肿瘤坏死因子-α抑制剂对轴性脊柱关节炎患者血脂谱和血浆致动脉粥样硬化指数的影响：来自天主教轴性脊柱关节炎队列（CASCO）的 2 年随访数据。
Impact of TNF-α inhibitor on lipid profile and atherogenic index of plasma in axial spondyloarthritis: 2-year follow-up data from the Catholic Axial Spondyloarthritis COhort (CASCO).
机构信息
Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
出版信息
Clin Rheumatol. 2020 Feb;39(2):471-477. doi: 10.1007/s10067-019-04767-z. Epub 2019 Sep 5.
To evaluate the influence of TNF-α inhibitor on lipid profile and atherogenic index of plasma (AIP) in axial spondyloarthritis (axSpA) patients with long-term use of stable dose TNF-α inhibitor. AxSpA patients were enrolled in the Catholic Axial Spondyloarthritis COhort (CASCO). We collected their data annually and analyzed their lipid profile and AIP. Comparison was conducted between TNF-α inhibitor user group and non-user group. Additionally, lipid profile and AIP of TNF-α inhibitor user group were compared over 2 years. A total of 238 axSpA patients were enrolled for the present study, including 132 TNF-α inhibitor users and 106 non-users. Changes of total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-C), and HDL-C over 2 years did not show significant difference between TNF-α inhibitor user group and non-user group. When baseline data and 2-year follow-up data were compared within the TNF-α inhibitor user group, there was no significant increase in TG, LDL-C, HDL-C, or AIP. Only TC level was slightly increased in the 2-year follow-up data for the TNF-α inhibitor user group (177.86 ± 28.73 vs. 183.08 ± 29.82, P = 0.019). Long-term use of stable dose TNF-α inhibitor did not increase atherogenic lipid profile or AIP compared to the control group. Furthermore, atherogenic lipid profile or AIP was not increased significantly in the TNF-α inhibitor user group over the 2-year follow-up. Therefore, using TNF-α inhibitor for a long term might not affect atherosclerosis of axSpA.Key Points• Managing risk factors of cardiovascular disease (CVD) such as dyslipidemia in axSpA is important because axSpA patients have increased risk of CVD.• Using TNF-α inhibitor for 2 years with stable dose did not deteriorate atherogenic lipid profile or AIP as predictor of atherosclerosis.• Maintaining stable dose of TNF-α inhibitor for long-term in axSpA may be relatively safe for managing atherogenic lipid.
目的
评估长期使用稳定剂量 TNF-α 抑制剂对轴性脊柱关节炎（axSpA）患者血脂谱和血浆致动脉粥样硬化指数（AIP）的影响。
方法
axSpA 患者纳入天主教轴性脊柱关节炎队列研究（CASCO）。我们每年收集他们的数据并分析其血脂谱和 AIP。比较 TNF-α 抑制剂使用者和非使用者。此外，比较 TNF-α 抑制剂使用者组的血脂谱和 AIP 在 2 年内的变化。
结果
共纳入 238 例 axSpA 患者，其中 132 例为 TNF-α 抑制剂使用者，106 例为非使用者。TNF-α 抑制剂使用者组和非使用者组 2 年内总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）的变化无显著差异。当比较 TNF-α 抑制剂使用者组的基线数据和 2 年随访数据时，TG、LDL-C、HDL-C 或 AIP 无显著升高。仅在 TNF-α 抑制剂使用者组的 2 年随访数据中 TC 水平略有升高（177.86 ± 28.73 与 183.08 ± 29.82，P=0.019）。与对照组相比，长期使用稳定剂量的 TNF-α 抑制剂并未增加致动脉粥样硬化性脂质谱或 AIP。此外，在 2 年随访期间，TNF-α 抑制剂使用者组的致动脉粥样硬化性脂质谱或 AIP 无显著增加。
结论
与对照组相比，长期使用稳定剂量的 TNF-α 抑制剂不会加重 axSpA 患者的动脉粥样硬化脂质谱或 AIP。因此，在 axSpA 患者中长期使用 TNF-α 抑制剂可能不会影响动脉粥样硬化的发生。
关键要点
管理 axSpA 患者心血管疾病（CVD）的危险因素（如血脂异常）很重要，因为 axSpA 患者 CVD 风险增加。
使用稳定剂量的 TNF-α 抑制剂 2 年不会恶化动脉粥样硬化的脂质谱或 AIP，作为动脉粥样硬化的预测因子。
在 axSpA 中长期维持稳定剂量的 TNF-α 抑制剂可能对管理致动脉粥样硬化性脂质相对安全。
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