摘要:
类风湿关节炎(RA)是一种以慢性炎症为特征的自身免疫性疾病,如果不加以治疗,会导致关节破坏和全身多系统损害。RA的炎症过程贯穿全程,与发病率和死亡率的增加有关。近年来由于对疾病认识加深以及药物的合理应用,RA患者的死亡率呈下降趋势。但RA患者的心血管疾病(CVD)风险仍很高,因此,RA患者中CVD风险的管理是非常重要的。研究表明,血脂水平改变与CVD关系密切,但在炎症过程的影响下,RA患者的血脂水平遵循不同的模式。本文探讨RA患者的“脂质悖论”中血脂与炎症之间的关系,以及抗风湿药物对RA患者血脂谱影响。
中图分类号:
杨瑞, 刘宇宏. 类风湿关节炎患者血脂水平与心血管疾病风险相关研究进展[J]. 临床荟萃, 2022, 37(1): 92-96.
[1] |
Chuang YW, Yu MC, Lin CLY,, et al. Risk of peripheral arterial occlusive disease in patients with rheumatoid arthritis. A nationwide population-based cohort study[J]. Thromb Haemost, 2016, 115(2):439-445.
doi: 10.1160/th15-07-0600 URL |
[2] |
Myasoedova E, Crowson CS, Kremers HM, et al. Lipid paradox in rheumatoid arthritis: The impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease[J]. Ann Rheum Dis, 2011, 70(3):482-487.
doi: 10.1136/ard.2010.135871 pmid: 21216812 |
[3] |
Wu MF, Xu KZ, Guo YG, et al. Lipoprotein(a) and Atherosclerotic Cardiovascular Disease: Current Understanding and Future Perspectives[J]. Cardiovasc Drugs Ther, 2019, 33(6):739-748.
doi: 10.1007/s10557-019-06906-9 pmid: 31655942 |
[4] |
Jagpal A, Navarro-Millán I. Cardiovascular co-morbidity in patients with rheumatoid arthritis: A narrative review of risk factors, cardiovascular risk assessment and treatment[J]. BMC Rheumatol, 2018, 2:10.
doi: 10.1186/s41927-018-0014-y URL |
[5] | Toms TE, Symmons DP, Kitas GD. Dyslipidaemia in rheumatoid arthritis: The role of inflammation, drugs, lifestyle and genetic factors[J]. Curr Vasc Pharmaco, 2010, 8(3):301-326. |
[6] | Yoshinaga R, Doi Y, Ayukawa K, et al. High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: A retrospective cohort study[J]. BMJ Open, 2017, 7(10):e015112. |
[7] |
El Bakry SA, Fayez D, Morad CS, et al. Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role[J]. Cytokine, 2017, 96:228-233.
doi: 10.1016/j.cyto.2017.04.026 URL |
[8] | Provan SA, Berg IJ, Hammer HB, et al. The impact of newer biological disease modifying anti-rheumatic drugs on cardiovascular risk factors: A 12-month longitudinal study in rheumatoid arthritis patients treated with rituximab, abatacept and tociliziumab[J]. PLoS One, 2015, 10(6):e0130709. |
[9] |
Arts EE, Popa C, Den Broeder AA, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis[J]. Ann Rheum Dis, 2015, 74(4):668-674.
doi: 10.1136/annrheumdis-2013-204024 pmid: 24389293 |
[10] |
Gossec L, Salejan F, Nataf H, et al. Challenges of cardiovascular risk assessment in the routine rheumatology outpatient setting: An observational study of 110 rheumatoid arthritis patients[J]. Arthritis Care Res (Hoboken), 2013, 65(5):712-717.
doi: 10.1002/acr.21935 pmid: 23589412 |
[11] |
Arida A, Protogerou AD, Kitas GD, et al. Systemic Inflammatory response and atherosclerosis: The paradigm of chronic inflammatory rheumatic diseases[J]. Int J Mol Sci, 2018, 19(7):1890.
doi: 10.3390/ijms19071890 URL |
[12] | Schultz O, Oberhauser F, Saech J, et al. Effects of inhibition of interleukin-6 signalling on insulin sensitivity and lipoprotein (a) levels in human subjects with rheumatoid diseases[J]. PLoS One, 2010, 5(12):e14328. |
[13] |
Guin A, Sinhamahapatra P, Misra S, et al. Incidence and effect of insulin resistance on progression of atherosclerosis in rheumatoid arthritis patients of long disease duration[J]. Biomed J, 2019, 42(6):394-402.
