Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Faculdade de Medicina, UFMG, Belo Horizonte, Brazil.
Rheumatol Int. 2018 Sep;38(9):1671-1677. doi: 10.1007/s00296-018-4082-5. Epub 2018 Jun 11.
The determination of excess of body fat mass provides a more suitable determinant of obesity in rheumatoid arthritis patients; however, body mass index (BMI) may not be accurate for the quantification of adiposity. To identify a marker of excess adiposity in women with rheumatoid arthritis (RA) using different methods for fat mass evaluation. A cross-sectional study was conducted in adult female patients with RA. Disease activity was assessed by DAS28-ESR, and obesity was determined by waist circumference (WC), BMI and dual-energy X-ray absorptiometry (DXA). The Human Bone Metabolism kit (Merck Millipore, Darmstadt, Alemanha) was used to determine the plasma levels of leptin, TNF-α, IL-6, and IL-1β by quantification of serum proteins by technical microspheres (LUMINEX, TX, USA). Adiponectin was measured by enzyme-linked immunosorbent assay sandwich kit (R&D Systems, Minneapolis, MN, USA). Eighty-nine female patients, median age of 55.4 (± 11.6) years, and median disease duration of 16.4 (± 14.9) years were included. The frequency of obesity was 33.7% according to BMI, 89.9% with WC, and 56.1% with DXA. The median serum leptin concentration was the only marker that correlated with body fat percentage according to the three methods. This correlation was positive and not influenced by DAS28, C-reactive protein, erythrocyte sedimentation rate, or inflammatory cytokines levels (IL-6, TNF-α, IL-1β). Analysis of ROC curves determined the cut-off point of 10.3 ng/mL of leptin as an obesity marker, with a sensitivity of 96.43% and a specificity of 23.81%. Serum leptin correlates positively with fat mass and is potentially useful in excess fat mass determination in clinical practice.
肥胖程度的确定可以为类风湿关节炎患者提供更合适的肥胖判断标准；然而，身体质量指数（BMI）可能无法准确衡量体脂含量。本研究旨在使用不同的脂肪量评估方法，确定类风湿关节炎（RA）女性患者的肥胖指标。这是一项横断面研究，纳入了成年女性 RA 患者。通过 DAS28-ESR 评估疾病活动度，通过腰围（WC）、BMI 和双能 X 射线吸收法（DXA）确定肥胖程度。采用 Merck Millipore（德国达姆施塔特）的 Human Bone Metabolism 试剂盒通过技术微球定量血清蛋白来测定血浆瘦素、TNF-α、IL-6 和 IL-1β的水平（LUMINEX，TX，USA）。通过酶联免疫吸附测定夹心试剂盒（R&D Systems，明尼苏达州明尼阿波利斯市）测定脂联素水平。共纳入 89 例女性患者，年龄中位数为 55.4（±11.6）岁，疾病病程中位数为 16.4（±14.9）年。根据 BMI，肥胖的发生率为 33.7%，根据 WC 为 89.9%，根据 DXA 为 56.1%。根据三种方法，瘦素的血清浓度是唯一与体脂肪百分比相关的标志物。这种相关性是阳性的，不受 DAS28、C 反应蛋白、红细胞沉降率或炎症细胞因子（IL-6、TNF-α、IL-1β）水平的影响。ROC 曲线分析确定 10.3ng/ml 瘦素作为肥胖标志物的截断点，其灵敏度为 96.43%，特异性为 23.81%。血清瘦素与脂肪量呈正相关，在临床实践中可能有助于确定脂肪量过多。
