【《银屑病的病因与发病机制研究国内外文献综述》7300字】

I银屑病的病因与发病机制研究国内外文献综述银屑病的流行病学银屑病是一种慢性、复发性、炎症性、致残性、非传染性疾病。任何年龄均可受累，好发于青壮年人群，全球约有1.25亿银屑病患者ADDINEN.CITEADDINEN.CITE.DATA[22]，但不同国家和地区患病率差异较大，人群中银屑病的患病率最低为1996年非洲坦桑尼亚西北部的0.09％ADDINEN.CITE<EndNote><Cite><Author>Gibbs</Author><Year>1996</Year><RecNum>579</RecNum><DisplayText><styleface="superscript">[1]</style></DisplayText><record><rec-number>579</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616171704"guid="eb55ecd7-1ca1-4cfa-a86a-7715c754a748">579</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Gibbs,S.</author></authors></contributors><auth-address>MurgwanzaHospital,Ngara,Kagera,Tanzania.</auth-address><titles><title>SkindiseaseandsocioeconomicconditionsinruralAfrica:Tanzania</title><secondary-title>IntJDermatol</secondary-title><alt-title>Internationaljournalofdermatology</alt-title></titles><periodical><full-title>IntJDermatol</full-title><abbr-1>Internationaljournalofdermatology</abbr-1></periodical><alt-periodical><full-title>IntJDermatol</full-title><abbr-1>Internationaljournalofdermatology</abbr-1></alt-periodical><pages>633-9</pages><volume>35</volume><number>9</number><edition>1996/09/01</edition><keywords><keyword>Africa/epidemiology</keyword><keyword>DataCollection</keyword><keyword>*DevelopingCountries</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>RiskFactors</keyword><keyword>RuralPopulation</keyword><keyword>SkinDiseases/diagnosis/*epidemiology/physiopathology</keyword><keyword>SocioeconomicFactors</keyword><keyword>Tanzania/epidemiology</keyword></keywords><dates><year>1996</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0011-9059(Print) 0011-9059</isbn><accession-num>8876289</accession-num><urls></urls><electronic-resource-num>10.1111/j.1365-4362.1996.tb03687.x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><research-notes><styleface="normal"font="default"charset="134"size="100%">全球最低患病率</style><styleface="normal"font="default"size="100%">0.09%</style></research-notes><language>eng</language></record></Cite></EndNote>[1]，最高为2008年北挪威的11.43%ADDINEN.CITE<EndNote><Cite><Author>Danielsen</Author><Year>2013</Year><RecNum>580</RecNum><DisplayText><styleface="superscript">[2]</style></DisplayText><record><rec-number>580</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616224458"guid="57b9f1da-a9ca-4c42-80c2-95902f3108ab">580</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Danielsen,K.</author><author>Olsen,A.O.</author><author>Wilsgaard,T.</author><author>Furberg,A.S.</author></authors></contributors><auth-address>DepartmentofDermatology,NeurologyandOrthopaedicClinic,UniversityHospitalofNorthNorway,Tromsø,Norway.kjersti.danielsen@unn.no</auth-address><titles><title>Istheprevalenceofpsoriasisincreasing?A30-yearfollow-upofapopulation-basedcohort</title><secondary-title>BrJDermatol</secondary-title><alt-title>TheBritishjournalofdermatology</alt-title></titles><periodical><full-title>BrJDermatol</full-title></periodical><pages>1303-10</pages><volume>168</volume><number>6</number><edition>2013/02/05</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>CohortStudies</keyword><keyword>DiagnosticSelfEvaluation</keyword><keyword>Female</keyword><keyword>Follow-UpStudies</keyword><keyword>*HealthStatus</keyword><keyword>Humans</keyword><keyword>LifeStyle</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>Norway/epidemiology</keyword><