Proliferative function of endothelium in local scleroderma, gender and age characteristics of the disease

Al­-Omary Obadeh Mahmoud, S. Bondar
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Abstract

Objective — to investigate the variability of vascular endothelial growth factor (VEGF) in localized scleroderma (LS), characteristics of the disease in different age groups. Materials and methods. The study included the clinical evaluation of 78 patients (27 men, 51 women) with localized scleroderma aged (43.2 ± 7.28) years. All patients underwent clinical, laboratory, and enzyme immunoassay investigation of VEGF. The criteria for inclusion in the study were: the presence of localized scleroderma and the absence of signs of a systemic process. Results and discussion. It has been proven that localized scleroderma is gender­related, more often recorded in women (65.4 %, p < 0.05), with an attributive risk of 50.0 % compared to men. Late diagnosis of the disease was proven in 78.2 % of patients. The age and gender characteristics of this pathology were determined — men are more likely to get sick at a young age (up to 20 years; 22.2 % of the surveyed), however, women over the age of 55 prevail (p < 0.05). Women sought dermatological help earlier compared to men (29.4 %; p < 0.05), but had a higher risk of early progression (p < 0.05). Among the clinical forms of localized scleroderma, most of the cases (70.5 %) were of the plaque form. In 15.4% of cases, a linear form was diagnosed, in 9.0% ­ lichen sclerosus, in 5.1 % — Pasini—Pierini idiopathic atrophoderma. The plaque form of LS was significantly more often detected in women (80.3 %), and the linear form and lichen sclerosus — in men (22.2 % each). The average number of lesions was 2.8 ± 1.12. Three lesions were found in almost half (43.6 %) of the patients, one lesion – in 23.1%, two lesions – in 16.7%, four lesions – in 11.5%. Five or more lesions were present in 4 (5.1 %) patients. It has been found that the highest content of VEGF was observed in classic plaque form (p < 0.05), the lowest — in Pasini—Pierini idiopathic atrophoderma (p < 0.05). U­shaped age dependence of the disease was determined: high content of VEGF­A in patients under the age of 20 (p < 0.05), with a significant decrease of VEGF­A in patients aged 20—35 years (p < 0.05) and further increase in those aged 35 to 55 years (p < 0.05). It was established that VEGF­A level increased at patients with early progression of the disease — in the first 2 years after the start of clinical manifestations against the group of patients with slow progression — more than 6 years (p < 0.05). In assessment of gender dependence, we found a higher content of VEGF­A in female patients compared to male patients (p < 0.05). Conclusions. Localized scleroderma has gender and age­related characteristics and is 50.0 % more often recorded in women. Among men, young patients predominate. Studying the pathogenesis of LS and assessing the proliferative function of the endothelium of the disease will make it possible to predict the course of the disease, improve the diagnosis and treatment.
局部硬皮病患者内皮细胞增殖功能及性别、年龄特征
目的:探讨局限性硬皮病(LS)患者血管内皮生长因子(VEGF)的变异性及不同年龄组的病变特点。材料和方法。本研究纳入78例局限性硬皮病患者(男性27例,女性51例),年龄(43.2±7.28)岁。所有患者均进行了临床、实验室和酶免疫分析研究。纳入研究的标准是:局部硬皮病的存在和没有系统性过程的迹象。结果和讨论。已经证明,局限性硬皮病与性别有关,女性更常记录(65.4%,p < 0.05),与男性相比,其归因风险为50.0%。在78.2%的患者中证实了疾病的晚期诊断。这种病理的年龄和性别特征是确定的——男性更容易在年轻时患病(20岁;(22.2%),但55岁以上女性居多(p < 0.05)。与男性相比,女性更早寻求皮肤科治疗(29.4%;P < 0.05),但早期进展的风险较高(P < 0.05)。在局限性硬皮病的临床表现中,以斑块型为主(70.5%)。在15.4%的病例中,诊断为线性形式,9.0%为硬化性地衣,5.1%为帕西尼-皮里尼特发性萎缩皮病。斑块型LS在女性中更为常见(80.3%),而线状和硬化衣型LS在男性中更为常见(22.2%)。平均病灶数为2.8±1.12个。几乎一半(43.6%)的患者发现三个病变,23.1%的患者发现一个病变,16.7%的患者发现两个病变,11.5%的患者发现四个病变。4例(5.1%)患者存在5个或更多病变。VEGF在经典斑块形态中含量最高(p < 0.05),在Pasini-Pierini特发性萎缩皮病中含量最低(p < 0.05)。疾病的u型年龄依赖性:20岁以下患者VEGF-A含量较高(p < 0.05), 20 - 35岁患者VEGF-A含量显著降低(p < 0.05), 35 - 55岁患者VEGF-A含量进一步升高(p < 0.05)。VEGF-A水平在疾病早期进展患者(临床表现开始后的前2年)高于进展缓慢患者组(6年以上)(p < 0.05)。在性别依赖性评估中,我们发现女性患者VEGF-A含量高于男性患者(p < 0.05)。局限性硬皮病具有与性别和年龄相关的特征,女性的发病率高于50%。在男性中,年轻患者居多。研究LS的发病机制,评估其内皮细胞的增殖功能,有助于预测病程,提高诊断和治疗水平。
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