Kobayashi Yasuyuki, Kobayashi Hitomi, Giles Jon T, Hirano Masaharu, Nakajima Yasuo, Takei Masami
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Divisions of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Int J Rheum Dis. 2016 Nov;19(11):1169-1174. doi: 10.1111/1756-185X.12632. Epub 2015 Oct 20.
The goal of this study was to determine whether the powerful anti-inflammatory effect of anti-interleukin-6 with tocilizumab (TCZ) might lead to a reduction in left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA).
Consecutive RA patients with active disease and healthy control subjects without a clinical diagnosis of cardiovascular disease were enrolled. The RA patients each had inadequate clinical response to non-biologic disease-modifying anti-rheumatic drugs and were prescribed TCZ therapy. All subjects underwent baseline evaluation of LV function, as measured by cardiac magnetic resonance imaging (CMRI). Peak systolic regional radial strain (Err, %) was calculated by feature tracking of cine CMRI. After baseline (BL) CMRI measurements, treatment with TCZ was initiated, and patients were followed for 52 weeks. We compared peak Err of RA patients at BL and at 52 weeks.
Thirteen RA patients (mean age 52.6 ± 5.4 years) were assessed at BL and at 52 weeks, and these patients were compared with 10 non-RA controls (mean age 55.7 ± 4.6 years). Disease Activity Score of 28 joints - erythrocyte sedimentation rate and Simple Disease Activity Index were significantly lower in RA patients at 52 weeks than at BL. Mean peak Err at BL in RA patients was significantly lower than in normal subjects (P = 0.03). Mean peak Err was significantly higher at 52 weeks than at BL (P = 0.028) in RA patients.
We showed that TCZ was associated with left ventricular dysfunction in RA patients which correlated with a reduction in RA disease activity.
本研究的目的是确定使用托珠单抗（TCZ）抗白细胞介素-6的强大抗炎作用是否可能导致类风湿关节炎（RA）患者左心室（LV）功能障碍的减轻。
纳入患有活动性疾病的连续RA患者和无心血管疾病临床诊断的健康对照受试者。每位RA患者对非生物改善病情抗风湿药物的临床反应不足，并接受了TCZ治疗。所有受试者均通过心脏磁共振成像（CMRI）进行LV功能的基线评估。通过电影CMRI的特征跟踪计算收缩期峰值区域径向应变（Err，%）。在进行基线（BL）CMRI测量后，开始使用TCZ治疗，并对患者进行52周的随访。我们比较了RA患者在BL和52周时的峰值Err。
在BL和52周时对13例RA患者（平均年龄52.6±5.4岁）进行了评估，并将这些患者与10例非RA对照者（平均年龄55.7±4.6岁）进行了比较。RA患者在52周时的28个关节疾病活动评分 - 红细胞沉降率和简单疾病活动指数显著低于BL时。RA患者在BL时的平均峰值Err显著低于正常受试者（P = 0.03）。RA患者在52周时的平均峰值Err显著高于BL时（P = 0.028）。
我们表明，TCZ与RA患者的左心室功能障碍有关，这与RA疾病活动的降低相关。
