抗TNF生物制剂对类风湿关节炎脂质谱的影响

抗TNF生物制剂对类风湿关节炎脂质谱的影响

        摘要（法国）  背景  类风湿关节炎患者发生心血管病的风险增高。类风湿关节炎可出现与炎症相关的脂质改变。抗TNF抑制剂治疗对控制炎症和降低心血管事件是有效的。

        目的  通过系统综述和荟萃分析，了解评估类风湿关节炎患者使用抗TNF制剂治疗导致的脂质改变。

        方法 采用Medline检索截止到2011年3月的文献。文献中包括有抗TNF抑制剂治疗前后的总胆固醇、低密度脂蛋白、高密度脂蛋白、甘油三酯、致动脉粥样硬化指数和载脂蛋白B/A的数据，根据短期、中期和长期治疗来分析。采用综合荟萃分析进行治疗前后资料的统计学分析，但如有不均一性证据时，采用随机作用模型。

        结果  总共检索了32篇文章，其中13篇为分析了抗TNF治疗前后数据的前瞻性研究。长期使用TNF抑制剂 与高密度脂蛋白水平增高有关(+0.27 mmol/l, p<0.0001)，也与总胆固醇增高有关 (+0.27 mmol/l, p=0.03), 而低密度脂蛋白水平和致动脉粥样硬化指数不变。长期治疗后，甘油三酯水平增高 (+0.28 mmol/l, p<0.001)，载脂蛋白B/A降低(-0.3, p<0.0001)。

        结论: 因长期用抗TNF抑制剂治疗对低密度脂蛋白水平和致动脉粥样硬化指数无影响，故推测抗TNF抑制剂对心血管的保护作用似乎并不能用血脂改变来解释。高密度脂蛋白水平的增高可能有一些好处，但是这需前瞻性研究并长期随访来证实。

        附原文： Abstract BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Lipid changes related to inflammation have been described in RA. Tumour necrosis factor α (TNFα) inhibitor (TNFi) treatment is effective in controlling inflammation and decreasing the number of cardiovascular events. OBJECTIVE:  To assess the change in lipid levels with TNFi treatment in patients with RA by systematic review and meta-analysis. METHODS:  A Medline search was performed for articles published up to March 2011. Reports describing values for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), atherogenic index (AI) and apolipoprotein B/A (apoB/A) collected before and after TNFi initiation were included. Data were analysed according to short-, mid- and long-term treatment. Statistical analysis of pre-post data was performed by comprehensive meta-analysis. A random effects model was used when there was evidence of heterogeneity. RESULTS:  The search retrieved 32 articles, of which 13 prospective before/after studies were analysed. Long-term TNFi treatment was associated with increased levels of HDL (+0.27 mmol/l, p<0.0001) and TC (+0.27 mmol/l, p=0.03), whereas LDL levels and AI remained unchanged. After long-term treatment, TG levels increased (+0.28 mmol/l, p<0.001) and apoB/A decreased (-0.3, p<0.0001). CONCLUSION:  The presumed cardioprotective effects of TNFi in RA do not seem to be explained by quantitative lipid changes since long-term treatment has no effect on LDL levels or on AI. Increased HDL levels could have some beneficial effects, but this needs to be confirmed by prospective studies with long-term follow-up.

引自：Daïen CI, Duny Y, Barnetche T, Daurès JP, Combe B, Morel J. Effect of TNF inhibitors on lipid profile in rheumatoid arthritis: a systematic review with meta-analysis. Ann Rheum Dis. 2012 Jan 20. [Epub ahead of print]