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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En la psoriasis&#44; la inflamaci&#243;n sist&#233;mica ocasiona s&#237;ndrome metab&#243;lico y enfermedad cardiovascular &#40;ECV&#41;&#44; con resistencia a la insulina &#40;RI&#41; como posible factor pat&#243;geno<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nuestro grupo de trabajo llev&#243; a cabo un estudio transversal para determinar la prevalencia de la RI&#44; mediante el &#237;ndice de evaluaci&#243;n del modelo de la homeostasis &#40;HOMA-RI&#41;&#44; en pacientes psori&#225;sicos moderados-graves atendidos en nuestra consulta externa de dermatolog&#237;a&#46; A partir de los niveles plasm&#225;ticos de glucosa e insulina en ayunas&#44; se calcul&#243; el HOMA-RI mediante el &#237;ndice obtenido de la f&#243;rmula &#40;insulina en ayunas &#91;mlU&#47;L&#93; x glucosa en ayunas &#91;mg&#47;dL&#93;&#41; &#247; 405&#44; en todos los pacientes&#46; La RI se defini&#243;&#44; de acuerdo con la investigaci&#243;n original del HOMA&#44; como un valor HOMA-RI alto &#40;&#62; 2&#44;5&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nuestra muestra inicial estuvo compuesta por 100 pacientes&#46; Excluimos a 19 pacientes con diabetes&#44; quedando la muestra formada por 81 integrantes &#40;46 hombres y 35 mujeres&#41;&#44; con una mediana de edad de 46 a&#241;os &#40;rango intercuart&#237;lico &#91;IQR&#93; 35-36&#41;&#46; La mediana del &#237;ndice de masa corporal &#40;IMB&#41; fue de 28 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;IQR 24&#44;5-31&#44;6&#41;&#46; La mediana del HOMA-RI fue de 2&#44;9 &#40;IQR 1&#44;6-5&#44;0&#41;&#44; teniendo el 49&#44;4&#37; de los pacientes RI &#40;intervalo de confianza &#91;IC&#93; 95&#37; 38&#44;6-60&#44;0&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes&#44; seg&#250;n el &#237;ndice HOMA-RI&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">En los pacientes de edad superior a los 45 a&#241;os&#44; la mediana del HOMA-RI fue significativamente mayor que en los de 45 a&#241;os o m&#225;s j&#243;venes &#40;p &#61; 0&#44;002&#41;&#44; lo que indica la existencia de una correlaci&#243;n entre la edad y el HOMA-RI&#46; La prevalencia de la RI en pacientes mayores de 45 a&#241;os fue del 65&#44;9&#37; &#40;odds ratio &#91;OR&#93; 4&#44;0&#59; IC 95&#37; 1&#44;6-10&#59; p &#61; 0&#44;003&#41;&#46; El IMC tambi&#233;n se relacion&#243; con la mediana m&#225;s alta del HOMA-RI &#40;1&#44;3 en pacientes con peso normal &#91;IMC &#60; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; 3&#44;0 en pacientes con sobrepeso &#91;IMC 25-29&#44;9 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; y 4&#44;7 en pacientes obesos &#91;IMC &#8805; 30 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; p &#61; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En los pacientes con peso normal&#44; la prevalencia de la RI &#62; 2&#44;5 fue del 13&#37;&#59; del 53&#44;6&#37; en los pacientes con sobrepeso &#40;p &#60; 0&#44;003&#41; y del 73&#44;3&#37; en los pacientes obesos &#40;p &#60; 0&#44;001&#41;&#46; Es interesante resaltar que los valores del HOMA-RI no estaban relacionados con el sexo&#44; el &#237;ndice de la severidad del &#225;rea de psoriasis &#40;PASI&#41;&#44; o el &#237;ndice de calidad de vida en dermatolog&#237;a &#40;DLQI&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La RI constituye el mejor predictor de la diabetes mellitus tipo 2&#44; y desempe&#241;a un papel central en el aumento del riesgo cardiovascular asociado con el s&#237;ndrome metab&#243;lico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; En nuestra poblaci&#243;n de estudio con psoriasis de moderada a grave&#44; la prevalencia de la RI fue alta&#44; casi la mitad de los pacientes &#40;el 49&#44;4&#37;&#41;&#46; Aunque nuestro trabajo no ha tenido un grupo control&#44; la prevalencia global de