Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
Semin Arthritis Rheum. 2011 Dec;41(3):393-400. doi: 10.1016/j.semarthrit.2011.04.003. Epub 2011 Jun 12.
Changes in the lipid profile have been described in patients with rheumatoid arthritis (RA) following therapy with tumor necrosis factor (TNF)-alpha blocking agents. However, thus far, results have been inconsistent. Therefore, we investigated changes in lipid levels after TNF-alpha blocking therapy using meta-analysis of published data.
The literature was searched to identify studies assessing changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, triglycerides, atherogenic index (ie, TC/HDLc ratio), and apolipoprotein levels in response to TNF-alpha blocking therapy. Weighted mean levels of lipids at different time points and subsequent changes in these lipid levels between these time points were calculated with multivariate linear mixed models.
Data were available on TC in 15 studies encompassing 766 RA patients and on HDLc in 14 studies encompassing 736 RA patients. TC increased significantly (maximum increase of 10%) and HDLc increased significantly in the first 2 to 6 weeks of therapy (maximum increase of 7%), after which it remained more or less stable. The atherogenic index did not significantly change over time. There was too limited information to evaluate changes in other lipids and apolipoproteins.
TNF-alpha blocking therapy has a modest effect on TC and HDLc levels in RA patients with no significant overall effect on the atherogenic index. Whether TNF-alpha blocking effects on qualitative lipid changes (structure and function) are more relevant to their presumed vascular benefits requires further study.
在接受肿瘤坏死因子 (TNF)-α 阻断剂治疗后，类风湿关节炎 (RA) 患者的血脂谱发生了变化。然而，到目前为止，结果并不一致。因此，我们通过对已发表数据的荟萃分析来研究 TNF-α 阻断治疗后血脂水平的变化。
检索文献，以确定评估总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDLc)、低密度脂蛋白胆固醇、甘油三酯、致动脉粥样硬化指数（即 TC/HDLc 比值）和载脂蛋白水平因 TNF-α 阻断治疗而变化的研究。使用多变量线性混合模型计算不同时间点的血脂加权平均水平以及这些时间点之间这些血脂水平的变化。
共有 15 项研究提供了 TC 数据，共纳入 766 例 RA 患者，14 项研究提供了 HDLc 数据，共纳入 736 例 RA 患者。TC 在治疗的前 2 至 6 周内显著增加（最大增加 10%），HDLc 在治疗的前 2 至 6 周内显著增加（最大增加 7%），之后基本保持稳定。致动脉粥样硬化指数随时间无明显变化。由于信息有限，无法评估其他脂质和载脂蛋白的变化。
TNF-α 阻断疗法对 RA 患者的 TC 和 HDLc 水平有适度影响，但对致动脉粥样硬化指数无显著总体影响。TNF-α 阻断对定性脂质变化（结构和功能）的影响是否与其假定的血管益处更相关，需要进一步研究。