keyword>Prevalence</keyword><keyword>Psoriasis/*epidemiology/psychology</keyword><keyword>RiskFactors</keyword><keyword>SurveysandQuestionnaires</keyword><keyword>TimeFactors</keyword><keyword>YoungAdult</keyword></keywords><dates><year>2013</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0007-0963</isbn><accession-num>23374051</accession-num><urls></urls><electronic-resource-num>10.1111/bjd.12230</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[2]，欧美国家银屑病的患病率高于我国ADDINEN.CITEADDINEN.CITE.DATA[23]（见图1-1）。1984年我国的银屑病患病率为1.23‰ADDINEN.CITEADDINEN.CITE.DATA[24]，2008年增长至0.47%ADDINEN.CITEADDINEN.CITE.DATA[3]，基于我国庞大的人口基数和逐年上升的患病率趋势，银屑病患者人群数量不可小觑。在地理位置上分布不均匀，北方患病率高于南方ADDINEN.CITE<EndNote><Cite><Author>Braathen</Author><Year>1989</Year><RecNum>581</RecNum><DisplayText><styleface="superscript">[25]</style></DisplayText><record><rec-number>581</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616225162"guid="5f99b92b-6fe2-4041-b0d2-30b0bba8cc6b">581</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Braathen,L.R.</author><author>Botten,G.</author><author>Bjerkedal,T.</author></authors></contributors><auth-address>DepartmentofDermatology,Rikshospitalet,NationalHospital,Oslo,Norway.</auth-address><titles><title>PrevalenceofpsoriasisinNorway</title><secondary-title>ActaDermVenereolSuppl(Stockh)</secondary-title><alt-title>Actadermato-venereologica.Supplementum</alt-title></titles><periodical><full-title>ActaDermVenereolSuppl(Stockh)</full-title><abbr-1>Actadermato-venereologica.Supplementum</abbr-1></periodical><alt-periodical><full-title>ActaDermVenereolSuppl(Stockh)</full-title><abbr-1>Actadermato-venereologica.Supplementum</abbr-1></alt-periodical><pages>5-8</pages><volume>142</volume><edition>1989/01/01</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Child</keyword><keyword>Female</keyword><keyword>HealthSurveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>Norway</keyword><keyword>Psoriasis/*epidemiology</keyword><keyword>RuralPopulation</keyword><keyword>SamplingStudies</keyword><keyword>SexFactors</keyword><keyword>UrbanPopulation</keyword></keywords><dates><year>1989</year></dates><isbn>0365-8341(Print) 0365-8341</isbn><accession-num>2763787</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[25]，且靠近地球两极地区患病率更高ADDINEN.CITEADDINEN.CITE.DATA[26,27]；在高收入国家和老龄化人口较高地区患病率更高ADDINEN.CITEADDINEN.CITE.DATA[23]；在性别方面，多数研究发现男性患病率高于女性ADDINEN.CITEADDINEN.CITE.DATA[24,28,29]，但也有研究认为银屑病的患病率无明显性别差异ADDINEN.CITE<EndNote><Cite><Author>Boehncke</Author><Year>2015</Year><RecNum>566</RecNum><DisplayText><styleface="superscript">[4]</style></DisplayText><record><rec-number>566</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616035964"guid="0e4e7dac-0a97-4626-82c4-82b2968cff44">566</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Boehncke,W.H.</author><author>Schön,M.P.</author></authors></contributors><auth-address>DepartmentofDermatologyandVenereology,GenevaUniversityHospitals,Geneva,Switzerland;DepartmentofPathologyandImmunology,UniversityofGeneva,Geneva,Switzerland.Electronicaddress:wolf-henning.boehncke@hcuge.ch. DepartmentofDermatology,VenereologyandAllergology,UniversityMedicalCenter,GeorgAugustUniversity,Göttingen,Germany.Electronicaddress:michael.schoen@med.uni-goettingen.de.