اسم المؤلف:
شكرية حاتم علوان
اسم المشرف:
محمد عبيد المحمدي | محمد كاظم الحطاب
المستخلص:
مبدا الدراسة : الصدفية مرض جلدي شائع ذو علامات جلدية ظاهرة، يتميز بالتهاب مزمن للجلد مع اختلاف في نضوج الخلايا الكيراتينية، التي تزيد من سمك الجلد. عملية تكوين الاوعية الدموية (Angiogenesis) هي المسؤول بالدرجة الاساس عن تطور افة الصدفية، واحد اهم عوامل تكو | Background : Psoriasis is a common skin disease with extra - cutaneous manifestations. It characterized by chronic inflammation of the skin with changes in the maturation of keratinocytes, which manifested by the hyperproliferation of the epidermis. Angiogenesis process is a central regulator of development psoriasis lesion and one of the important angiogenesis factor is vascular endothelial growth factor (VEGF).A major site of oxidative stress occurs in the skin due to reactive oxygen species, which play an important role in inflammatory skin diseases such as psoriasis. Objectives : The aim of this presented study is to evaluating the effect of MTX drug on psoriatic lesions by calculating psoriasis area and severity index (PASI) for three months. In addition, investigate the changes of the level of serum VEGF, antioxidants (GSH and SOD) and lipid profile, which include (TC, TG, HDL, LDL and VLDL). As well as, hematological assessment such as (RBCs, Hb, PCV, RBCs indices, ESR and WBCs) in patients with psoriasis before and after (one and three months) from treatment with oral methotrexate therapy in comparison to their levels in healthy control persons. Materials and Methods : This study was a cohort study in which a total of 80 subjects, half of them(40) with psoriasis (25 male and 15 female) had selected randomly from Marjan Medical City in AL - Hilla city and the other half (40)as healthy controls (21 male and 19 female). These subjects collected during the period from 28th/ October /2014 until 15th/ August/ 2015. Physical examination (body mass index) done to each subject that enrolled in the study. A clinical assessment of psoriasis disease activity in psoriasis patients and methotrexate efficacy was done with the Disease Activity Index (DAI) represented by PASI score. Blood collection was obtained from all psoriatic patients and control to use in determine the level of all biochemical parameter such as VEGF, GSH SOD and lipid profile , as well as hematological investigation which include RBCs, Hb, PCV, RBCs indices, ESR and WBCs. Result : The results of this work showed, The effect of systemic methotrexate therapy on psoriasis lesion by significant reduction of PASI levels after treatment and by a significant mean difference in psoriasis area severity index before and after (one and three months) from treatment in psoriatic lesions (P?0.05). Also, no significant differences (p> 0.05) between the mean of age for psoriatic patients group (male and female) and healthy control group (males and females). The body mass index shows significant increase (P?0.05) in psoriasis patients than control group. The serum of VEGF level was significant increase in patients with psoriasis when compare with control through study periods, and there was significant reduction in the level of VEGF in psoriasis patients as compared its level before and after treatment with MTX for one and three months (P?0.05). While, the level of GSH and SOD significant decrease in patients than control ,during the treatment with MTX ,there was significant difference increase in the level of GSH of patients as compare with baseline level (before treatment) (P?0.05). In addition, the level of SOD of patients appear there was no statically difference before treatment and after treatment with MTX. The results of the present study also show a significant increase (P?0.05) in total cholesterol(TC), triglycerides(TG), low density lipoprotein - cholesterol (LDL) and very low density lipoprotein - cholesterol(VLDL) concentration, while found a significant decrease (P?0.05) in level of HDL in serum of psoriasis group compared with those of the healthy control group. When compare between patients during follow up periods, found there was no significant different of level of TC, TG, LDL and VLDL between psoriasis patients in period before treatment when compared with after one months from treatment with MTX (P>0.05). While there is a significant increase between patients before treatment compare with after three months, and after one month from treatment compare with after three months from treatment with MTX (P? 0.05). The level of HDL in psoriatic patients was significant increase at (P? 0.05) before treatment as comparing with after (one month and three months) from treatment with MTX, but there is no significant difference between patients after one from treatment as compared to with after three month from treatment with methotrexate (P> 0.05). The result of hematological for the results of study showed , there is a significant decrease (P? 0.05) in RBCs counts, Hb, PCV and RBCs indices compared with healthy control. While significant increase in total WBCs counts and ESR in psoriatic patients in all periods of follow up periods as compare with control. When compare the RBCs, Hb, PCV, RBCs indices of patients in all periods before and after (one and three months) from treatment with MTX, found there is no significant difference among them at (P> 0.05). While the result of WBCs count show significant decrease (P?0.05) between patient before treatment and after three months from treatment with MTX , and between after one month from treatment with MTX as compare with after three month from treatment , but there is no significant difference between before treatment compare to after one month from treated with MTX. The results of ESR of psoriasis patient show significant decrease (P? 0.05) between before treatment as compare with after three months from treatment with MTX , and after one month from treatment compare to after three month from treatment.While there is no any significant difference between patient before treatment compare with after one month from treatment with methotrexate (P>0.05). Conclusion : The vascular endothelial growth factor have play important role in the evaluation of psoriasis severity, oral methotrexate therapy have efficacy upon serum levels of vascular endothelial growth factor. Efficacy of oral methotrexate therapy on psoriatic patient’s treatment, have there was faster remission of psoriatic lesions and this reflect the immune - modulatory anti - inflammatory role of The MTX in psoriasis patient.
