García-Gómez Carmen, Martín-Martínez Maria A, Castañeda Santos, Sanchez-Alonso Fernando, Uriarte-Ecenarro Miren, González-Juanatey Carlos, Romera-Baures Montserrat, Santos-Rey José, Pinto-Tasende José Antonio, Quesada-Masachs Estefanía, Tornero-Molina Jesús, Martínez-González Olga, Cobo-Ibáñez Tatiana, Chamizo-Carmona Eugenio, Manrique-Arija Sara, Fábregas-Canales Dolores, Díaz-González Federico, Llorca Javier, González-Gay Miguel A
Division of Rheumatology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain.
Research Unit of Spanish Society of Rheumatology, Madrid, Spain.
J Clin Lipidol. 2017 May-Jun;11(3):749-756.e3. doi: 10.1016/j.jacl.2017.02.018. Epub 2017 Mar 16.
Plasma concentrations of lipoprotein (a) (Lp(a)), a lipoprotein with atherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as in rheumatoid arthritis (RA). Few studies evaluate the impact of biologic therapies (BT) on Lp(a) in RA, taking into account that with these new therapies a better control of inflammation is achieved.
The aim of the study was to evaluate the plasma concentrations of Lp(a) in Spanish RA patients on BT attending rheumatology outpatient clinics.
Baseline analysis of the CARdiovascular in rheuMAtology project, a 10-year prospective study, evaluating the risk of cardiovascular events in RA and other forms of inflammatory arthritis. RA patients were classified according to treatment: no biologic, anti-tumor necrosis factor, anti-interleukin-6 receptor tocilizumab (TCZ), and other biologic (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was BT. The model was adjusted for confounding factors.
Seven hundred and seventy-five RA patients were analyzed. Plasma concentrations of total cholesterol and triglyceride were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index between TCZ-treated patients and patients without BT was found. After adjusting for confounding factors, patients with BT had lower concentrations of Lp(a) than those without BT; however, only TCZ-treated patients achieved statistically significant differences (β: -0.303, 95% confidence interval: -0.558 to -0.047; P = .02).
RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT.
脂蛋白（a）[Lp（a）]是一种具有致动脉粥样硬化和致血栓形成特性的脂蛋白，其血浆浓度有很强的遗传基础，不过在炎症情况下，如类风湿关节炎（RA）中，也有高浓度Lp（a）的报道。很少有研究评估生物疗法（BT）对RA患者Lp（a）的影响，因为考虑到这些新疗法能更好地控制炎症。
本研究旨在评估在风湿病门诊接受BT治疗的西班牙RA患者的血浆Lp（a）浓度。
对心血管疾病在风湿病中的项目进行基线分析，这是一项为期10年的前瞻性研究，评估RA和其他形式炎症性关节炎患者发生心血管事件的风险。RA患者根据治疗方法分类：未使用生物制剂、使用抗肿瘤坏死因子、使用抗白细胞介素-6受体托珠单抗（TCZ）以及使用其他生物制剂（利妥昔单抗或阿巴西普）。建立了一个线性多元回归模型，其中因变量是Lp（a）浓度，解释变量是BT。该模型针对混杂因素进行了调整。
分析了775例RA患者。TCZ治疗的患者总胆固醇和甘油三酯的血浆浓度显著更高。然而，TCZ治疗的患者与未使用BT的患者之间的动脉粥样硬化指数没有显著差异。在对混杂因素进行调整后，使用BT的患者Lp（a）浓度低于未使用BT的患者；然而，只有TCZ治疗的患者达到了统计学显著差异（β：-0.303，95%置信区间：-0.558至-0.047；P = 0.02）。
与未使用BT的患者相比，接受TCZ治疗的RA患者血浆Lp（a）浓度更低。
