依那西普对代谢综合征患者的影响。
Effects of etanercept in patients with the metabolic syndrome.
作者信息
Bernstein L Elizabeth, Berry Jacqueline, Kim Sunnie, Canavan Bridget, Grinspoon Steven K
机构信息
Program in Nutritional Metabolism and the Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
出版信息
Arch Intern Med. 2006 Apr 24;166(8):902-8. doi: 10.1001/archinte.166.8.902.
BACKGROUND
Adipose-derived cytokines, including tumor necrosis factor alpha, may contribute to the inflammation that occurs in the metabolic syndrome. We investigated the effects of inhibition of tumor necrosis factor alpha with etanercept in patients with the metabolic syndrome.
METHODS
Fifty-six subjects with the metabolic syndrome were randomized to administration of either etanercept or identical placebo, 50 mg subcutaneously once a week for 4 weeks. The C-reactive protein level was the primary end point. Effects on other inflammatory markers (including fibrinogen, interleukin 6, and adiponectin), insulin sensitivity, lipid levels, and body composition were also determined.
RESULTS
Baseline characteristics were similar between the groups. Two subjects dropped out of each group, and etanercept was well tolerated throughout the study. The C-reactive protein levels decreased significantly in the treated compared with the placebo group (-2.4 +/- 0.4 vs 0.5 +/- 0.7 mg/L; P<.001). Adiponectin levels rose significantly in the etanercept group compared with the placebo group (0.8 +/- 0.4 vs -0.3 +/- 0.3 microg/mL; P = .03). Fibrinogen levels decreased (-68 +/- 16 vs -2 +/- 31 mg/dL [-2.0 +/- 0.47 vs -0.06 +/- 0.91 micromol/L]; P = .04) and interleukin 6 levels tended to decrease (-1.2 +/- 0.8 vs 0.5 +/- 0.5 ng/L; P = .07) in the etanercept-treated subjects compared with placebo, respectively. No changes occurred in body composition parameters or insulin sensitivity, but high-density lipoprotein levels tended to decrease in the etanercept group (-1 +/- 1 vs 2 +/- 1 mg/dL [-0.03 +/- 0.03 vs 0.05 +/- 0.03 mmol/L]; P = .06) compared with the placebo group.
CONCLUSIONS
Etanercept reduces C-reactive protein levels and tends to improve other inflammatory cardiovascular risk indexes in patients with the metabolic syndrome. Etanercept may interrupt the inflammatory cascade that occurs with abdominal obesity. Further, longer-term studies are needed to determine the effects of tumor necrosis factor alpha inhibition on cardiovascular disease in patients with the metabolic syndrome.
背景
包括肿瘤坏死因子α在内的脂肪源性细胞因子可能会导致代谢综合征中出现的炎症。我们研究了依那西普抑制肿瘤坏死因子α对代谢综合征患者的影响。
方法
56名代谢综合征患者被随机分为两组，分别接受依那西普或相同的安慰剂治疗，每周皮下注射50mg，共4周。C反应蛋白水平是主要终点。还测定了对其他炎症标志物（包括纤维蛋白原、白细胞介素6和脂联素）、胰岛素敏感性、血脂水平和身体成分的影响。
结果
两组的基线特征相似。每组有两名受试者退出，在整个研究过程中依那西普耐受性良好。与安慰剂组相比，治疗组的C反应蛋白水平显著降低（-2.4±0.4 vs 0.5±0.7mg/L；P<0.001）。与安慰剂组相比，依那西普组的脂联素水平显著升高（0.8±0.4 vs -0.3±0.3μg/mL；P = 0.03）。与安慰剂相比，依那西普治疗的受试者纤维蛋白原水平降低（-68±16 vs -2±31mg/dL [-2.0±0.47 vs -0.06±0.91μmol/L]；P = 0.04），白细胞介素6水平有降低趋势（-1.2±0.8 vs 0.5±0.5ng/L；P = 0.07）。身体成分参数或胰岛素敏感性没有变化，但与安慰剂组相比，依那西普组的高密度脂蛋白水平有降低趋势（-1±1 vs 2±1mg/dL [-0.03±0.03 vs 0.05±0.03mmol/L]；P = 0.06）。
结论
依那西普可降低代谢综合征患者的C反应蛋白水平，并倾向于改善其他炎症性心血管风险指标。依那西普可能会中断腹部肥胖时发生的炎症级联反应。此外，需要进行更长期的研究来确定抑制肿瘤坏死因子α对代谢综合征患者心血管疾病的影响。
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