</auth-address><titles><title>Psoriasis</title><secondary-title>Lancet</secondary-title><alt-title>Lancet(London,England)</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet(London,England)</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet(London,England)</abbr-1></alt-periodical><pages>983-94</pages><volume>386</volume><number>9997</number><edition>2015/05/31</edition><keywords><keyword>Humans</keyword><keyword>*Psoriasis/diagnosis/metabolism/therapy</keyword></keywords><dates><year>2015</year><pub-dates><date>Sep5</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>26025581</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(14)61909-7</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[4]。图1-1世界银屑病患病率概况ADDINEN.CITEADDINEN.CITE.DATA[23]关于银屑病发病率的研究较少，但也有逐年上升趋势，1980年~1983年美国明尼苏达州包含各年龄段的人群中银屑病发病率估计为60.4/10万，且女性发病率（60.2/10万）高于男性（54.4/10万）ADDINEN.CITE<EndNote><Cite><Author>Bell</Author><Year>1991</Year><RecNum>571</RecNum><DisplayText><styleface="superscript">[30]</style></DisplayText><record><rec-number>571</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616158427"guid="e4b4698a-50ae-4c38-a26a-0757b631f3b9">571</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Bell,L.M.</author><author>Sedlack,R.</author><author>Beard,C.M.</author><author>Perry,H.O.</author><author>Michet,C.J.</author><author>Kurland,L.T.</author></authors></contributors><auth-address>DepartmentofHealthSciencesResearch,MayoClinic,Rochester,MN55905.</auth-address><titles><title>IncidenceofpsoriasisinRochester,Minn,1980-1983</title><secondary-title>ArchDermatol</secondary-title><alt-title>Archivesofdermatology</alt-title></titles><periodical><full-title>ArchDermatol</full-title></periodical><pages>1184-7</pages><volume>127</volume><number>8</number><edition>1991/08/01</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>CohortStudies</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>Minnesota/epidemiology</keyword><keyword>PilotProjects</keyword><keyword>Psoriasis/*epidemiology</keyword><keyword>Smoking/epidemiology</keyword></keywords><dates><year>1991</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0003-987X(Print) 0003-987x</isbn><accession-num>1863076</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[30]；1987年~1988年和1995年荷兰的人群发病率分别为130/10万和120/10万ADDINEN.CITEADDINEN.CITE.DATA[31]；1996年~1997年英国的人群银屑病发病率估计为140/10万ADDINEN.CITEADDINEN.CITE.DATA[32]。对于未成年人银屑病，1970年~1999年美国的研究发现发病率估计为40.8/10万ADDINEN.CITE<EndNote><Cite><Author>Tollefson</Author><Year>2010</Year><RecNum>575</RecNum><DisplayText><styleface="superscript">[33]</style></DisplayText><record><rec-number>575</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616163219"guid="b648b44d-bcdb-4a1e-a0c0-41d273fd3a58">575</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Tollefson,M.M.</author><author>Crowson,C.S.</author><author>McEvoy,M.T.</author><author>MaraditKremers,H.</author></authors></contributors><auth-address>DepartmentofDermatology,CollegeofMedicine,MayoClinic,Rochester,Minnesota55905,USA.