la RI es mucho m&#225;s elevada que la notificada en un estudio poblacional similar &#40;aproximadamente el 9&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Hemos detectado una clara relaci&#243;n entre la RI y el IMC&#44; tal y como muestra la <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#46; De la misma forma&#44; Boehncke et al&#46; observaron una clara relaci&#243;n entre el IMC alto y la RI<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; Resulta interesante&#44; por el contrario que&#44; en nuestros pacientes&#44; los valores del &#237;ndice HOMA-RI no guardan relaci&#243;n con la gravedad de la psoriasis&#44; seg&#250;n el PASI&#44; a diferencia de lo publicado en el estudio anterior&#44; en el que s&#237; se detect&#243; una relaci&#243;n significativa entre el PASI y la secreci&#243;n de insulina<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Una proporci&#243;n sustancial de pacientes con psoriasis&#44; en particular aquellos con un elevado IMC&#44; tendr&#225; RI&#46; Nos gustar&#237;a insistir en que los dermat&#243;logos deben asumir la responsabilidad de prevenir&#44; detectar&#44; tratar y cuidar con prontitud a los pacientes con psoriasis con RI subcl&#237;nica y&#44; por lo tanto&#44; en riesgo de diabetes y ECV&#46; Por tanto&#44; el &#237;ndice HOMA-RI puede ayudar a los m&#233;dicos a conseguirlo de forma sencilla&#46;</p></span>"
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CARTA CIENTÍFICO-CLÍNICA
Índice de evaluación del modelo de homeostasis (HOMA) y resistencia a la insulina en la psoriasis
Homeostasis Model Assessment (HOMA) and Insulin Resistance in Psoriasis
D. Romero-Péreza,
Corresponding author
davidromero66@hotmail.com

Autor para correspondencia.
, I. Belinchón Romeroa,b, J.M. Ramos Rincóna,b,c
a Departamento de Dermatología, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
b Departamento de Medicina Interna, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
c Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Campus de San Juan , Elche, Alicante , España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En la psoriasis&#44; la inflamaci&#243;n sist&#233;mica ocasiona s&#237;ndrome metab&#243;lico y enfermedad cardiovascular &#40;ECV&#41;&#44; con resistencia a la insulina &#40;RI&#41; como posible factor pat&#243;geno<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nuestro grupo de trabajo llev&#243; a cabo un estudio transversal para determinar la prevalencia de la RI&#44; mediante el &#237;ndice de evaluaci&#243;n del modelo de la homeostasis &#40;HOMA-RI&#41;&#44; en pacientes psori&#225;sicos moderados-graves atendidos en nuestra consulta externa de dermatolog&#237;a&#46; A partir de los niveles plasm&#225;ticos de glucosa e insulina en ayunas&#44; se calcul&#243; el HOMA-RI mediante el &#237;ndice obtenido de la f&#243;rmula &#40;insulina en ayunas &#91;mlU&#47;L&#93; x glucosa en ayunas &#91;mg&#47;dL&#93;&#41; &#247; 405&#44; en todos los pacientes&#46; La RI se defini&#243;&#44; de acuerdo con la investigaci&#243;n original del HOMA&#44; como un valor HOMA-RI alto &#40;&#62; 2&#44;5&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nuestra muestra inicial estuvo compuesta por 100 pacientes&#46; Excluimos a 19 pacientes con diabetes&#44; quedando la muestra formada por 81 integrantes &#40;46 hombres y 35 mujeres&#41;&#44; con una mediana de edad de 46 a&#241;os &#40;rango intercuart&#237;lico &#91;IQR&#93; 35-36&#41;&#46; La mediana del &#237;ndice de masa corporal &#40;IMB&#41; fue de 28 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;IQR 24&#44;5-31&#44;6&#41;&#46; La mediana del HOMA-RI fue de 2&#44;9 &#40;IQR 1&#44;6-5&#44;0&#41;&#44; teniendo el 49&#44;4&#37; de los pacientes RI &#40;intervalo de confianza &#91;IC&#93; 95&#37; 38&#44;6-60&#44;0&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes&#44; seg&#250;n el &#237;ndice