5年白介素6受体抑制剂治疗背景下类风湿关节炎患者心血管危险因素的变化动态

IF 0.8 4区 生物学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY
E V Gerasimova, T V Popkova, I G Kirillova, D A Gerasimova, E L Nasonov
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引用次数: 0

摘要

白细胞介素(IL) 6受体抑制剂对类风湿关节炎(RA)患者心血管系统状态的影响尚不清楚,特别是长期使用。这项工作的目的是研究IL-6受体抑制剂tocilizumab (TCZ)治疗在260周随访期间对类风湿关节炎患者可变危险因素(RF)、总心血管风险(CVR)、颈动脉结构变化(CA)和心血管并发症(CVC)发生率的影响。材料和方法:该研究纳入37例活动期RA患者(32名女性和5名男性),这些患者对改善疾病的抗风湿药物(DMARDs)无效和/或不耐受;中位年龄56岁[48岁;[68]年,病程92 [49];158]个月;DAS28(疾病活动评分28)-6.2 [5.5;6.7)点;所有患者血清类风湿因子(RF)阳性,86%为环瓜氨酸肽(ACCP)抗体阳性。患者给予TCZ治疗,8 mg/kg静脉滴注,每4周;源自192 [176;210周后,60%的患者改为皮下给药,剂量为162毫克,每周一次。51%的RA患者采用TCZ单药治疗,49%的患者采用TCZ联合DMARDs治疗。17例(46%)患者接受了他汀类药物治疗,其中纳入研究前7例,纳入研究后10例。所有患者均进行传统危险因素评估,采用mSCORE量表计算心血管总危险,通过检测CA的动脉粥样硬化斑块(ASP)评估动脉粥样硬化性血管病变。283.4)周。结果:经过260周的TCZ治疗,32例(86%)患者RA缓解,5例(14%)患者RA活动降低。观察期间,改良射频频率和总CVR无明显变化,体重指数(BMI)增加11%,高胆固醇血症患者数量和HDL胆固醇(C)水平降低。在未接受他汀类药物治疗的患者中,血脂谱没有明显变化。在接受他汀类药物治疗的患者组中,HDL-CH升高43%,胆固醇水平降低15%,动脉粥样硬化指数(AI)降低56%(所有病例均p < 0.01),∆胆固醇与∆CRP的动态关系(r = 0.35;p = 0.04),∆LDL-CH和∆CRP (r = 0.41;P = 0.03)。到260周的TCZ治疗结束时,RA患者CA的显著结构变化未被发现。最初,内膜-中膜厚度(IMT) CA与年龄呈正相关(r = 0.7;p < 0.01), BMI (r = 0.37;p < 0.01),收缩压(SBP) (r = 0.62;P < 0.01),与血脂谱参数胆固醇呈弱相关性(r = 0.29;p < 0.01), LDL-CH (r = 0.36;P < 0.01)。观察结束时,没有发现新的IMT CA关联,也没有发现IMT CA值与RA活性指标和正在进行的治疗之间的关系。研究结束时,患者的mSCORE值和CVR水平分布无明显变化。在使用TCZ的260周期间,CVC的发生率为0.54 / 100患者-年。结论:在RA患者长期接受TCZ治疗的背景下,CVR没有增加,CA结构也没有明显改变,有必要对接受TCZ治疗的RA患者的血脂和CVR进行动态监测。他汀类药物治疗可以成功控制长期接受TCZ治疗的RA患者的血脂异常。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dynamics of Modified Cardiovascular Risk Factors in Patients with Rheumatoid Arthritis on the Background of 5-Year Therapy with an Interleukin 6 Receptor Inhibitor.

The effect of an inhibitor of interleukin (IL) 6 receptors on the state of the cardiovascular system in patients with rheumatoid arthritis (RA) remains poorly understood, especially with its long-term use.