doi: 10.1016/j.bj.2019.01.007 URL |
[14] |
Zeisbrich M, Yanes RE, Zhang H, et al. Hypermetabolic macrophages in rheumatoid arthritis and coronary artery disease due to glycogen synthase kinase 3b inactivation[J]. Ann Rheum Dis, 2018, 77(7):1053-1062.
doi: 10.1136/annrheumdis-2017-212647 pmid: 29431119 |
[15] |
Semb AG, Kvien TK, Aastveit AH, et al. Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study[J]. Ann Rheum Dis, 2010, 69(11):1996-2001.
doi: 10.1136/ard.2009.126128 pmid: 20551156 |
[16] |
Myasoedova E, Crowson CS, Kremers HM, et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease[J]. Ann Rheum Dis, 2011, 70(3):482-487.
doi: 10.1136/ard.2010.135871 pmid: 21216812 |
[17] |
Giles JT, Wasko MCM, Chung CP, et al. Exploring the lipid paradox theory in rheumatoid arthritis: Associations of low circulating low-density lipoprotein concentration with subclinical coronary atherosclerosis[J]. Arthritis Rheumatol, 2019, 71(9):1426-1436.
doi: 10.1002/art.40889 |
[18] |
Lubrano V, Gabriele M, Puntoni MR, et al. Relationship among IL-6, LDL cholesterol and lipid peroxidation[J]. Cell Mol Biol Lett, 2015, 20(2):310-322.
doi: 10.1515/cmble-2015-0020 pmid: 26204410 |
[19] |
Strang AC, Bisoendial RJ, Kootte RS, et al. Pro-atherogenic lipid changes and decreased hepatic LDL receptor expression by tocilizumab in rheumatoid arthritis[J]. Atherosclerosis, 2013, 229(1):174-181.
doi: 10.1016/j.atherosclerosis.2013.04.031 pmid: 23746537 |
[20] |
Charles-Schoeman C, Fleischmann R, Davignon J, et al. Potential mechanisms leading to the abnormal lipid profile in patients with rheumatoid arthritis versus healthy volunteers and reversal by tofacitinib[J]. Arthritis Rheumatol, 2015, 67(3):616-625.
doi: 10.1002/art.38974 URL |
[21] |
Robertson J, Porter D, Sattar N, et al. Interleukin-6 blockade raises LDL via reduced catabolism rather than via increased synjournal: A cytokine-specific mechanism for cholesterol changes in rheumatoid arthritis[J]. Ann Rheum Dis, 2017, 76(11):1949-1952.
doi: 10.1136/annrheumdis-2017-211708 pmid: 28916714 |
[22] |
Chistiakov DA, Bobryshev YV, Orekhov AN. Macrophage-mediated cholesterol handling in atherosclerosis[J]. J Cell Mol Med, 2016, 20(1):17-28.
doi: 10.1111/jcmm.12689 pmid: 26493158 |
[23] |
Hu J, Xi D, Zhao J, et al. High-density Lipoprotein and Inflammation and Its Significance to Atherosclerosis[J]. Am J Med Sci, 2016, 352(4):408-415.
doi: 10.1016/j.amjms.2016.06.014 URL |
[24] |
Jia C, Anderson JLC, Gruppen EG, et al. High-density lipoprotein anti-inflammatory capacity and incident cardiovascular events[J]. Circulation, 2021, 143(20):1935-1945.
doi: 10.1161/CIRCULATIONAHA.120.050808 URL |
[25] |
Ormseth MJ, Yancey PG, Solus JF, et al. Effect of drug therapy on net cholesterol efflux capacity of high-density lipoprotein-enriched serum in rheumatoid arthritis[J]. Arthritis Rheumatol, 2016, 68(9):2099-2105.
doi: 10.1002/art.39675 URL |
[26] |
Chang TI, Streja E, Moradi H. Could high-density lipoprotein cholesterol predict increased cardiovascular risk?[J]. Curr Opin Endocrinol Diabetes Obes, 2017, 24(2):140-147.
doi: 10.1097/MED.0000000000000318 pmid: 28099207 |
[27] |
Bassu S, Zinellu A, Sotgia S, et al. Oxidative stress biomarkers and peripheral endothelial dysfunction in rheumatoid arthritis: A monocentric cross-sectional case-control study[J]. Molecules, 2020, 25(17):3855.