HOMA-RI&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">En los pacientes de edad superior a los 45 a&#241;os&#44; la mediana del HOMA-RI fue significativamente mayor que en los de 45 a&#241;os o m&#225;s j&#243;venes &#40;p &#61; 0&#44;002&#41;&#44; lo que indica la existencia de una correlaci&#243;n entre la edad y el HOMA-RI&#46; La prevalencia de la RI en pacientes mayores de 45 a&#241;os fue del 65&#44;9&#37; &#40;odds ratio &#91;OR&#93; 4&#44;0&#59; IC 95&#37; 1&#44;6-10&#59; p &#61; 0&#44;003&#41;&#46; El IMC tambi&#233;n se relacion&#243; con la mediana m&#225;s alta del HOMA-RI &#40;1&#44;3 en pacientes con peso normal &#91;IMC &#60; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; 3&#44;0 en pacientes con sobrepeso &#91;IMC 25-29&#44;9 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; y 4&#44;7 en pacientes obesos &#91;IMC &#8805; 30 kg&#47;m<span class="elsevierStyleSup">2</span>&#93;&#59; p &#61; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En los pacientes con peso normal&#44; la prevalencia de la RI &#62; 2&#44;5 fue del 13&#37;&#59; del 53&#44;6&#37; en los pacientes con sobrepeso &#40;p &#60; 0&#44;003&#41; y del 73&#44;3&#37; en los pacientes obesos &#40;p &#60; 0&#44;001&#41;&#46; Es interesante resaltar que los valores del HOMA-RI no estaban relacionados con el sexo&#44; el &#237;ndice de la severidad del &#225;rea de psoriasis &#40;PASI&#41;&#44; o el &#237;ndice de calidad de vida en dermatolog&#237;a &#40;DLQI&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La RI constituye el mejor predictor de la diabetes mellitus tipo 2&#44; y desempe&#241;a un papel central en el aumento del riesgo cardiovascular asociado con el s&#237;ndrome metab&#243;lico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; En nuestra poblaci&#243;n de estudio con psoriasis de moderada a grave&#44; la prevalencia de la RI fue alta&#44; casi la mitad de los pacientes &#40;el 49&#44;4&#37;&#41;&#46; Aunque nuestro trabajo no ha tenido un grupo control&#44; la prevalencia global de la RI es mucho m&#225;s elevada que la notificada en un estudio poblacional similar &#40;aproximadamente el 9&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Hemos detectado una clara relaci&#243;n entre la RI y el IMC&#44; tal y como muestra la <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#46; De la misma forma&#44; Boehncke et al&#46; observaron una clara relaci&#243;n entre el IMC alto y la RI<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; Resulta interesante&#44; por el contrario que&#44; en nuestros pacientes&#44; los valores del &#237;ndice HOMA-RI no guardan relaci&#243;n con la gravedad de la psoriasis&#44; seg&#250;n el PASI&#44; a diferencia de lo publicado en el estudio anterior&#44; en el que s&#237; se detect&#243; una relaci&#243;n significativa entre el PASI y la secreci&#243;n de insulina<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Una proporci&#243;n sustancial de pacientes con psoriasis&#44; en particular aquellos con un elevado IMC&#44; tendr&#225; RI&#46; Nos gustar&#237;a insistir en que los dermat&#243;logos deben asumir la responsabilidad de prevenir&#44; detectar&#44; tratar y cuidar con prontitud a los pacientes con psoriasis con RI subcl&#237;nica y&#44; por lo tanto&#44; en riesgo de diabetes y ECV&#46; Por tanto&#44; el &#237;ndice HOMA-RI puede ayudar a los m&#233;dicos a conseguirlo de forma sencilla&#46;</p></span>"
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                            0 => "I&#46; Snekvik"
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                      "doi" => "10.1111/jdv.14835"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "776"
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                            0 => "P&#46; Gisondi"
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ISSN: 00017310
Original language: Spanish
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