关节炎性银屑病与非关节炎性银屑病患者的血脂谱差异及甲氨蝶呤对载脂蛋白 B/载脂蛋白 A-1 比值的性别特异性下调。
The difference of lipid profiles between psoriasis with arthritis and psoriasis without arthritis and sex-specific downregulation of methotrexate on the apolipoprotein B/apolipoprotein A-1 ratio.
机构信息
Institute of Dermatology and Department of Dermatology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.
Department of Dermatology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200223, China.
出版信息
Arthritis Res Ther. 2022 Jan 7;24(1):17. doi: 10.1186/s13075-021-02715-4.
BACKGROUND
Methotrexate (MTX) has a protective effect against cardiovascular diseases (CVD), but the mechanism is unclear.
OBJECTIVE
To investigate the effect of MTX on lipid profiles and the difference between psoriasis without arthritis (PsO) and psoriatic arthritis (PsA).
METHODS
In this prospective study, we recruited 288 psoriatic patients (136 PsA and 152 PsO) who completed 12 weeks of MTX treatment. Total cholesterol (TC), triglycerides (TG), lipoprotein A [LP(a)], high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL), apolipoprotein A1 (ApoA1), and ApoB were measured.
RESULTS
Compared with sex- and age-matched healthy controls, psoriatic patients had significantly (p < 0.0001) higher levels of proatherogenic lipids and lower levels of anti-atherogenic lipids. PsA patients had a higher ApoB/ApoA1 ratio than PsO patients (p < 0.05). Stepwise regression analysis found a positive correlation between the inflammatory marker hCRP and the Psoriasis Area Severity Index (PASI), ApoB/ApoA1 ratio, BMI, and smoking. ApoB was positively associated with concomitant arthritis, diabetes, and hypertension. MTX decreased the levels of pro-atherogenic and anti-atherogenic lipids. However, a significant reduction of the ApoB/ApoA1 ratio by MTX was only observed in male patients.
CONCLUSION
PsA patients had a significantly higher percentage of concomitant disease than PsO. The decrease of MTX on CVD might be related with sex.
TRIAL REGISTRATION
ChiCTR2000036192.
背景
甲氨蝶呤（MTX）对心血管疾病（CVD）有保护作用，但机制尚不清楚。
目的
探讨 MTX 对血脂谱的影响及在无关节炎银屑病（PsO）和银屑病关节炎（PsA）患者中的差异。
方法
在这项前瞻性研究中，我们招募了 288 例银屑病患者（136 例 PsA 和 152 例 PsO），他们完成了 12 周的 MTX 治疗。测量总胆固醇（TC）、甘油三酯（TG）、脂蛋白 A [LP(a)]、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白（LDL）、载脂蛋白 A1（ApoA1）和载脂蛋白 B（ApoB）。
结果
与性别和年龄匹配的健康对照组相比，银屑病患者的致动脉粥样硬化脂质水平显著升高（p < 0.0001），抗动脉粥样硬化脂质水平显著降低。与 PsO 患者相比，PsA 患者的 ApoB/ApoA1 比值更高（p < 0.05）。逐步回归分析发现，炎症标志物 hCRP 与银屑病面积严重程度指数（PASI）、ApoB/ApoA1 比值、BMI 和吸烟呈正相关。ApoB 与同时存在的关节炎、糖尿病和高血压呈正相关。MTX 降低了致动脉粥样硬化和抗动脉粥样硬化脂质的水平。然而，只有男性患者的 ApoB/ApoA1 比值明显降低。
结论
与 PsO 相比，PsA 患者同时患有其他疾病的比例显著更高。MTX 降低 CVD 的作用可能与性别有关。
临床试验注册
ChiCTR2000036192。
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