology,the severity of PSV histopathology can be objectively quantified.Many studies believe that blood cell-derived inflammation indexes are closely related to the histopathological changes of tumors,inflammatory diseases,and other diseases,which can effectively reflect the degree of histopathological damage and evaluate the prognosis,however,there are few studies to explore the relationship between blood cell-derived inflammatory indexes and histopathological changes of PsV.In this study,a retrospective case-control study was used to analyze the correlation between blood cell-derived inflammatory indexes and the severity of PsV patients,and to explore the relationship between blood cells and their derived inflammatory indexes and histopathological changes of PsV,so as to provide a more comprehensive reference for clinical diagnosis and treatment.Based on this,this study included the following two parts:Part Ⅰ: Correlation between blood cell-derived inflammatory indexes and the severity of psoriasis vulgarisObjective To investigate the correlation between the level of blood cell-derived inflammatory indexes and the severity in patients with PsV.Methods The clinical data of 99 patients with PsV(PsV group)and 99 surgical inpatients without a history of psoriasis or inflammatory diseases(control group)who were hospitalized in the Department of Dermatology of our hospital from March 2014 to May 2022 were retrospectively collected,including general clinical data and blood cell-derived inflammatory indexes.Firstly,the clinical data of the PsV group and the control group were compared in each group.Then,according to the psoriasis area and severity index(PASI)score,the PsV patients were further divided into two subgroups: mild group(PASI < 10)and moderate to severe group(PASI ≥ 10),and the clinical data of the two subgroups were compared in each subgroup.Spearman correlation analysis was used to analyze the correlation between blood cell-derived inflammatory indexes and PASI score in PsV patients,receiver operating characteristic(ROC)curve was used to calculate area under the curve(AUC)and Youden index of blood cell-derived inflammatory indexes in predicting the severity of PsV,the optimal cut-off value of each index was determined according to the Youden index,and the corresponding sensitivity and specificity were calculated.Results 1.There were 99 cases in the PsV group and 99 cases in the control group,there were 76 males and 23 females in each group,the ratio of male to female was 3.30 : 1,and the median age was 51(40,61)years in both groups.According to the PASI score,patients with PsV were divided into two subgroups: including 62 cases in the mild group and 37 cases in the moderate to severe group;The PsV group had significantly higher levels of NLR,MLR,SIRI,SII,AISI,d NLR,and NLPR than the control group(P < 0.05),the moderate to severe group had significantly higher levels of PLR,MLR,SIRI,SII,AISI,and d NLR than the mild group(P < 0.05).2.PLR,MLR,SIRI,SII,AISI,and d NLR were all positively correlated with the PASI score(P < 0.05).3.ROC curve showed that the best sensitivity of PLR,SII,and AISI to predict the severity of PSV were 62.9%,40.5%,and 56.8%,and the best specificity was 70.3%,85.5%,and 77.4%;Among them,AISI had the best value in predicting the severity of PsV,the area under the AUC curve was 0.711 [95%CI(0.606,0.815)].Conclusion The levels of PLR,MLR,SIRI,SII,AISI,and d NLR were positively correlated with the severity of PsV.PLR,SII,and AISI had certain predictive values in evaluating the severity of PsV,among them,AISI had the best predictive value for the severity of PsV.Part Ⅱ: Correlation between blood cell-derived inflammatory indexes and histopathological changes of psoriasis vulgarisObjective To investigate the correlation between the level of blood cell-derived inflammatory indexes and histopathological changes in patients with PsV.Methods The clinical data of 41 patients with PsV(PsV group)and 30 patients with surgery(control group)who underwent skin biopsy and blood routine test before dermatology treatment in the Department of Dermatology of our hospital from February 2018 to March 2022 were retrospectively collected,the histopathological changes of skin lesions in the two groups were observed and the Image J software was used for quantitative measurement,the measurement indexes included: maximum epidermal thickness(ETmax),minimum suprapapillary epidermis thickness(SPETmin),dermal inflammatory cell infiltration rate,and dermal vessel count.Spearman correlation analysis was used to analyze the correlation between blood cell-derived inflammation indexes and the results of histopathological measurement in PsV patients,according to the median of histopathological measurement results of PsV patients,all PsV patients were divided into high/low value groups,logistic regression analysis was used to evaluate the independent influencing factors of the high value of PsV histopathological measurement results,and the predictive value of independent influencing factors was evaluated by the area under the ROC curve(AUC).Results 1.There were 30 males and 11 females in 41 patients with PsV,with an average age of 42.78 ± 18.30 years.There were 23 males and 7 females in 30 surgical patients,with an average age of 40.87 ± 19.60 years.Compared with the control group,the PsV group had significant increases in ETmax,SPETmin,dermal inflammatory cell infiltration degree,and dermal blood vessel count(P < 0.01).2.The levels of NEU positively correlated with ETmax(P < 0.01),SPETmin was not significantly correlated with peripheral blood cell-derived inflammatory indexes in PsV patients(P > 0.05),WBC,NEU,SIRI,SII,and AISI were positively correlated with the degree of dermal inflammatory cell infiltration in PsV patients(P < 0.01),WBC,NEU,SIRI,and AISI were positively correlated with the count of dermal blood vessels in PsV patients(P < 0.05).3.Logistic multivariate analysis regression showed that SII(95%CI: 1.00 ~ 1.03,P = 0.019),and AISI(95%CI: 0.96 ~ 0.99,P = 0.027)were the independent risk factors affecting the high value of PsV dermal inflammatory cell infiltration,ROC curve analysis showed that the sensitivity and specificity of SII combined with AISI in predicting the high value of dermal inflammatory cell infiltration were 75.0% and 66.7%,respectively,the AUC was 0.721(95%CI: 0.597 ~ 0.898).Conclusion 1.The increase of NEU in peripheral blood was positively correlated with the thickening of ETmax in skin biopsies of patients with PsV,WBC,NEU,SIRI,SII,and AISI were positively correlated with the degree of dermal inflammatory cell infiltration in PsV patients, and WBC,NEU,SIRI,and AISI were positively correlated with the count of dermal vessels in PsV patients.2.The SII and AISI were independent risk factors affecting the high value of dermal inflammatory cell infiltration in PsV patients.SII combined with AISI is more helpful to predict the high value of dermal inflammatory cell infiltration in PsV patients.It has certain reference value for clinical evaluation of histopathological severity in PsV patients.