</auth-address><titles><title>Incidenceofpsoriasisinchildren:apopulation-basedstudy</title><secondary-title>JAmAcadDermatol</secondary-title><alt-title>JournaloftheAmericanAcademyofDermatology</alt-title></titles><periodical><full-title>JAmAcadDermatol</full-title><abbr-1>JournaloftheAmericanAcademyofDermatology</abbr-1></periodical><alt-periodical><full-title>JAmAcadDermatol</full-title><abbr-1>JournaloftheAmericanAcademyofDermatology</abbr-1></alt-periodical><pages>979-87</pages><volume>62</volume><number>6</number><edition>2009/12/08</edition><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child,Preschool</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Male</keyword><keyword>Minnesota/epidemiology</keyword><keyword>Psoriasis/*epidemiology/pathology</keyword></keywords><dates><year>2010</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0190-9622(Print) 0190-9622</isbn><accession-num>19962785</accession-num><urls></urls><custom2>PMC3818908</custom2><custom6>NIHMS515152</custom6><electronic-resource-num>10.1016/j.jaad.2009.07.029</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[33]，2006年和2012年意大利的研究发现发病率分别为60/10万和57/10万ADDINEN.CITEADDINEN.CITE.DATA[34]。在年龄方面，银屑病的发病率在39岁时达到高峰，在40~49岁时发病率下降，在50~59岁或60~69岁时发病率再次升高出现第二高峰后下降ADDINEN.CITEADDINEN.CITE.DATA[23]。银屑病的病因与发病机制银屑病的病因与发病机制尚不完全清楚，目前认为是遗传易感性、环境和生活方式因素及自身免疫紊乱等多因素共同作用的结果。1）遗传易感性银屑病在双胞胎的研究中证实了其遗传易感性，同卵双胞胎中发病一致性为35%~72%，而在异卵双胞胎中为12%~30%，并且一致发病的二者的发病年龄、皮损分布、严重程度及病程相似ADDINEN.CITE<EndNote><Cite><Author>Oka</Author><Year>2012</Year><RecNum>585</RecNum><DisplayText><styleface="superscript">[35]</style></DisplayText><record><rec-number>585</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616248750"guid="65d9d93d-8996-4b33-8400-14fa548c65b3">585</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Oka,A.</author><author>Mabuchi,T.</author><author>Ozawa,A.</author><author>Inoko,H.</author></authors></contributors><auth-address>TheInstituteofMedicalScience,TokaiUniversity,Isehara,Kanagawa,Japan.oka246@is.icc.u-tokai.ac.jp</auth-address><titles><title>Currentunderstandingofhumangeneticsandgeneticanalysisofpsoriasis</title><secondary-title>JDermatol</secondary-title><alt-title>TheJournalofdermatology</alt-title></titles><periodical><full-title>JDermatol</full-title></periodical><pages>231-41</pages><volume>39</volume><number>3</number><edition>2012/02/23</edition><keywords><keyword>Chromosomes,Human,Pair1</keyword><keyword>Chromosomes,Human,Pair17</keyword><keyword>Chromosomes,Human,Pair3</keyword><keyword>*GeneticLinkage</keyword><keyword>Genome-WideAssociationStudy</keyword><keyword>Humans</keyword><keyword>*Polymorphism,SingleNucleotide</keyword><keyword>Psoriasis/epidemiology/*genetics</keyword></keywords><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0385-2407</isbn><accession-num>22352847</accession-num><urls></urls><electronic-resource-num>10.1111/j.1346-8138.2012.01504.x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[35]。银屑病患病率的地理差异也可能是由于种群的遗传易感性和人群迁移的模式，如美国的白种人的银屑病患病率为2.5%，而非洲裔的美国人患病率为1.3%ADDINEN.CITEADDINEN.CITE.DATA[36]。Andressen等ADDINEN.CITE<EndNote><Cite><Author>Andressen</Author><Year>1982</Year><RecNum>591</RecNum><DisplayText><styleface="superscript">[37]</style></DisplayText><record><rec-number>591</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616252684"guid="bb32c793-2b69-41a4-85ae-fc0d9b215c9b">591</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Andressen,C.</author><author>Henseler,T.