在风湿性关节炎患者的个性化心血管风险评估中,使用循环分子概况及其通过TNFi,IL6Ri和JAKinibs的调制
Laura Muñoz-Barrera1, Carlos Perez-Sanchez1, Rafaela Ortega-Castro1
1Rheumatology service/Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/ Reina Sofia University Hospital/ University of Cordoba, Spain.
概括
类风湿性关节炎患者的高炎症显示心血管风险增加. 像TNFi,IL6Ri和JAKinibs这样的治疗方法有效地减少了RA患者的炎症和心血管风险.
科学领域:
- 免疫学 免疫学 免疫学
- 心脏病学 心脏病学
- 类风湿病学 类风湿病学
背景情况:
- 类风湿性关节炎 (RA) 与心血管 (CV) 风险增加有关.
- 了解RA的炎症概况对于识别患有心血管事件风险的患者至关重要.
研究的目的:
- 分析RA患者的炎症概况,并确定与心血管风险相关的表型.
- 评估生物和向合成疾病修饰性抗风湿药物 (b-DMARD和 ts-DMARD) 对炎症和心血管风险的影响.
- 描述RA中免疫细胞激活和内皮细胞功能障碍背后的分子机制.
主要方法:
- 在三个队列中研究了387名RA患者和45名健康捐赠者:确立的RA,具有心血管事件的RA (RA-CVD),以及用b-DMARDs/ts-DMARDs治疗的RA.
- 评估了血清炎症概况,NETosis和氧化应激生物标志物.
- 试验室研究涉及暴露于患者血清和药物治疗的单细胞,中性粒细胞和内皮细胞 (EC).
主要成果:
- 无监督集群确定了基于炎症和心血管风险的三个RA患者组;炎症最高的组 (C3) 显示心血管风险升高和动脉瘤斑块,类似于RA-CVD患者.
- 治疗b-DMARDs和ts-DMARDs显著降低了疾病活性 (DAS28) 和正常化生物标志物水平,减轻了心血管风险.
- 在体外,RA患者血清促进了单细胞和EC中的中性粒细胞活性和CV相关蛋白质表达,其作用被TNFi,IL6Ri和JAKinibs部分阻断.
结论:
- 循环分子概况可以帮助个性化管理RA患者.
- 识别特定的炎症表型可以定制治疗策略,以减轻心血管风险.
- 这种方法可以通过解决疾病活动和相关的心血管并发症来改善RA患者的临床结果.
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