类风湿关节炎中体重指数类别与疾病活动及影像学关节损伤的关联：一项系统评价和荟萃分析
Association of Body Mass Index Categories with Disease Activity and Radiographic Joint Damage in Rheumatoid Arthritis: A Systematic Review and Metaanalysis.
作者信息
Vidal Celine, Barnetche Thomas, Morel Jacques, Combe Bernard, Daïen Claire
机构信息
From the Rheumatology Department, Hôpital Lapeyronie, Montpellier I University; Institut of Molecular Genetic of Montpellier, Unité Mixte de Recherche n. 5535 (UMR5535), Montpellier; Rheumatology Department, Hôpital Pellegrin, Bordeaux, France.C. Vidal, MD, Rheumatology Department, Hôpital Lapeyronie, Montpellier I University; T. Barnetche, PhD, Rheumatology Department, Hôpital Pellegrin; J. Morel, MD, PhD, Rheumatology Department, Hôpital Lapeyronie, Montpellier I University, and Institut of Molecular Genetic of Montpellier, UMR5535; B. Combe, MD, PhD, Rheumatology Department, Hôpital Lapeyronie, Montpellier I University, and Institut of Molecular Genetic of Montpellier, UMR5535; C. Daïen, MD, PhD, Rheumatology Department, Hôpital Lapeyronie, Montpellier I University, and Institut of Molecular Genetic of Montpellier, UMR5535.
出版信息
J Rheumatol. 2015 Dec;42(12):2261-9. doi: 10.3899/jrheum.150224. Epub 2015 Nov 1.
OBJECTIVE
Obesity and overweight are increasing conditions. Adipose tissue with proinflammatory properties could be involved in rheumatoid arthritis (RA) activity and radiographic progression. This study aims to investigate the influence of overweight and obesity on RA activity and severity.
METHODS
We conducted a systematic review and metaanalysis to assess the association of body mass index (BMI) categories with the Disease Activity Score in 28 joints (DAS28), functional disability [Health Assessment Questionnaire (HAQ)], and radiographic joint damage in patients with RA. We searched Medline through PubMed, EMBASE, and the Cochrane Database of Systematic Reviews for all studies assessing DAS28, HAQ, or/and radiographic damage according to predefined BMI groups.
RESULTS
Among the 737 citations retrieved, 58 articles met the inclusion criteria and 7 were included in the metaanalysis. DAS28 was higher in obese (BMI > 30 kg/m(2)) than non-obese (BMI ≤ 30 kg/m(2)) patients (mean difference 0.14, 95% CI 0.01-0.27, p = 0.04, I(2) = 0%). HAQ score was also higher among obese patients (mean difference 0.10, 95% CI 0.01-0.19, p = 0.03, I(2) = 0%). Radiographic joint damage was negatively associated with obesity (standardized mean difference -0.15, 95% CI -0.29 to -0.02, p = 0.03, I(2) = 38%).
CONCLUSION
Obesity in RA is associated with increased DAS28 and HAQ score and with lower radiographic joint damage. These associations mainly result from an increase of subjective components of the DAS28 (total joint count and global health assessment) in obese patients. Conflicting results were reported concerning inflammation markers (C-reactive protein and erythrocyte sedimentation rate).
目的
肥胖和超重的情况日益增多。具有促炎特性的脂肪组织可能与类风湿关节炎（RA）的活动及影像学进展有关。本研究旨在调查超重和肥胖对RA活动及严重程度的影响。
方法
我们进行了一项系统评价和荟萃分析，以评估体重指数（BMI）类别与RA患者28个关节疾病活动评分（DAS28）、功能残疾[健康评估问卷（HAQ）]以及影像学关节损伤之间的关联。我们通过PubMed、EMBASE和Cochrane系统评价数据库检索Medline，查找所有根据预定义BMI组评估DAS28、HAQ或/和影像学损伤的研究。
结果
在检索到的737篇文献中，58篇文章符合纳入标准，7篇被纳入荟萃分析。肥胖（BMI>30kg/m²）患者的DAS28高于非肥胖（BMI≤30kg/m²）患者（平均差值0.14，95%CI 0.01 - 0.27，p = 0.04，I² = 0%）。肥胖患者的HAQ评分也更高（平均差值0.10，95%CI 0.01 - 0.19，p = 0.03，I² = 0%）。影像学关节损伤与肥胖呈负相关（标准化平均差值 - 0.15，95%CI - 0.29至 - 0.02，p = 0.03，I² = 38%）。
结论
RA患者中的肥胖与DAS28和HAQ评分升高以及较低的影像学关节损伤相关。这些关联主要源于肥胖患者中DAS28主观成分（关节总数和整体健康评估）的增加。关于炎症标志物（C反应蛋白和红细胞沉降率）的报道结果相互矛盾。
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