Wong M, Oakley S P, Young L, Jiang B Y, Wierzbicki A, Panayi G, Chowienczyk P, Kirkham B
Guy's and St Thomas' Hospital, London, UK.
Ann Rheum Dis. 2009 Aug;68(8):1277-84. doi: 10.1136/ard.2007.086157. Epub 2008 Oct 17.
Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. Tumour necrosis factor alpha (TNFalpha)-blocking therapy has been shown to reduce RA disease activity measures and joint damage progression. Some observational studies suggest that TNFalpha blockade reduces mortality and incidence of first cardiovascular events. The mechanisms contributing to these outcomes are unclear. This study assessed the effects of infliximab treatment on vascular stiffness and structure in patients with RA.
A post hoc analysis of longitudinal data from a randomised placebo controlled study evaluated the effect of infliximab on vascular assessments. 26 patients received intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter to week 54. Patients were followed up to 56 weeks of infliximab therapy with assessments of RA disease activity, cardiovascular risk factors, vascular stiffness (pulse wave velocity (PWV)), carotid intima media thickness (CIMT) and carotid artery plaque (CAP). Univariate analyses of changes over time by repeated measures analysis of variance (ANOVA) were followed by multivariate time-series regression analysis (TSRA) if changes were seen.
PWV was significantly lower (better) after 56 weeks of treatment with infliximab (ANOVA p<0.01, TSRA p<0.01). However, CIMT (ANOVA p = 0.50) and CAP (chi(2) = 4.13, p = 0.88) did not change over the study period. Multiple cardiovascular risk measures did not change with treatment and did not correlate with changes in measures of vascular structure.
Arterial stiffness improves with infliximab treatment in RA. This change may help explain the improved cardiovascular disease survival in patients with RA receiving TNFalpha-blocking therapy.
类风湿关节炎（RA）患者的心血管死亡率增加。肿瘤坏死因子α（TNFα）阻断疗法已被证明可降低RA疾病活动度指标并减缓关节损伤进展。一些观察性研究表明，TNFα阻断可降低死亡率和首次心血管事件的发生率。导致这些结果的机制尚不清楚。本研究评估了英夫利昔单抗治疗对RA患者血管硬度和结构的影响。
一项来自随机安慰剂对照研究的纵向数据的事后分析评估了英夫利昔单抗对血管评估的影响。26例患者在第0、2、6周接受静脉注射英夫利昔单抗（3mg/kg），此后每8周一次，直至第54周。对患者进行英夫利昔单抗治疗至56周的随访，评估RA疾病活动度、心血管危险因素、血管硬度（脉搏波速度（PWV））、颈动脉内膜中层厚度（CIMT）和颈动脉斑块（CAP）。采用重复测量方差分析（ANOVA）对随时间的变化进行单变量分析，若有变化则随后进行多变量时间序列回归分析（TSRA）。
英夫利昔单抗治疗56周后，PWV显著降低（改善）（ANOVA p<0.01，TSRA p<0.01）。然而，在研究期间，CIMT（ANOVA p = 0.50）和CAP（χ² = 4.13，p = 0.88）没有变化。多种心血管风险指标在治疗后没有变化，且与血管结构指标的变化无关。
RA患者接受英夫利昔单抗治疗后动脉硬度改善。这一变化可能有助于解释接受TNFα阻断疗法的RA患者心血管疾病生存率提高的原因。
