Th17/Treg imbalance and clinical characteristics in psoriasis patients with metabolic dysfunction-associated steatotic liver disease: a cross-sectional analysis

Abstract

Psoriasis is a chronic systemic inflammatory disease that imposes a considerable burden of metabolic comorbidities. Metabolic dysfunction-associated steatotic liver disease (MASLD) is particularly common among patients with psoriasis, which may be attributed to shared metabolic and immune-inflammatory pathogenic pathways. However, evidence linking peripheral T-cell profiles to clinical phenotypes remains limited. This is a cross-sectional study. A total of 408 participants were enrolled stratified into three groups: 206 patients with plaque psoriasis, 100 subjects undergoing routine health examinations (RHE group), and 102 patients with isolated MASLD. All participants underwent vibration-controlled transient elastography (VCTE) via FibroScan®, with simultaneous acquisition of Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP). Comprehensive clinical and laboratory data were collected for further analysis. In a subset of 49 psoriasis participants (32 patients with psoriasis and MASLD and 17 patients with psoriasis alone), peripheral T-cell subpopulations were quantified using flow cytometry. Psoriasis patients had a higher MASLD prevalence than participants in RHE group (65.5% vs. 46.0%, P = 0.002), with psoriasis independently associated with MASLD (adjusted OR = 2.282, 95% CI: 1.181-4.408). Body mass index (BMI), hyperuricemia, insulin resistance-related indices (triglyceride glucose index [TyG], TyG-BMI), and uric acid-to-high-density lipoprotein cholesterol ratio (UHR) were linked to concomitant MASLD in psoriasis patients. Elevated liver enzymes were associated with severe hepatic steatosis grades. An exploratory model combining BMI, TyG and hyperuricemia exhibited favorable performance for MASLD screening, with an area under the receiver operating characteristic curve (AUC) of 0.84 (95% CI, 0.78-0.89). Compared with patients with psoriasis alone, those with coexisting MASLD showed elevated circulating IL-17+ Th17 cells and an increased Th17/Treg ratio, and this immune imbalance correlated positively with the grade of hepatic steatosis. Psoriasis is independently associated with MASLD. Psoriasis patients with coexisting MASLD present metabolic abnormalities along with peripheral Th17/Treg immune imbalance. The exploratory model combining BMI, the TyG index and hyperuricemia shows good performance for MASLD screening. These findings highlight the importance of multidisciplinary management for patients with psoriasis.