Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-α blockers: A meta-analysis of prospective studies
Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-α blockers: A meta-analysis of prospective studies
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DOI：
10.3109/07853890.2013.874661
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发表时间：
2014-03-01
影响因子：
4.4
通讯作者：
Dentali, Francesco
中科院分区：
文献类型：
--
作者：
Di Minno, Matteo Nicola Dario;Ambrosino, Pasquale;Dentali, Francesco
背景一些研究表明TNF-α阻滞剂对血脂具有抗动脉粥样硬化作用，但这些数据受到质疑。Objective.对TNF-α阻滞剂治疗诱导的血脂变化进行荟萃分析。纳入了对接受TNF-α阻滞剂治疗的风湿病患者进行的前瞻性研究，并提供了治疗前后的甘油三酯（TG）、总胆固醇（TC）、HDL-胆固醇（HDL c）、LDL-胆固醇（LDL c）和致动脉粥样硬化指数（AI）值。在短期（2-12周）、中期（13-24周）和长期（25-52周）评估中分析血脂谱的标准化平均差异（SMD）。纳入了30篇文章（1707例患者）。TNF-α阻滞剂在短期、中期和长期评估中确定了TC升高（SMD：0.20 mmol/L [95% CI：0.04，0.35]; SMD：0.27 mmol/L [95% CI：0.08，0.46]; SMD：0.22 mmol/L [95% CI：0.01，0.43]）。HDLc仅在短期评估时升高（SMD：0.19 mmol/L [95% CI：0.10，0.28]），TG在长期评估时显著升高（SMD：0.19 mmol/L [95% CI：0.04，0.34]）。LDLc和AI不受TNF-α阻滞剂治疗的影响。TC轻微但显著增加，LDLc和AI无任何显著变化。不同时间点评估的HDLc和TG变化不一致。这些脂质谱的定量变化似乎不能解释接受TNF-α阻滞剂患者报告的心血管风险改善。为解决这一问题，需要进一步研究其他机制。
Background. Some studies showed an anti-atherogenic effect of TNF-alpha blockers on lipid profile, but these data have been challenged. Objective. To perform a meta-analysis on lipid profile changes induced by TNF-alpha blocker treatment.Methods. Prospective studies on rheumatic patients receiving TNF-alpha blockers and providing before-and-after treatment values of triglycerides (TGs), total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc), and atherogenic index (AI) were included. Standardized mean differences (SMD) in lipid profile were analyzed at short-term (2-12 weeks), middle-term (13-24 weeks), and long-term (25-52 weeks) assessments.Results. Thirty articles (1707 patients) were included. TNF-alpha blockers determined an increase in TC at short-term, middle-term, and long-term assessments (SMD: 0.20 mmol/L [95% CI: 0.04, 0.35]; SMD: 0.27 mmol/L [95% CI: 0.08, 0.46]; SMD: 0.22 mmol/L [95% CI: 0.01, 0.43]). HDLc increased only at the shortterm assessment (SMD: 0.19 mmol/L [95% CI: 0.10, 0.28]), and TGs achieved a significant increase at the long-term assessment (SMD: 0.19 mmol/L [95% CI: 0.04, 0.34]). LDLc and AI were not affected by TNF-alpha blocker treatment.Conclusions. Slight but significant increases in TC occurred without any significant change in LDLc and AI. Changes in HDLc and TGs were not consistent among the different time point assessments. These quantitative changes in lipid profile do not seem to be able to explain cardiovascular risk improvement reported in patients receiving TNF-alpha blockers. Further studies on other mechanisms are needed to address this issue.