类风湿关节炎中脑型利钠肽原激素的氨基末端片段
Amino-terminal fragment of the prohormone brain-type natriuretic peptide in rheumatoid arthritis.
作者信息
Solus Joseph, Chung Cecilia P, Oeser Annette, Avalos Ingrid, Gebretsadik Tebeb, Shintani Ayumi, Raggi Paolo, Sokka Tuulikki, Pincus Theodore, Stein C Michael
机构信息
Vanderbilt University Medical Center, Nashville, Tennessee 37232-6602, USA.
出版信息
Arthritis Rheum. 2008 Sep;58(9):2662-9. doi: 10.1002/art.23796.
OBJECTIVE
Increased concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with cardiovascular morbidity and mortality, but little is known about their relationship to chronic inflammation. Patients with rheumatoid arthritis (RA) have chronic inflammation, increased arterial stiffness, and accelerated coronary atherosclerosis. This study was undertaken to test the hypothesis that NT-proBNP concentrations are elevated in patients with RA and are associated with coronary artery calcification and markers of inflammation.
METHODS
In 159 patients with RA (90 with early RA and 69 with longstanding RA) without heart failure and 88 control subjects, serum concentrations of NT-proBNP, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFalpha) were measured and coronary calcification was assessed. Associations between NT-proBNP levels and the other parameters were investigated.
RESULTS
NT-proBNP concentrations were elevated in patients with longstanding RA (median 142.8 pg/ml [interquartile range 54.8-270.5]) and those with early RA (median 58.1 pg/ml [interquartile range 19.4-157.6]) compared with controls (18.1 [3.2-46.0]) (P < 0.001). In patients with RA, NT-proBNP concentrations were associated with age (rho = 0.35, P < 0.001), levels of IL-6 (rho = 0.33, P < 0.001), TNFalpha (rho = 0.23, P = 0.003), and C-reactive protein (CRP) (rho = 0.21, P = 0.01), coronary calcium score (rho = 0.30, P < 0.001), systolic blood pressure (rho = 0.30, P < 0.001), and disease activity (rho = 0.29, P < 0.001). After adjustment for age, race, and sex, the associations between NT-proBNP concentrations and disease activity, TNFalpha, IL-6, and CRP remained significant, but those with systolic blood pressure and coronary calcium score were attenuated.
CONCLUSION
NT-proBNP concentrations are increased in patients with RA without clinical heart failure and may indicate subclinical cardiovascular disease and a chronic inflammatory state.
目的
N 端前脑钠肽（NT-proBNP）浓度升高与心血管疾病的发病率和死亡率相关，但关于其与慢性炎症的关系知之甚少。类风湿关节炎（RA）患者存在慢性炎症、动脉僵硬度增加和冠状动脉粥样硬化加速。本研究旨在验证 RA 患者 NT-proBNP 浓度升高且与冠状动脉钙化及炎症标志物相关这一假说。
方法
对 159 例无心力衰竭的 RA 患者（90 例早期 RA 和 69 例病程较长的 RA）及 88 例对照者测定血清 NT-proBNP、白细胞介素-6（IL-6）和肿瘤坏死因子α（TNFα）浓度，并评估冠状动脉钙化情况。研究 NT-proBNP 水平与其他参数之间的关联。
结果
与对照组（18.1[3.2 - 46.0]）相比，病程较长的 RA 患者（中位数 142.8 pg/ml[四分位间距 54.8 - 270.5]）和早期 RA 患者（中位数 58.1 pg/ml[四分位间距 19.4 - 157.6]）的 NT-proBNP 浓度升高（P < 0.001）。在 RA 患者中，NT-proBNP 浓度与年龄（rho = 0.35，P < 0.001）、IL-6 水平（rho = 0.33，P < 0.001）、TNFα（rho = 0.23，P = 0.003）、C 反应蛋白（CRP）（rho = 0.21，P = 0.01）、冠状动脉钙化评分（rho = 0.30，P < 0.001）、收缩压（rho = 0.30，P < 0.001）及疾病活动度（rho = 0.29，P < 0.001）相关。在对年龄、种族和性别进行校正后，NT-proBNP 浓度与疾病活动度、TNFα、IL-6 和 CRP 之间的关联仍然显著，但与收缩压和冠状动脉钙化评分的关联减弱。
结论
无临床心力衰竭的 RA 患者 NT-proBNP 浓度升高，可能提示亚临床心血管疾病和慢性炎症状态。
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