Philadelphia Veterans Affairs Medical Center, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia.
University of California, San Francisco.
Arthritis Care Res (Hoboken). 2023 Mar;75(3):616-624. doi: 10.1002/acr.24790. Epub 2022 Oct 31.
We determined associations between adipokines and abnormal body composition in patients with rheumatoid arthritis (RA).
Combining data from three RA cohorts, whole-body dual-energy absorptiometry measures of appendicular lean mass and fat mass indices were converted to age-, sex-, and race- and ethnicity-specific Z scores. Lean mass relative to fat mass was determined based on prior methods. Independent associations between body composition profiles and circulating levels of adiponectin, leptin, and fibroblast growth factor (FGF)-21 were assessed using linear and logistic regression models adjusting for demographic characteristics and study cohort. We also determined the improvement in the area under the curve (AUC) for prediction of low lean mass when adipokines were added to predictive models that included clinical factors such as demographic characteristics, study, and body mass index (BMI).
Among 419 participants, older age was associated with higher levels of all adipokines, whereas higher C-reactive protein level was associated with lower adiponectin levels and higher FGF-21 levels. Greater fat mass was strongly associated with lower adiponectin levels and higher leptin and FGF-21 levels. Higher levels of adiponectin, leptin, and FGF-21 were independently associated with low lean mass. The addition of adiponectin and leptin levels to regression models improved prediction of low lean mass when combined with demographic characteristics, study, and BMI (AUC 0.75 vs. 0.66).
Adipokines are associated with both excess adiposity and low lean mass in patients with RA. Improvements in the prediction of body composition abnormalities suggest that laboratory screening could help identify patients with altered body composition who may be at greater risk of adverse outcomes.
我们旨在确定类风湿关节炎（RA）患者的脂肪因子与异常体成分之间的关联。
综合三个 RA 队列的数据，通过全身双能吸收仪测量四肢瘦体质指数和脂肪质量指数，将其转换为年龄、性别、种族和民族特异性 Z 评分。根据之前的方法确定瘦体质与脂肪质量的比值。使用线性和逻辑回归模型，在调整人口统计学特征和研究队列后，评估体成分特征与循环中脂联素、瘦素和成纤维细胞生长因子（FGF）-21 水平之间的独立相关性。我们还确定了在将脂联素等脂肪因子添加到包括人口统计学特征、研究和体重指数（BMI）等临床因素的预测模型中时，预测低瘦体质的曲线下面积（AUC）的改善情况。
在 419 名参与者中，年龄较大与所有脂肪因子水平升高相关，而 C 反应蛋白水平较高与脂联素水平降低和 FGF-21 水平升高相关。脂肪质量增加与脂联素水平降低以及瘦素和 FGF-21 水平升高密切相关。较高的脂联素、瘦素和 FGF-21 水平与低瘦体质独立相关。将脂联素和瘦素水平添加到回归模型中，与人口统计学特征、研究和 BMI 相结合，可以改善低瘦体质的预测（AUC 为 0.75 比 0.66）。
脂肪因子与 RA 患者的肥胖和低瘦体质均相关。对体成分异常预测的改善表明，实验室筛查可以帮助识别体成分改变的患者，这些患者可能面临更大的不良结局风险。
