Division of Rheumatology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary.
Division of Metabolic Diseases, Department of Medicine, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary.
Biomolecules. 2021 Oct 18;11(10):1535. doi: 10.3390/biom11101535.
Cardiovascular (CV) morbidity, mortality, and metabolic syndrome are associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Here, lipids and other metabolic markers in relation to vascular function and clinical markers were evaluated in RA and AS patients undergoing one-year anti-TNF therapy.
Fifty-three patients including 36 RA patients treated with either etanercept (ETN) or certolizumab pegol (CZP) and 17 AS patients treated with ETN were included in a 12-month follow-up study. Various lipids, paraoxonase (PON) and arylesterase (ARE) activities, myeloperoxidase (MPO) and adipokine levels were determined overtime. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT), and arterial pulse-wave velocity (PWV) in all patients. All assessments were performed at baseline and 6 and 12 months after treatment initiation.
Anti-TNF therapy decreased ARE activity, MPO, adiponectin, and chemerin levels after 12 months ( < 0.05). Lipids, PON activity, and leptin remained unchanged. Regression analyses suggested variable associations of IMT, PWV, and FMD with ARE, MPO, leptin, and lipids ( < 0.05). On the other hand, these metabolic parameters were significantly associated with disease duration, CV history, CRP, obesity, PWV, and IMT ( < 0.05). One-year anti-TNF treatment together with baseline leptin ( = 0.039) or CRP ( = 0.016) levels determined 12 months of lipid changes overtime. TNF inhibition together with baseline disease activity determined ARE activity changes ( = 0.046). Anti-TNF therapy and baseline chemerin levels determined IMT changes overtime ( = 0.003).
Assessment of various metabolic parameters together with disease activity, CRP, and ultrasound-based techniques may exert additional value in determining CV burden and in monitoring the effects of biologics on preclinical vascular pathophysiology.
心血管（CV）发病率、死亡率和代谢综合征与类风湿关节炎（RA）和强直性脊柱炎（AS）相关。在此，我们评估了接受为期一年抗 TNF 治疗的 RA 和 AS 患者的血脂和其他代谢标志物与血管功能和临床标志物的关系。
53 名患者（包括 36 名接受依那西普（ETN）或培塞利珠单抗（CZP）治疗的 RA 患者和 17 名接受 ETN 治疗的 AS 患者）纳入为期 12 个月的随访研究。在整个研究过程中，我们测定了各种血脂、对氧磷酶（PON）和芳基酯酶（ARE）活性、髓过氧化物酶（MPO）和脂肪因子水平。所有患者均接受超声检查以测量血流介导的血管扩张（FMD）、颈总动脉内膜中层厚度（ccIMT）和动脉脉搏波速度（PWV）。所有评估均在治疗开始前、6 个月和 12 个月时进行。
抗 TNF 治疗 12 个月后，ARE 活性、MPO、脂联素和 chemerin 水平降低（<0.05）。血脂、PON 活性和瘦素水平无变化。回归分析表明，IMT、PWV 和 FMD 与 ARE、MPO、瘦素和血脂之间存在多种关联（<0.05）。另一方面，这些代谢参数与疾病持续时间、CV 病史、CRP、肥胖、PWV 和 IMT 显著相关（<0.05）。基线时的 leptin（=0.039）或 CRP（=0.016）水平与抗 TNF 治疗后 12 个月的脂质变化相关。TNF 抑制与基线时的疾病活动度决定了 ARE 活性的变化（=0.046）。抗 TNF 治疗和基线时的 chemerin 水平与 IMT 的变化相关（=0.003）。
评估各种代谢参数以及疾病活动度、CRP 和基于超声的技术可能在确定 CV 负担和监测生物制剂对临床前血管病理生理学的影响方面具有额外的价值。
