Spanakis Elias, Sidiropoulos Prodromos, Papadakis John, Ganotakis Emmanuel, Katsikas George, Karvounaris Stylianos, Bizaki Argyro, Kritikos Heraklis, Boumpas Dimitrios T
Department of Rheumatology, Clinical Immunology, and Allergy, University Hospital, Medical School, University of Crete, Heraklion, Greece.
J Rheumatol. 2006 Dec;33(12):2440-6. Epub 2006 Oct 1.
Tumor necrosis factor-a (TNF-a) is a key cytokine in the pathogenesis of chronic inflammatory arthritides, has proatherogenic effects, and may be positively correlated with impairment of the action of insulin. Patients with chronic inflammatory arthritides have an increased risk for cardiovascular diseases. We assessed whether anti-TNF-a treatment modifies the unfavorable lipid profile induced by chronic inflammatory arthritides.
Sixty patients (24 with rheumatoid arthritis, 26 ankylosing spondylitis, and 10 psoriatic arthritis) receiving infliximab because of ongoing disease activity despite disease modifying drugs (DMARD) were prospectively studied for 6 months. Lipid profile, total cholesterol/high density lipoprotein cholesterol (TC/HDL-C), and low density lipoprotein cholesterol (LDL-C)/HDL-C ratios, as well as disease activity indices (DAS28 and BASDAI), were assessed.
A sustained increase of serum HDL-C was observed [mean increase (95% CI)] 5 (3-7) mg/dl, 3.5 (1-6) mg/dl, and 3 (1-5) mg/dl at 1, 3, and 6 months, respectively (p < 0.01). Compared to nonresponders, HDL-C increased significantly more in EULAR or BASDAI responders (0.8 vs 5.8 mg/dl; p = 0.05). Serum TC was significantly increased [11 (4-8) mg/dl; p = 0.001] only after the first month of treatment. TC/HDL-C and LDL-C/HDL-C decreased only after the first month [0.3 (0.1-0.4), p < 0.01, and 0.2 (0.1-0.4), p < 0.01, respectively]. For patients with baseline LDL-C > 130 mg/dl, LDL-C/HDL-C decreased (p < 0.05) during the whole study period and TC/HDL-C decreased (p < 0.05) at 1 and 3 months.
Anti-TNF-a treatment in patients with chronic inflammatory arthritides induces a modest, but sustained, increase in serum HDL-C levels, which may have a favorable effect in reducing the cardiovascular risk in these patients.
肿瘤坏死因子-α（TNF-α）是慢性炎症性关节炎发病机制中的关键细胞因子，具有促动脉粥样硬化作用，且可能与胰岛素作用受损呈正相关。慢性炎症性关节炎患者患心血管疾病的风险增加。我们评估了抗TNF-α治疗是否能改善慢性炎症性关节炎所致的不良血脂谱。
对60例因尽管使用了改善病情抗风湿药（DMARD）但疾病仍持续活动而接受英夫利昔单抗治疗的患者（24例类风湿关节炎患者、26例强直性脊柱炎患者和10例银屑病关节炎患者）进行了为期6个月的前瞻性研究。评估了血脂谱、总胆固醇/高密度脂蛋白胆固醇（TC/HDL-C）和低密度脂蛋白胆固醇（LDL-C）/HDL-C比值以及疾病活动指数（DAS28和BASDAI）。
观察到血清HDL-C持续升高[平均升高幅度（95%可信区间）]，在第1、3和6个月时分别为5（3 - 7）mg/dl、3.5（1 - 6）mg/dl和3（1 - 5）mg/dl（p < 0.01）。与无反应者相比，欧洲抗风湿病联盟（EULAR）或BASDAI反应者的HDL-C升高更为显著（0.8 vs 5.8 mg/dl；p = 0.05）。仅在治疗的第一个月后血清TC显著升高[11（4 - 8）mg/dl；p = 0.001]。TC/HDL-C和LDL-C/HDL-C仅在第一个月后下降[分别为0.3（0.1 - 0.4），p < 0.01和0.2（0.1 - 0.4），p < 0.01]。对于基线LDL-C > 130 mg/dl的患者，在整个研究期间LDL-C/HDL-C下降（p < 0.05），在第1和3个月时TC/HDL-C下降（p < 0.05）。
对慢性炎症性关节炎患者进行抗TNF-α治疗可使血清HDL-C水平适度但持续升高，这可能对降低这些患者的心血管风险具有有益作用。