doi: 10.3390/molecules25173855 URL |
[28] |
ZMacLeod C, Hadoke PWF, Nixon M. Glucocorticoids: Fuelling the fire of atherosclerosis or therapeutic extinguishers[J]. Int J Mol Sci, 2021, 22(14):7622.
doi: 10.3390/ijms22147622 URL |
[29] |
Hafström I, Rohani M, Deneberg S, et al. Effects of low-dose prednisolone on endothelial function, atherosclerosis, and traditional risk factors for atherosclerosis in patients with rheumatoid arthritis-a randomized study[J]. J Rheumatol, 2007, 34(9):1810-1816.
pmid: 17696277 |
[30] |
Restrepo JF, Del Rincon I, Molina E, et al. Use of hydroxychloroquine is associated with improved lipid profile in rheumatoid arthritis patients[J]. J Clin Rheumatol, 2017, 23(3):144-148.
doi: 10.1097/RHU.0000000000000502 pmid: 28277344 |
[31] |
Reiss AB, Carsons SE, Anwar K, et al. Atheroprotective effects of methotrexate on reverse cholesterol transport proteins and foam cell transformation in human THP-1 monocyte/macrophages[J]. Arthritis Rheum, 2008, 58(12):3675-3683.
doi: 10.1002/art.v58:12 URL |
[32] |
Johnson TM, Sayles HR, Baker JF, et al. Investigating changes in disease activity as a mediator of cardiovascular risk reduction with methotrexate use in rheumatoid arthritis[J]. Ann Rheum Dis, 2021, 80(11):1385-1392.
doi: 10.1136/annrheumdis-2021-220125 URL |
[33] |
Mitoma H, Horiuchi T, Tsukamoto H, et al. Molecular mechanisms of action of anti-TNF-α agents-Comparison among therapeutic TNF-α antagonists[J]. Cytokine, 2018, 101:56-63.
doi: 10.1016/j.cyto.2016.08.014 URL |
[34] |
Stagakis I, Bertsias G, Karvounaris S, et al. Anti-tumor necrosis factor therapy improves insulin resistance, beta cell function and insulin signaling in active rheumatoid arthritis patients with high insulin resistance[J]. Arthritis Res Ther, 2012, 14(3):R141.
doi: 10.1186/ar3874 URL |
[35] |
Ursini F, Leporini C, Bene F, et al. Anti-TNF-alpha agents and endothelial function in rheumatoid arthritis: A systematic review and meta-analysis[J]. Sci Rep, 2017, 7(1):5346.
doi: 10.1038/s41598-017-05759-2 URL |
[36] |
Corrado A, Colia R, Rotondo C, et al. Changes in serum adipokines profile and insulin resistance in patients with rheumatoid arthritis treated with anti-TNF-α[J]. Curr Med Res Opin, 2019, 35(12):2197-2205.
doi: 10.1080/03007995.2019.1654988 URL |
[37] |
Popa C, van Tits LJ, Barrera P, et al. Anti-inflammatory therapy with tumour necrosis factor alpha inhibitors improves high-density lipoprotein cholesterol antioxidative capacity in rheumatoid arthritis patients[J]. Ann Rheum Dis, 2009, 68(6):868-872.
doi: 10.1136/ard.2008.092171 pmid: 18635596 |
[38] |
Veldhuijzen van Zanten JJCS, Sandoo A, Metsios GS, et al. Comparison of the effects of exercise and anti-TNF treatment on cardiovascular health in rheumatoid arthritis: Results from two controlled trials[J]. Rheumatol Int, 2019, 39(2):219-225.
doi: 10.1007/s00296-018-4183-1 pmid: 30421104 |
[39] |
Hassan S, Milman U, Feld J, Eder L, et al. Effects of anti-TNF-α treatment on lipid profile in rheumatic diseases: An analytical cohort study[J]. Arthritis Res Ther, 2016, 18(1):261.
pmid: 27832797 |
[40] |
Végh E, Kerekes G, Pusztai A, et al. Effects of 1-year anti-TNF-α therapy on vascular function in rheumatoid arthritis and ankylosing spondylitis[J]. Rheumatol Int, 2020, 40(3):427-436.
