Tam Lai-Shan, Tomlinson Brian, Chu Tanya T, Li Tena K, Li Edmund K
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Clin Rheumatol. 2007 Sep;26(9):1495-8. doi: 10.1007/s10067-007-0539-8. Epub 2007 Jan 20.
Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. TNF-alpha is a critical mediator of inflammation and metabolic response in patients with RA. Increased insulin resistance and dyslipidemia were known risk factors in patients with active RA, however, the regulation of these metabolic parameters by TNF-alpha is poorly understood. Neutralization of TNF-alpha with infliximab offers a unique opportunity to study TNF-alpha-mediated regulation of these metabolic parameters in RA. The aim of the study was to assess the in vivo TNF-alpha-mediated regulation of insulin resistance and lipids levels in RA. Nineteen patients with active RA treated with infliximab were prospectively followed for 14 weeks. Plasma lipids levels and insulin resistance were measured at baseline, 6 and 14 weeks after infliximab treatment. At week 14, the disease activity (DAS-28 score) improved significantly (p < 0.000), with a significant reduction in both C-reactive protein (p = 0.007) and erythrocyte sedimentation rate (p = 0.006) levels. The body weight did not change during the study period. After infliximab treatment, insulin resistance improved as reflected by the significant reduction in the Homeostasis Model Assessment Index. Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and apolipoprotein B (apoB) levels all increased significantly from baseline. Nonetheless, the atherogenic index, LDL-cholesterol/HDL-cholesterol ratio, and the LDL/apoB ratio remained unchanged. Infliximab improves insulin sensitivity and alters lipid profile in patients with active RA.
类风湿关节炎（RA）患者的心血管死亡率有所增加。肿瘤坏死因子-α（TNF-α）是RA患者炎症和代谢反应的关键介质。胰岛素抵抗增加和血脂异常是活动性RA患者已知的危险因素，然而，TNF-α对这些代谢参数的调节作用却知之甚少。英夫利昔单抗中和TNF-α为研究TNF-α介导的RA患者这些代谢参数的调节提供了独特的机会。本研究的目的是评估体内TNF-α介导的RA患者胰岛素抵抗和血脂水平的调节情况。对19例接受英夫利昔单抗治疗的活动性RA患者进行了为期14周的前瞻性随访。在英夫利昔单抗治疗前、治疗后6周和14周测量血脂水平和胰岛素抵抗。在第14周时，疾病活动度（DAS-28评分）显著改善（p < 0.000），C反应蛋白（p = 0.007）和红细胞沉降率（p = 0.006）水平均显著降低。研究期间体重未发生变化。英夫利昔单抗治疗后，稳态模型评估指数显著降低，反映出胰岛素抵抗得到改善。总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯和载脂蛋白B（apoB）水平均较基线显著升高。尽管如此，动脉粥样硬化指数、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值和低密度脂蛋白/apoB比值仍保持不变。英夫利昔单抗可改善活动性RA患者的胰岛素敏感性并改变血脂谱。
