生物制剂对类风湿关节炎患者心血管危险因素的影响：一项荟萃分析。
The impact of biologic agents on cardiovascular risk factors in patients with rheumatoid arthritis: A meta analysis.
机构信息
State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China.
出版信息
PLoS One. 2024 Aug 29;19(8):e0306513. doi: 10.1371/journal.pone.0306513. eCollection 2024.
OBJECTIVE
The purpose of the study is to evaluate the effects of biologic therapy on cardiovascular risk factors in rheumatoid arthritis patients to determine its clinical efficacy.
METHODS
Relevant literature was systematically searched in PubMed, Embase, and Cochrane Library databases. Meta-analysis was conducted using standardized mean differences (SMDs) and 95% confidence intervals (CIs) to evaluate cardiovascular risk factors and atherosclerosis. Heterogeneity, sensitivity analysis, and publication bias were assessed. Statistical significance was set at P<0.05.
RESULTS
The meta-analysis revealed that biologic treatment in RA patients was associated with decreased high-density lipoprotein cholesterol (HDL-C) levels compared to controls (MD: -0.10, 95% CI: [-0.14, -0.05], P<0.0001). Subgroup analysis based on treatment duration showed heterogeneity and a potential decrease in total cholesterol levels after 12 months of treatment (MD = -0.03, 95% CI [-0.21, -0.15], P = 0.76). Biologic therapy significantly reduced triglyceride levels compared to controls (MD = -0.23, 95% CI [-0.37, -0.09], P = 0.001), as observed in subgroup analysis. Moreover, biologics effectively decreased low-density lipoprotein cholesterol (LDL-C) levels (MD: -0.10, 95% CI: [-0.14, -0.05], P<0.0001). However, biologic treatment was associated with increased inner carotid artery thickness (MD: 0.05, 95% CI: [0.03, 0.07], P<0.0001), indicating potential adverse effects on cardiovascular health. No significant effect on pulse wave velocity (PWV) was observed (MD: -0.23, 95% CI: [-0.80, 0.34], P = 0.43, I2 = 0%, P = 0.55).
CONCLUSION
Biologic agents may improve lipid profiles in RA patients but could also have adverse effects on cardiovascular health. Further research is needed to comprehensively understand the impact of biologic therapy on lipid metabolism and cardiovascular outcomes in RA patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, CRD42024504911.
目的
本研究旨在评估生物治疗对类风湿关节炎患者心血管风险因素的影响，以确定其临床疗效。
方法
系统检索 PubMed、Embase 和 Cochrane Library 数据库中的相关文献。采用标准化均数差（SMD）和 95%置信区间（CI）评估心血管风险因素和动脉粥样硬化的变化。评估异质性、敏感性分析和发表偏倚。P<0.05 为差异有统计学意义。
结果
Meta 分析显示，与对照组相比，生物治疗可降低类风湿关节炎患者的高密度脂蛋白胆固醇（HDL-C）水平（MD：-0.10，95%CI：[-0.14，-0.05]，P<0.0001）。基于治疗持续时间的亚组分析显示存在异质性，且治疗 12 个月后总胆固醇水平可能降低（MD=-0.03，95%CI[-0.21，-0.15]，P=0.76）。与对照组相比，生物治疗可显著降低甘油三酯水平（MD=-0.23，95%CI[-0.37，-0.09]，P=0.001），且亚组分析结果一致。此外，生物制剂可有效降低低密度脂蛋白胆固醇（LDL-C）水平（MD：-0.10，95%CI：[-0.14，-0.05]，P<0.0001）。然而，生物治疗与内颈动脉厚度增加相关（MD：0.05，95%CI：[0.03，0.07]，P<0.0001），表明对心血管健康可能存在潜在不良影响。未观察到脉搏波速度（PWV）的显著影响（MD：-0.23，95%CI：[-0.80，0.34]，P=0.43，I2=0%，P=0.55）。
结论
生物制剂可能改善类风湿关节炎患者的血脂谱，但可能对心血管健康产生不良影响。需要进一步研究以全面了解生物治疗对类风湿关节炎患者脂代谢和心血管结局的影响。
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