doi: 10.1007/s00296-019-04497-0 URL |
[41] | Cacciapaglia F, Anelli MG, Rinaldi A, et al. Lipids and atherogenic indices fluctuation in rheumatoid arthritis patients on long-term tocilizumab treatment[J]. Mediators Inflamm, 2018, 2018:2453265. |
[42] | Popkova TV, Novikova DS, Nasonov EL. Interleukin-6 inhibition and cardiovascular disease in patients with rheumatoid arthritis[J]. Ter Arkh, 2016, 88(5):93-101. |
[43] |
Genovese MC, Kremer JM, van Vollenhoven RF, et al. Transaminase levels and hepatic events during tocilizumab treatment: Pooled analysis of long-term clinical trial safety data in rheumatoid arthritis[J]. Arthritis Rheumatol, 2017, 69(9):1751-1761.
doi: 10.1002/art.40176 URL |
[44] |
Schiff MH, Kremer JM, Jahreis A, et al. Integrated safety in tocilizumab clinical trials[J]. Arthritis Res Ther, 2011, 13(5):R141.
doi: 10.1186/ar3455 URL |
[45] |
Fleischmann R, Kremer J, Cush J, et al. Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis[J]. N Engl J Med, 2012, 367(6):495-507.
doi: 10.1056/NEJMoa1109071 URL |
[46] |
Kume K, Amano K, Yamada S, et al. Tofacitinib improves atherosclerosis despite up-regulating serum cholesterol in patients with active rheumatoid arthritis: A cohort study[J]. Rheumatol Int, 2017, 37(12):2079-2085.
doi: 10.1007/s00296-017-3844-9 URL |
[1] | 顾天舒, 梁雪, 蔡嘉庚, 李广平. m6A RNA甲基化修饰在心血管疾病中的进展[J]. 临床荟萃, 2023, 38(8): 743-748. |
[2] | 易静静, 圈启芳, 马婕. 调节小胶质细胞反应性:糖尿病视网膜病变新见解[J]. 临床荟萃, 2023, 38(4): 364-368. |
[3] | 谢少为, 吕小涵, 董艳红, 吕佩源. 抗炎细胞因子在阿尔茨海默病中的研究进展[J]. 临床荟萃, 2023, 38(2): 185-188. |
[4] | 代菁, 陈华茜. 血液透析患者自发性肾破裂1例并文献复习[J]. 临床荟萃, 2023, 38(12): 1107-1111. |
[5] | 王思源, 王利, 温新然, 李小青. 新型冠状病毒感染后儿童多系统炎症综合征2例并文献复习[J]. 临床荟萃, 2023, 38(12): 1112-1116. |
[6] | 李志勇. 超声诊断短暂颈动脉周围炎症综合征1例并文献复习[J]. 临床荟萃, 2023, 38(11): 1027-1030. |
[7] | 张娟, 田茂露, 查艳. 维持性血液透析患者的微炎症状态与促红细胞生成素低反应性贫血[J]. 临床荟萃, 2023, 38(10): 949-953. |
[8] | 王宁, 李勇. 簇集蛋白在心血管疾病中的研究进展[J]. 临床荟萃, 2022, 37(9): 842-845. |
[9] | 张舒, 包云, 陈芳, 单清. 人体成分分析及人体测量对绝经后女性血脂异常的预测价值[J]. 临床荟萃, 2022, 37(8): 708-712. |
[10] | 轩晓倩, 赵君慧, 杨小茜. 炎性指标在非小细胞肺癌患者预后中的临床意义[J]. 临床荟萃, 2022, 37(7): 663-667. |
[11] | 王杰, 陈宝昌, 黄嘉瑜, 孟金凤, 李尚彬, 闫伟宸, 赵倩, 李娇, 任常军. 新生儿脑损伤与围生期感染关联性的Meta分析[J]. 临床荟萃, 2022, 37(6): 497-503. |
[12] | 张怡, 崔晓冉, 杨晓红. 单核细胞/高密度脂蛋白胆固醇比值在心血管疾病中研究进展[J]. 临床荟萃, 2022, 37(6): 551-555. |
[13] | 何洪真, 吕佩源. 调节性T细胞与缺血性脑卒中危险因素的相关性[J]. 临床荟萃, 2022, 37(4): 369-372. |
[14] | 林长艺, 宋明辉, 吴培埕. 缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征与血清阴性类风湿性关节炎患者临床和实验室特征比较[J]. 临床荟萃, 2022, 37(3): 262-265. |
[15] | 杜菲, 李英. 老年糖尿病肾病患者肠道菌群失调的研究进展[J]. 临床荟萃, 2022, 37(2): 178-181. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||