The aim: of this work was to study the effect of therapy with the IL-6 receptor inhibitor tocilizumab (TCZ) on the dynamics of modifiable risk factors (RF), total cardiovascular risk (CVR), structural changes in the carotid arteries (CA), and the incidence of cardiovascular complications (CVC) in patients with rheumatoid arthritis during the 260-week follow-up period.

Materials and methods: : The study included 37 patients with active RA (32 women and 5 men) with ineffectiveness and/or intolerance to disease modifying anti-rheumatic drugs (DMARDs); median age was 56 [48; 68] years, disease duration was 92 [49; 158] months; DAS28 (Disease Activity Score 28)-6.2 [5.5; 6.7] points; all patients were seropositive for rheumatoid factor (RF), 86%-for antibodies to cyclic citrullinated peptide (ACCP). Patients received TCZ therapy 8 mg/kg intravenously every 4 weeks; after 192 [176; 210] weeks, 60% of patients switched to subcutaneous administration of the drug at a dose of 162 mg once a week. In 51% of patients with RA, TCZ monotherapy was performed, in 49%-combination therapy of TCZ with DMARDs. Statins were received by 17 (46%) patients, including 7 patients before and 10 after inclusion in the study. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE scale, atherosclerotic vascular lesions were assessed by the detection of atherosclerotic plaques (ASP) of CA. The observation period was 260.4 [251.5; 283.4] weeks.

Results: : After 260 weeks of TCZ therapy, RA remission was observed in 32 (86%) patients, low activity-in 5 (14%) patients. During the observation period, the frequency of modified RF and the total CVR did not change significantly, an increase in body mass index (BMI) by 11% was recorded, the number of patients with hypercholesterolemia and a reduced level of HDL cholesterol (C) decreased. In patients without statin therapy, there were no significant changes in the blood lipid spectrum. In the group of patients receiving statins, there was an increase in HDL-CH by 43%, a decrease in cholesterol levels by 15%, atherogenic index (AI) by 56% (p < 0.01 in all cases) and associations between the dynamics of ∆cholesterol and ∆CRP (r = 0.35; p = 0.04), ∆LDL-CH and ∆CRP (r = 0.41; p = 0.03). Significant structural changes in CA in RA patients by the end of  260 weeks of TCZ therapy were not identified. Initially, intima-media thickness (IMT) CA positively moderately correlated with age (r = 0.7; p < 0.01), BMI (r = 0.37; p < 0.01), systolic blood pressure (SBP) (r = 0.62; p < 0.01) and weakly with lipid spectrum parameters-cholesterol (r = 0.29; p < 0.01), LDL-CH (r = 0.36; p < 0.01). No new associations of IMT CA by the end of the observation, as well as the relationship of the IMT CA value with the indicators of RA activity and the ongoing therapy, were identified. By the end of the study, the distribution of patients by mSCORE value and CVR level did not change significantly. The incidence of CVC was 0.54 per 100 patient-years over a 260-week period of TCZ use.

Conclusions: : Against the background of long-term TCZ therapy in RA patients, there was no increase in CVR and significant structural changes in CA. It is necessary to dynamically monitor the blood lipid profile and CVR in RA patients receiving TCZ therapy. Statin therapy can successfully control dyslipidemia in RA patients who receive long-term TCZ.

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来源期刊
Doklady Biochemistry and Biophysics
Doklady Biochemistry and Biophysics 生物-生化与分子生物学
CiteScore
1.60
自引率
12.50%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Doklady Biochemistry and Biophysics is a journal consisting of English translations of articles published in Russian in biochemistry and biophysics sections of the Russian-language journal Doklady Akademii Nauk. The journal''s goal is to publish the most significant new research in biochemistry and biophysics carried out in Russia today or in collaboration with Russian authors. The journal accepts only articles in the Russian language that are submitted or recommended by acting Russian or foreign members of the Russian Academy of Sciences. The journal does not accept direct submissions in English.
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