Tam Lai-Shan, Kitas George D, González-Gay Miguel A
Rheumatology (Oxford). 2014 Jun;53(6):1108-19. doi: 10.1093/rheumatology/ket454.
It remains a matter of debate whether TNF-a antagonists have favourable effects on the cardiovascular (CV) system. This systematic review evaluates the effect of TNF-a blockers on the progression of subclinical atherosclerosis and arterial stiffness in patients with inflammatory arthritis.
A search of the MEDLINE and Web of Knowledge databases was conducted to identify studies into the effect of TNF-a antagonists on subclinical atherosclerosis and arterial stiffness in patients with RA, AS and PsA. Carotid intimamedia thickness (cIMT) was used to assess subclinical atherosclerosis. Two methods were used to assess arterial stiffness: pulse wave velocity (PWV) and aortic augmentation index (AIx). Twenty-three studies matching the search criteria were included for analysis.
TNF-a blockers probably are effective in preventing (7/13 studies) or even reversing (5/13 studies) the progression of IMT in patients with RA, AS and PsA who are responding to treatment. With regard to arterial stiffness, PWV was either significantly reduced (7/13 studies) or remained unchanged (6/13 studies) following TNF-a antagonist treatment. Nonetheless, most studies in RA (7/10) reported significant improvement of PWV. AIx remained unchanged in 10 of 13 studies.
The balance of evidence suggests that TNF-a antagonists may have a beneficial effect on preventing the progression of subclinical atherosclerosis and arterial stiffness. It remains unknown whether this effect is specific to TNF-a antagonists or relates to better control of inflammation irrespective of the disease modification strategy by which this is achieved.
肿瘤坏死因子-α（TNF-a）拮抗剂对心血管（CV）系统是否具有有益作用仍存在争议。本系统评价评估了TNF-a阻滞剂对炎性关节炎患者亚临床动脉粥样硬化进展和动脉僵硬度的影响。
检索MEDLINE和知识网络数据库，以确定关于TNF-a拮抗剂对类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA）患者亚临床动脉粥样硬化和动脉僵硬度影响的研究。采用颈动脉内膜中层厚度（cIMT）评估亚临床动脉粥样硬化。使用两种方法评估动脉僵硬度：脉搏波速度（PWV）和主动脉增强指数（AIx）。纳入23项符合检索标准的研究进行分析。
TNF-a阻滞剂可能有效预防（7/13项研究）甚至逆转（5/13项研究）对治疗有反应的RA、AS和PsA患者的IMT进展。关于动脉僵硬度，TNF-a拮抗剂治疗后PWV要么显著降低（7/13项研究），要么保持不变（6/13项研究）。尽管如此，大多数RA研究（7/10）报告PWV有显著改善。13项研究中有10项AIx保持不变。
证据表明，TNF-a拮抗剂可能对预防亚临床动脉粥样硬化进展和动脉僵硬度具有有益作用。尚不清楚这种作用是否特定于TNF-a拮抗剂，还是与更好地控制炎症有关，而与实现这种控制的疾病改善策略无关。
