Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor
Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor
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DOI：
10.1080/03009740802055984
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发表时间：
2008-01-01
影响因子：
2.1
通讯作者：
Hafstrom, I.
中科院分区：
文献类型：
--
作者：
Engvall, I-L;Elkan, A-C;Hafstrom, I.
目的：研究炎症、胰岛素样生长因子（IGF-1）及其调节结合蛋白（IGFBP-1）对类风湿关节炎（RA）患者瘦体重（LBM）的影响。在60名住院患者中（50名女性），通过疾病活动性评分28（DAS 28）、C-反应蛋白（CRP）和白细胞介素（IL）-6测量炎症活性，健康评估问卷（HAQ）。采用双能X线吸收法（DXA）测定LBM，计算无脂肪质量指数（FFMI; kg/m2）和脂肪质量指数（FMI; kg/m2）。50%的患者的FFMI低于参考人群的第10百分位数，45%的患者的FMI高于第90百分位数，对应于称为类风湿性恶病质的疾病（在FM稳定或增加的情况下肌肉质量损失）。DAS 28、CRP和IL-6与LBM呈负相关（分别为p=0.001、0.001和0.018），HAQ也是如此（p=0.001）。平均（置信区间）IGF-1处于正常范围，为130（116-143）g/L。与正常人群（女性33 g/L，男性24 g/L）相比，患者的IGFBP-1水平升高（女性中位数为58 g/L，男性中位数为59 g/L）。反映生物可利用IGF-1的IGF-1/IGFBP-1比值较低（2.0 g/L），与LBM呈正相关（p=0.015）。在多元回归分析中，IGF-1/IGFBP-1、HAQ评分和DAS 28可解释LBM变异的42%。结论：RA住院患者中，以女性为主，有较大比例的类风湿性恶病质。肌肉萎缩是由炎症活动和身体残疾以及低生物可利用的IGF-1解释的。
Objectives: To examine the impact of inflammation, insulin-like growth factor (IGF-1) and its regulating binding protein (IGFBP-1) on lean body mass (LBM) in patients with rheumatoid arthritis (RA).Methods: In 60 inpatients (50 women), inflammatory activity was measured by Disease Activity Score 28 (DAS28), C-reactive protein (CRP), and interleukin (IL)-6, and physical disability by the Health Assessment Questionnaire (HAQ). LBM was assessed by dual-energy X-ray absorptiometry (DXA) and fat free mass index (FFMI; kg/m(2)) and fat mass index (FMI; kg/m(2)) were calculated.Results: Median age was 65 years and disease duration 13 years. Fifty per cent of the patients had FFMI below the 10th percentile of a reference population and 45% had FMI above the 90th percentile, corresponding to the condition known as rheumatoid cachexia (loss of muscle mass in the presence of stable or increased FM). DAS28, CRP, and IL-6 correlated negatively with LBM (p=0.001, 0.001, and 0.018, respectively), as did HAQ (p=0.001). Mean (confidence interval) IGF-1 was in the normal range, at 130 (116-143) g/L. IGFBP-1 levels were elevated in patients (median 58 g/L in women and 59 g/L in men) compared with a normal population (33 g/L in women and 24 g/L in men). The ratio IGF-1/IGFBP-1, which reflects bioavailable IGF-1, was low (2.0 g/L) and was positively correlated with LBM (p=0.015). In multiple regression analysis, 42% of the LBM variance was explained by IGF-1/IGFBP-1, HAQ score, and DAS28.Conclusion: A large proportion of RA inpatients, mainly women, had rheumatoid cachexia. The muscle wasting was explained by inflammatory activity and physical disability as well as low bioavailable IGF-1.