EADV 2026视频特辑｜Peter van de Kerkhof教授与史玉玲教授：银屑病的共病管理与精准诊疗

过去，银屑病一直被简单视为一种皮肤病；随着临床研究证据的不断积累，人们逐渐认识到它是一种影响全身的系统性疾病。如今，学界不仅关注皮肤局部病变，也越来越重视银屑病可能伴随的共病及其对全身的影响。

史玉玲教授介绍，其团队已针对银屑病不同生物制剂分别建立队列，纳入司库奇尤单抗、依奇珠单抗、古塞奇尤单抗、氘可来昔替尼，以及口服IL-23受体拮抗肽伊可白滞素等；每个队列均采集治疗前、治疗后及为期五年随访的临床信息与多组学检测数据，并重点关注胰岛素抵抗等代谢因素。史玉玲教授表示，建立这一庞大数据库的目标，是更精准地判断不同患者的适配疗法，并针对不同靶点建立新策略。史玉玲教授指出，每位患者的病情可借助分子诊断识别不同疾病内型：有的可能是IL-17、IL-23通路过度活化，有的存在显著的IL-36信号通路异常，或是以IFN-α信号通路为主导。对于对IL-17和IL-23抑制剂应答不佳、甚至对多种抑制剂产生耐药的患者，团队已专门建立难治性队列，通过多组学研究探索其耐药机制。

Psoriasis was long viewed as nothing more than a skin condition. Yet as clinical research evidence continues to accumulate, it has come to be widely recognized as a systemic disease with whole-body impacts. Today, beyond local cutaneous lesions, the academic community is paying increasing attention to psoriasis-associated comorbidities and their systemic implications.

As Professor Shi Yuling detailed, her team has established independent treatment cohorts for psoriasis patients on different biologic and targeted agents, including secukinumab, ixekizumab, guselkumab, deucravacitinib, and icotrokinra — an oral IL-23 receptor antagonist peptide. For each cohort, clinical information and multi-omics assay data are collected at baseline, post-treatment, and throughout a five-year follow-up, with a core focus on metabolic factors such as insulin resistance.

According to Professor Shi, the purpose of building this extensive database is to more accurately match patients with appropriate therapies and to devise novel treatment strategies targeting different pathogenic pathways.

She further noted that molecular diagnostics enable the identification of distinct disease endotypes across individual patients: some feature overactivation of the IL-17 and IL-23 pathways, some present with marked dysregulation of the IL-36 signaling pathway, and others are driven predominantly by the IFN-α signaling pathway.

For patients who have a suboptimal response to IL-17 and IL-23 inhibitors, or who develop resistance to multiple therapeutic agents, the team has established a dedicated refractory cohort to investigate the mechanisms of drug resistance via multi-omics research.