Effect of 1-Year Anti-TNF-α Therapy on Aortic Stiffness, Carotid Atherosclerosis, and Calprotectin in Inflammatory Arthropathies: A Controlled Study
Effect of 1-Year Anti-TNF-α Therapy on Aortic Stiffness, Carotid Atherosclerosis, and Calprotectin in Inflammatory Arthropathies: A Controlled Study
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DOI：
10.1038/ajh.2012.12
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发表时间：
2012-06-01
影响因子：
3.2
通讯作者：
Atar, Dan
中科院分区：
文献类型：
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作者：
Angel, Kristin;Provan, Sella A.;Atar, Dan
背景技术在患有炎性关节病例如类风湿性关节炎(RA)、强直性脊柱炎(AS)和银屑病关节炎(PsA)的患者中，动脉过早硬化和动脉粥样硬化增加。促炎蛋白钙卫蛋白与炎症性关节病、血管病理学和急性冠状动脉事件相关。我们研究了肿瘤坏死因子 (TNF)-α 拮抗剂治疗对炎症性关节病患者主动脉僵硬度和颈动脉内膜中层厚度 (CIMT) 的长期影响，以及与钙卫蛋白水平的关系。 方法 纳入 55 名具有抗 TNF-α 治疗临床指征的 RA、AS 或 PsA 患者，并定期进行为期 1 年的检查。将 36 名开始接受抗 TNF-α 治疗的患者与 19 名未接受治疗的患者进行比较。检查包括主动脉僵硬度（主动脉脉搏波速度，aPWV）、CIMT 和血浆钙卫蛋白的评估。 结果 1 年后，治疗组的 aPWV（平均值（s.d.））有所改善，但对照组则没有改善（分别为 -0.54 [0.79] m/s 与 0.06 [0.61] m/s；P = 0.004）和 CIMT 进展与对照组相比，治疗组的中位数（四分位数切点、第 25 个和第 75 个百分位数）有所减少（分别为 -0.002 [-0.038, 0.030] mm 与 0.030 [0.011, 0.043] mm；P = 0.01）。在多变量分析中，随着时间的推移，抗 TNF-α 治疗与 aPWV 改善（P = 0.02）和 CIMT 进展减缓（P = 0.04）相关，钙卫蛋白与 aPWV 纵向相关（P = 0.02）。 结论长期抗 TNF-α 治疗改善了炎症性关节病患者的主动脉僵硬度和 CIMT 进展。钙卫蛋白可能是反映这些患者主动脉硬化的可溶性生物标志物。
BACKGROUNDPremature arterial stiffening and atherosclerosis are increased in patients with inflammatory arthropathies such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The proinflammatory protein calprotectin is associated with inflammatory arthropathies, vascular pathology, and acute coronary events. We examined the long-term effects of treatment with tumor necrosis factor (TNF)-alpha antagonists on aortic stiffness and carotid intima media thickness (CIMT) in patients with inflammatory arthropathies, and the relationships to the levels of calprotectin.METHODSFifty-five patients with RA, AS, or PsA and a clinical indication for anti-TNF-alpha therapy were included and followed with regular examinations for 1 year. Thirty-six patients starting with anti-TNF-alpha therapy were compared with a nontreatment group of 19 patients. Examinations included assessments of aortic stiffness (aortic pulse wave velocity, aPWV), CIMT, and plasma calprotectin.RESULTSAfter 1 year, aPWV (mean (s.d.)) was improved in the treatment group, but not in the control group (-0.54 [0.79] m/s vs. 0.06 [0.61] m/s, respectively; P = 0.004), and CIMT progression (median (quartile cut-points, 25th and 75th percentiles)) was reduced in the treatment group compared to the control group (-0.002 [-0.038, 0.030] mm vs. 0.030 [0.011, 0.043] mm, respectively; P = 0.01). In multivariable analyses, anti-TNF-alpha therapy over time was associated with improved aPWV (P = 0.02) and reduced CIMT progression (P = 0.04), and calprotectin was longitudinally associated with aPWV (P = 0.02).CONCLUSIONSLong-term anti-TNF-alpha therapy improved aortic stiffness and CIMT progression in patients with inflammatory arthropathies. Calprotectin may be a soluble biomarker reflecting aortic stiffening in these patients.