</author></authors></contributors><titles><title>[Inheritanceofpsoriasis.Analysisof2035familyhistories]</title><secondary-title>Hautarzt</secondary-title><alt-title>DerHautarzt;ZeitschriftfurDermatologie,Venerologie,undverwandteGebiete</alt-title></titles><periodical><full-title>Hautarzt</full-title><abbr-1>DerHautarzt;ZeitschriftfurDermatologie,Venerologie,undverwandteGebiete</abbr-1></periodical><alt-periodical><full-title>Hautarzt</full-title><abbr-1>DerHautarzt;ZeitschriftfurDermatologie,Venerologie,undverwandteGebiete</abbr-1></alt-periodical><pages>214-7</pages><volume>33</volume><number>4</number><edition>1982/04/01</edition><keywords><keyword>Adult</keyword><keyword>DiseasesinTwins</keyword><keyword>Female</keyword><keyword>Germany,West</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Psoriasis/epidemiology/*genetics</keyword></keywords><dates><year>1982</year><pub-dates><date>Apr</date></pub-dates></dates><orig-pub>ErblichkeitderPsoriasis.EineAnalysevon2035Familienanamnesen.</orig-pub><isbn>0017-8470(Print) 0017-8470</isbn><accession-num>7096085</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>ger</language></record></Cite></EndNote>[37]研究发现如果父母双方均为银屑病患者其子女患病风险为40%；如果父亲或母亲一方为银屑病患者其子女的患病风险为14%；如果兄弟姐妹中有银屑病患者，则其患病风险为6%。关节型银屑病的遗传率高达80%~100%，如果一级亲属患有关节型银屑病，则其患关节型银屑病的风险要高出30-49倍ADDINEN.CITEADDINEN.CITE.DATA[13]。研究发现有多种人类白细胞抗原（HLA）基因与银屑病的发病风险密切相关，HLAC*06:02是最有可能的因果易感性等位基因ADDINEN.CITE<EndNote><Cite><Author>Ogawa</Author><Year>2020</Year><RecNum>586</RecNum><DisplayText><styleface="superscript">[38]</style></DisplayText><record><rec-number>586</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616248857"guid="7a01ce26-8e69-49ee-9a85-0f8992d380c3">586</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Ogawa,K.</author><author>Okada,Y.</author></authors></contributors><auth-address>DepartmentofStatisticalGenetics,OsakaUniversityGraduateSchoolofMedicine,Suita,Japan;DepartmentofNeurology,OsakaUniversityGraduateSchoolofMedicine,Suita,Japan.Electronicaddress:kogawa@sg.med.osaka-u.ac.jp. DepartmentofStatisticalGenetics,OsakaUniversityGraduateSchoolofMedicine,Suita,Japan;LaboratoryofStatisticalImmunologyFrontierResearchCenter(WPI-IFReC),OsakaUniversity,Suita,Japan;IntegratedFrontierResearchforMedicalScienceDivision,InstituteforOpenandTransdisciplinaryResearchInitiatives,OsakaUniversity,Suita,Japan.Electronicaddress:yokada@sg.med.osaka-u.ac.jp.</auth-address><titles><title>Thecurrentlandscapeofpsoriasisgeneticsin2020</title><secondary-title>JDermatolSci</secondary-title><alt-title>Journalofdermatologicalscience</alt-title></titles><periodical><full-title>JDermatolSci</full-title></periodical><pages>2-8</pages><volume>99</volume><number>1</number><edition>2020/06/17</edition><keywords><keyword>Hla</keyword><keyword>Mendelianrandomization</keyword><keyword>drugrepositioning</keyword><keyword>genome-wideassociationstudy</keyword><keyword>psoriasis</keyword><keyword>declare.</keyword></keywords><dates><year>2020</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0923-1811</isbn><accession-num>32536600</accession-num><urls></urls><electronic-resource-num>10.1016/j.jdermsci.2020.05.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[38]。近年来，全基因组关联研究（GWAS）发现遗传学可以协助区分银屑病患者的临床类型及其对治疗药物的反应ADDINEN.CITEADDINEN.CITE.DATA[39]。有学者将寻常型银屑病按发病年龄分为两类，早发型（I型，＜40岁）和迟发型（II型，≥40岁）ADDINEN.CITE<EndNote><Cite><Author>Henseler</Author><Year>1985</Year><RecNum>595</RecNum><DisplayText><styleface="superscript">[40]</style></DisplayText><record><rec-number>595</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616258344"guid="399ba369-1561-4578-bea3-610e28fcac80">595</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Henseler,T.</author><author>Christophers,E.