Department of Cardiology B, Oslo University Hospital Ullevaal, Oslo, Norway.
Am J Hypertens. 2012 Jun;25(6):644-50. doi: 10.1038/ajh.2012.12. Epub 2012 Mar 1.
Premature arterial stiffening and atherosclerosis are increased in patients with inflammatory arthropathies such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The proinflammatory protein calprotectin is associated with inflammatory arthropathies, vascular pathology, and acute coronary events. We examined the long-term effects of treatment with tumor necrosis factor (TNF)-α antagonists on aortic stiffness and carotid intima media thickness (CIMT) in patients with inflammatory arthropathies, and the relationships to the levels of calprotectin.
Fifty-five patients with RA, AS, or PsA and a clinical indication for anti-TNF-α therapy were included and followed with regular examinations for 1 year. Thirty-six patients starting with anti-TNF-α therapy were compared with a nontreatment group of 19 patients. Examinations included assessments of aortic stiffness (aortic pulse wave velocity, aPWV), CIMT, and plasma calprotectin.
After 1 year, aPWV (mean (s.d.)) was improved in the treatment group, but not in the control group (-0.54 [0.79] m/s vs. 0.06 [0.61] m/s, respectively; P = 0.004), and CIMT progression (median (quartile cut-points, 25th and 75th percentiles)) was reduced in the treatment group compared to the control group (-0.002 [-0.038, 0.030] mm vs. 0.030 [0.011, 0.043] mm, respectively; P = 0.01). In multivariable analyses, anti-TNF-α therapy over time was associated with improved aPWV (P = 0.02) and reduced CIMT progression (P = 0.04), and calprotectin was longitudinally associated with aPWV (P = 0.02).
Long-term anti-TNF-α therapy improved aortic stiffness and CIMT progression in patients with inflammatory arthropathies. Calprotectin may be a soluble biomarker reflecting aortic stiffening in these patients.
在类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA）等炎性关节病患者中，动脉早期僵硬和动脉粥样硬化增加。促炎蛋白钙卫蛋白与炎性关节病、血管病理学和急性冠状动脉事件有关。我们研究了肿瘤坏死因子（TNF）-α拮抗剂治疗对炎性关节病患者主动脉僵硬和颈动脉内膜中层厚度（CIMT）的长期影响，并研究了其与钙卫蛋白水平的关系。
纳入 55 例有 RA、AS 或 PsA 且有抗 TNF-α 治疗适应证的患者，并定期随访 1 年。36 例开始接受抗 TNF-α 治疗的患者与 19 例未接受治疗的患者进行比较。检查包括评估主动脉僵硬（脉搏波速度，aPWV）、CIMT 和血浆钙卫蛋白。
治疗 1 年后，治疗组的 aPWV（平均值（标准差））有所改善，但对照组无变化（-0.54（0.79）m/s 比 0.06（0.61）m/s，P=0.004），且治疗组 CIMT 进展（中位数（四分位区间，25 百分位和 75 百分位））较对照组减少（-0.002（-0.038，0.030）mm 比 0.030（0.011，0.043）mm，P=0.01）。多变量分析显示，随着时间的推移，抗 TNF-α治疗与 aPWV 的改善相关（P=0.02）和 CIMT 进展的减少相关（P=0.04），钙卫蛋白与 aPWV 呈纵向相关（P=0.02）。
长期抗 TNF-α治疗可改善炎性关节病患者的主动脉僵硬和 CIMT 进展。钙卫蛋白可能是反映这些患者主动脉僵硬的可溶性生物标志物。
