抗腫瘍ネクロシス因子-アルファ治療は,リウマチ性関節炎患者の内皮機能を改善します
David Hürlimann1, Adrian Forster, Georg Noll
1Cardiology Department, University Hospital, Zürich, Switzerland.
Circulation
|October 23, 2002
まとめ
インフリキシマブによる抗腫瘍ネクロシス因子アルファ (TNF-alpha) 治療は,リウマチ性関節炎 (RA) の患者の内皮機能の有意な改善と疾患の活性低下をもたらしました. これは,TNF-αがRAに関連した血管機能不全において重要な役割を果たしていることを示唆している.
科学分野:
- 心血管医学 心血管医学
- レウマトロジーの病理学
- 免疫学 免疫学とは
背景:
- リウマチ性関節炎 (RA) は,動脈硬化症の加速と関連しており,心血管疾患のリスクを高めています.
- RAと動脈硬化症の炎症プロセスは,腫瘍死滅因子アルファ (TNF-alpha) のようなサイトカインを含む類似点を共有しています.
- TNF-αは,動脈硬化疾患の進行における関節炎と血管機能不全の両方に関与しています.
研究 の 目的:
- 抗TNFα抗体インフリキシマブによる慢性抗炎症治療の効果を評価する.
- インフリキシマブ療法を受けている活性RA患者の疾患活動と内皮機能の変化を評価する.
主な方法:
- メソトレキサートとプレドニゾンの治療にも関わらず,高い疾患活性を持つ11人のRA患者の研究が行われました.
- 内皮機能は,高解像度の超音波を用いて,腕動脈の血管拡張 (フローメディエートおよびニトログリセリン誘導) を通して評価されました.
- 疾患アクティビティスコア (DAS28),赤血球沈殿率 (ESR),C反応性タンパク質 (CRP) を含む臨床状態は,インフリキシマブ治療の12週間前後に測定されました.
主要な成果:
- 流れ媒介血管拡張は,インフリキシマブ治療後の状態が有意に改善した (3.2%から4.1%,P=0.018).
- 内皮に依存しない血管拡張と出血の動脈直径は変わらなかった.
- 疾患活動スコア (DAS28) は著しく低下した (5.6から3.5,P=0.002),ESRとCRPが低下する傾向がある.
結論:
- この研究は,抗TNF-α治療,特にインフリキシマブが,RA患者の内皮機能を改善することを示しています.
- この発見は,RAにおける内皮機能不全が疾患過程の不可欠な部分であることを示唆しています.
- TNF-alphaは,RAにおけるこのTNF-alpha駆動の内皮機能不全の主要な媒介者として特定されています.
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