</author></authors></contributors><titles><title>Psoriasisofearlyandlateonset:characterizationoftwotypesofpsoriasisvulgaris</title><secondary-title>JAmAcadDermatol</secondary-title><alt-title>JournaloftheAmericanAcademyofDermatology</alt-title></titles><periodical><full-title>JAmAcadDermatol</full-title><abbr-1>JournaloftheAmericanAcademyofDermatology</abbr-1></periodical><alt-periodical><full-title>JAmAcadDermatol</full-title><abbr-1>JournaloftheAmericanAcademyofDermatology</abbr-1></alt-periodical><pages>450-6</pages><volume>13</volume><number>3</number><edition>1985/09/01</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>AgeFactors</keyword><keyword>Aged</keyword><keyword>Child</keyword><keyword>Child,Preschool</keyword><keyword>Female</keyword><keyword>HLAAntigens/analysis</keyword><keyword>*HLA-CAntigens</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Infant,Newborn</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>Psoriasis/*classification/epidemiology/genetics</keyword><keyword>Risk</keyword><keyword>SexFactors</keyword></keywords><dates><year>1985</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0190-9622(Print) 0190-9622</isbn><accession-num>4056119</accession-num><urls></urls><electronic-resource-num>10.1016/s0190-9622(85)70188-0</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[40]，早发型银屑病患者中有家族史者相对更多，随发病年龄的增长其与遗传易感位点的关联性减弱ADDINEN.CITEADDINEN.CITE.DATA[41]。早期关于银屑病遗传学的研究是对家系的基因组连锁分析，发现9个相关的位点（PSORS1~PSORS9）ADDINEN.CITE<EndNote><Cite><Author>Griffiths</Author><Year>2007</Year><RecNum>593</RecNum><DisplayText><styleface="superscript">[42]</style></DisplayText><record><rec-number>593</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616257116"guid="233a2815-21f2-4220-8a73-873804300010">593</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Griffiths,C.E.</author><author>Barker,J.N.</author></authors></contributors><auth-address>DermatologyCentre,HopeHospital,UniversityofManchester,ManchesterM68HD,UK.Electronicaddress:christopher.griffiths@manchester.ac.uk. StJohn'sInstituteofDermatology,Guy'sHospitalCampus,King'sCollegeLondon,London,UK.</auth-address><titles><title>Pathogenesisandclinicalfeaturesofpsoriasis</title><secondary-title>Lancet</secondary-title><alt-title>Lancet(London,England)</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet(London,England)</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet(London,England)</abbr-1></alt-periodical><pages>263-271</pages><volume>370</volume><number>9583</number><edition>2007/07/31</edition><keywords><keyword>Animals</keyword><keyword>Comorbidity</keyword><keyword>DiseaseModels,Animal</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>*Psoriasis/etiology/genetics/physiopathology</keyword><keyword>SocialIsolation</keyword></keywords><dates><year>2007</year><pub-dates><date>Jul21</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>17658397</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(07)61128-3</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[42]，其中PSORS1是早发型寻常型银屑病的主要易感位点，并且解释了35%~50%的遗传率ADDINEN.CITEADDINEN.CITE.DATA[43]。近年来，在欧洲和中国人群中通过GWAS已经发现86个基因组区域中与银屑病相关的基因位点，大多数易感位点对于关节型和寻常型银屑病的关联强度大致相等，其中仅为关节型银屑病的易感位点有16个，仅为寻常型银屑病的易感位点有12个ADDINEN.CITEADDINEN.CITE.DATA[44]。另外，与银屑病发病相关的信号通路的基因序列突变ADDINEN.CITEADDINEN.CITE.DATA[45]和表观遗传修饰ADDINEN.CITEADDINEN.CITE.DATA[46]也为银屑病的遗传学发病机制提供新的思路。2）环境和生活方式因素（1）感染链球菌是目前研究证据最多的感染因素。