Effects of Angiotensin-converting enzyme inhibition and statin treatment on inflammatory markers and endothelial functions in patients with longterm rheumatoid arthritis.
Effects of Angiotensin-converting enzyme inhibition and statin treatment on inflammatory markers and endothelial functions in patients with longterm rheumatoid arthritis.
复制标题
DOI：
--
复制
发表时间：
2005-11
期刊：
影响因子：
--
通讯作者：
Canan Tıkız;O. Utuk;T. Pırıldar;O. Bayturan;P. Bayındır;F. Taneli;H. Tıkız;C. Tuzun
中科院分区：
文献类型：
--
作者：
Canan Tıkız;O. Utuk;T. Pırıldar;O. Bayturan;P. Bayındır;F. Taneli;H. Tıkız;C. Tuzun
目的探讨血管紧张素转换酶（ACE）抑制剂和他汀类药物（羟甲基戊二酰辅酶A还原酶抑制剂）对类风湿关节炎（RA）患者炎症标志物和内皮功能的影响。方法将45例长期RA患者随机分为3组，每组15例，分别给予安慰剂（n = 15）、辛伐他汀（n = 15）和喹那普利（n = 15）治疗8周。在基线和治疗后阶段测量内皮功能障碍发展中的因素，如C-反应蛋白（CRP）、纤维蛋白原、一氧化氮（NO）和血清细胞因子浓度，包括白细胞介素1 β（IL-1 β）、IL-6和肿瘤坏死因子-α（TNF-α）。通过高分辨率超声评估肱动脉血管扩张反应以评价内皮功能。结果辛伐他汀治疗显著降低血清CRP和TNF-α [分别从14 +/- 6至7 +/- 3 mg/l（p = 0.025）和30 +/- 5至16 +/- 4 pg/ml（p = 0.012）]，而喹那普利在这两项指标上没有显著变化。IL-1 β和IL-6在2个药物组的患者中显示无显著变化。辛伐他汀组的内皮依赖性血管舒张显著改善[从5.3 +/- 1.1%至8.9 +/- 1.4%（p = 0.025）]，而内皮非依赖性血管舒张无差异[从9.0 +/- 1.8%至11.2 +/- 2.5%（p = 0.17）]。喹那普利组两种类型的血管舒张均无显著变化，但内皮依赖性血管舒张有增加的趋势[从6.1 +/- 0.8%增至7.8 +/- 0.7%（p = 0.06）]。两种药物治疗对静息动脉直径无显著影响。结论辛伐他汀20 mg/d可改善RA患者的内皮功能。其有益作用可能归因于降低CRP和TNF-α浓度。每日10 mg喹那普利的ACE抑制对炎症标志物和内皮血管舒张反应无显著影响。
OBJECTIVE To investigate the effects of angiotensin-converting enzyme (ACE) inhibitors and statins (hydroxy-methyl-glutaryl-CoA reductase inhibitors) on inflammatory markers and endothelial functions in patients with rheumatoid arthritis (RA). METHODS A total of 45 patients with longterm RA were randomized into 3 groups to receive 8 weeks of treatment with placebo (n = 15), simvastatin (20 mg/day, n = 15), or quinapril (10 mg/day, n = 15) as an adjunct to existing antirheumatic drug treatment. Factors with a role in the development of endothelial dysfunction, such as C-reactive protein (CRP), fibrinogen, nitric oxide (NO), and serum cytokine concentrations including interleukin 1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) were measured at baseline and in the posttreatment period. Brachial artery vasodilator responses were assessed by high resolution ultrasound to evaluate endothelial functions. RESULTS Simvastatin treatment significantly decreased serum CRP and TNF-a [from 14 +/- 6 to 7 +/- 3 mg/l (p = 0.025) and 30 +/- 5 to 16 +/- 4 pg/ml (p = 0.012), respectively], while quinapril had no significant changes in these 2 measures. IL-1beta and IL-6 showed insignificant changes in patients in the 2 drug groups. Endothelium-dependent vasodilatation was improved significantly in the simvastatin group [from 5.3 +/- 1.1% to 8.9 +/- 1.4% (p = 0.025)], while there was no difference in endothelium-independent vasodilatation [9.0 +/- 1.8% to 11.2 +/- 2.5% (p = 0.17)]. The quinapril group showed no significant changes in both types of vasodilation although there was a tendency to an increase in endothelium-dependent vasodilatation [from 6.1 +/- 0.8% to 7.8 +/- 0.7% (p = 0.06)]. Treatment with the 2 drugs had no significant effects on resting arterial diameter. CONCLUSION We show that simvastatin 20 mg daily improves endothelial function in patients with RA. Its beneficial effect may be attributed to lowering CRP and TNF-alpha concentrations. ACE inhibition with daily 10 mg quinapril was found to have no significant effects on inflammatory markers and endothelial vasodilator response.