环状肉芽肿患者多见血脂异常

波士顿——布朗大学皮肤病学系的George Kroumpouzos博士在美国皮肤病学会(AAD)夏季学术会议上报告称，在诊断环状肉芽肿(GA)时应高度警惕血脂异常，尤其是泛发型和环形GA患者。

Kroumpouzos博士及其同事发现，成年GA患者发生血脂异常的几率是非炎性皮肤病者的4倍。因此，治疗GA患者的医生有必要就同时治疗血脂异常的必要性与初级保健医生进行沟通。

 
环状肉芽肿
 
为评估GA患者血脂异常的发病率，研究者考察了140例特发性GA成年患者和420 例在年龄、性别、种族、2型糖尿病、高血压以及甲状腺功能减退症等方面与之相匹配的对照者的病历，受试者为大学附属医院或当地医院2002~2010年收治的患者。为考察疾病特征与共病的相关性，根据病变范围(局限型、弥散型和泛发型)、形态学(环形和非环形)和组织病理学(浸润型、栅栏型、混合型和结节性)特点对GA患者进行分组分析。血脂异常定义为下列一种或多种脂类异常：高胆固醇血症(＞200 mg/dl)、高甘油三酯血症(＞150 mg/dl)、高LDL胆固醇(＞130 mg/dl)或低HDL胆固醇(＜40 mg/dl)。

结果显示，GA患者血脂异常患病率为79.3%，而对照组为51.9%，校正混杂变量后GA患者血脂异常比值比(OR)为4.04。疾病病变范围与血脂异常具有显著相关性。与局限型或弥散型GA相比，泛发型GA患者血脂异常更为常见。出乎意料的是，环形病变与高胆固醇血症和血脂异常相关。

研究者指出，尽管该研究存在局限性，例如没有考虑患者吸烟史、锻炼、饮酒和其他药物使用等潜在混杂因素，上述结果以及GA作为血脂异常新的标志物也需要进一步研究确认，但医生还是应该注意到上述相关性的存在。

该研究结果同时发表于《皮肤病学文献》(2012 Jun 18 [doi:10.1001/archdermatol.2012 .1381])。

在随刊述评中，斯科茨代尔梅奥医院皮肤病科资深顾问Mark V. Dahl博士指出，如此多的GA患者患有血脂异常“令人惊讶”。GA病因不明，迄今“仅有模糊线索提示可能与血脂异常有关。”但值得注意的是，泛发型GA患者“偶尔患有葡萄糖代谢异常、微血管病变以及组织细胞脂质小滴沉积”(Arch. Dermatol. 2012 June 18 [doi:10.1001/ archdermatol .2012.1503])。

研究者和Dahl博士均报告无相关利益冲突。

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By: DIANA MAHONEY, Cardiology News Digital Network
BOSTON – A diagnosis of granuloma annulare "should trigger a high index of suspicion for dyslipidemia, especially among patients with generalized and annular disease," said Dr. George Kroumpouzos.

He and his colleagues found that adults with granuloma annulare are four times more likely to develop dyslipidemia than those without the inflammatory dermatosis.


Therefore, it is incumbent upon physicians treating granuloma annulare patients to communicate with primary care physicians regarding the need for simultaneous dyslipidemia management, said Dr. Kroumpouzos of the dermatology department at Brown University in Providence, R.I.

To estimate the prevalence of dyslipidemia in granuloma annulare patients, the investigators reviewed the medical records of 140 adult patients with idiopathic granuloma annulare and 420 controls matched for age, gender, race, type 2 diabetes, hypertension, and hypothyroidism, according to data presented in a poster at the American Academy of Dermatology’s Summer Academy Meeting.

The individuals included in the analysis were seen at a university hospital or a regional health care center from 2002 to 2010. To examine associations between disease characteristics and comorbidities, the granuloma annulare patients were divided into subgroups based on disease extent (localized, disseminated, generalized), morphology (annular, nonannular), and histopathology (interstitial, palisaded, mixed, deep).

Dyslipidemia was defined as the presence of one or more of the following lipid abnormalities: hypercholesterolemia (value greater than 200 mg/dL), hypertriglyceridemia (greater than 150 mg/dL), elevated LDL cholesterol (greater than 130 mg/dL), or low HDL cholesterol (less than 40 mg/dL).

According to the analysis, the prevalence of dyslipidemia in granuloma annulare patients was 79.3%, compared with 51.9% among the matched controls. After adjusting for confounding variables, the odds ratio for dyslipidemia in granuloma annulare was 4.04.

The investigators found that the association with dyslipidemia, which is independent of cardiovascular comorbidities, was more prevalent among individuals with the generalized form of the skin condition than among those with localized or disseminated disease.

"The data also demonstrates a statistically significant association between the extent of disease and dyslipidemia," said Dr. Kroumpouzos in an interview. Dyslipidemia was more common in the generalized disease subgroup than in the localized or disseminated subgroups, he explained. Further, annular lesion morphology was associated with hypercholesterolemia and dyslipidemia, which was an unexpected finding.

Although the findings are limited by the lack of account for other potential confounders, including smoking history, exercise, alcohol use, and use of other medications, and additional studies are needed to confirm the results and validate granuloma annulare as a new marker for dyslipidemia – physicians should be aware of the association, Dr. Kroumpouzos said.

The study was also published in Archives of Dermatology (2012 Jun 18 [doi: 10.1001/archdermatol.2012.1381]).

The investigators disclosed no financial conflicts of interest.

In a commentary accompanying the online publication of the study, Dr. Mark V. Dahl wrote that the finding of dyslipidemia among so many granuloma annulare patients "comes as a surprise." The cause of granuloma annulare is unknown, and until now, "only vague hints suggested a possible association with a lipid abnormality," he wrote, noting, however, that patients with generalized granuloma annulare "occasionally have an abnormality of glucose metabolism, microangiopathy, and microdroplet lipid deposits inside histiocytes" (Arch. Dermatol. 2012 June 18 [doi: 10.1001/archdermatol.2012.1503]).

Dr. Dahl is a senior consultant for the department of dermatology at the Mayo Clinic in Scottsdale, Ariz. He disclosed no financial conflicts of interest.