咽喉部β溶血性链球菌感染与银屑病（尤其是点滴型银屑病）的发病和急性加重有关ADDINEN.CITEADDINEN.CITE.DATA[6,47]，可能是由于细菌的超抗原能直接刺激T细胞增殖，这些T细胞可能来源于扁桃体，链球菌感染扁桃体诱导皮肤归巢表型，进而皮肤特异性表位与链球菌通过分子模拟相互作用ADDINEN.CITEADDINEN.CITE.DATA[48]。一些病例报道的结果提示使用抗生素对点滴型银屑病和斑块型银屑病均无明显效果，但缺乏安慰剂对照研究ADDINEN.CITE<EndNote><Cite><Author>Owen</Author><Year>2001</Year><RecNum>642</RecNum><DisplayText><styleface="superscript">[49]</style></DisplayText><record><rec-number>642</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616515791"guid="0f36148e-d192-46e1-a55a-75f4227be236">642</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Owen,C.M.</author><author>Chalmers,R.J.</author><author>O'Sullivan,T.</author><author>Griffiths,C.E.</author></authors></contributors><auth-address>DermatologyCentre,UniversityofManchester,HopeHospital,Salford,Manchester,UK.CarolineO@.uk</auth-address><titles><title>Asystematicreviewofantistreptococcalinterventionsforguttateandchronicplaquepsoriasis</title><secondary-title>BrJDermatol</secondary-title><alt-title>TheBritishjournalofdermatology</alt-title></titles><periodical><full-title>BrJDermatol</full-title></periodical><pages>886-90</pages><volume>145</volume><number>6</number><edition>2002/03/20</edition><keywords><keyword>Anti-BacterialAgents/*therapeuticuse</keyword><keyword>ChronicDisease</keyword><keyword>Humans</keyword><keyword>Psoriasis/*microbiology</keyword><keyword>RandomizedControlledTrialsasTopic</keyword><keyword>StreptococcalInfections/*complications/*drugtherapy</keyword><keyword>Tonsillectomy</keyword></keywords><dates><year>2001</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0007-0963(Print) 0007-0963</isbn><accession-num>11899140</accession-num><urls></urls><electronic-resource-num>10.1046/j.1365-2133.2001.04504.x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[49]。扁桃体切除术可能对银屑病的治疗和减少复发有一定作用ADDINEN.CITEADDINEN.CITE.DATA[50]。也有研究发现掌跖脓疱病可能与局部链球菌感染有关，儿童点滴型银屑病还可能与肛周链球菌感染相关ADDINEN.CITE<EndNote><Cite><Author>Garritsen</Author><Year>2017</Year><RecNum>650</RecNum><DisplayText><styleface="superscript">[51]</style></DisplayText><record><rec-number>650</rec-number><foreign-keys><keyapp="EN"db-id="ps2pted04pvff3eewtq5eedwxz2vwr9pzv9p"timestamp="1616589288"guid="55c36697-69b6-45f7-a994-af9d206fe703">650</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Garritsen,F.M.</author><author>Kraag,D.E.</author><author>deGraaf,M.</author></authors></contributors><auth-address>DepartmentofDermatology,UniversityMedicalCenterUtrecht,WilhelminaChildren'sHospital,theNetherlands.</auth-address><titles><title>Guttatepsoriasistriggeredbyperianalstreptococcalinfection</title><secondary-title>ClinExpDermatol</secondary-title><alt-title>Clinicalandexperimentaldermatology</alt-title></titles><periodical><full-title>ClinExpDermatol</full-title></periodical><pages>536-538</pages><volume>42</volume><number>5</number><edition>2017/05/26</edition><keywords><keyword>Anti-BacterialAgents/therapeuticuse</keyword><keyword>AnusDiseases/*complications/drugtherapy/microbiology</keyword><keyword>Humans</keyword><keyword>Infant</keyword><keyword>Male</keyword><keyword>Psoriasis/drugtherapy/*etiology/pathology</keyword><keyword>SkinDiseases,Bacterial/*complications/drugtherapy</keyword><keyword>StreptococcalInfections/*complications/drugtherapy</keyword><keyword>Streptococcuspyogenes/*isolation&purification</keyword></keywords><dates><year>2017</year><pub-dates><date>Jul</date></pub-dates