早期类风湿性关节炎的葡萄糖皮质类药物治疗独立与PCSK9水平的增加有关:来自随机对照试验的数据
Kristina Lend1,2, Jos Wr Twisk3, Nupur Kumar4
1Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, The Netherlands kristina.lend@ki.se.
RMD open
|June 6, 2025
概括
葡萄糖皮质体治疗增加了类型9的proprotein转化酶亚提利辛/kexin (PCSK9) 在类风湿性关节炎患者的水平,特别是那些具有自身抗体. 这表明葡萄糖皮质体,PCSK9和心血管疾病风险之间存在联系.
科学领域:
- 类风湿病学 类风湿病学
- 心血管医学 心血管医学
- 内分泌学 在内分泌学.
背景情况:
- 类风湿性关节炎 (RA) 显著增加了心血管疾病 (CVD) 的风险.
- 蛋白转化酶亚素/素9型 (PCSK9) 调节低密度脂蛋白 (LDL) 的新陈代谢,并影响血栓形成和动脉样硬化.
- 了解PCSK9在RA治疗中的作用对于控制心血管疾病风险至关重要.
研究的目的:
- 研究葡萄糖皮质类药物和生物修饰性抗风湿药物 (bDMARDs) 对 RA 患者的 PCSK9 和 LDL-胆固醇水平的影响.
- 确定自身抗体状态是否会改变这些治疗对PCSK9和LDL胆固醇的影响.
- 在RA治疗期间分析PCSK9和LDL胆固醇水平之间的关联.
主要方法:
- 对NORD-STAR试验的特异分析,包括296名新诊断的RA患者.
- 患者接受了甲状腺素与葡萄糖皮质类药物或bDMARDs (certolizumab pegol, abatacept,或tocilizumab).
- 在基线和24周测量血清PCSK9和LDL胆固醇水平;用于分析的线性回归模型.
主要成果:
- 在24周后,与bDMARD组合组相比,葡萄糖皮质醇组的PCSK9水平显著更高.
- 这种PCSK9的增加在自身抗体阳性患者 (风湿因子,抗CCP或ANA阳性) 中更为明显.
- 所有治疗组的LDL胆固醇水平都增加,与PCSK9.9不同,呈现出不同的模式.
结论:
- 葡萄糖皮质醇治疗与RA患者24周后PCSK9水平的增加有关.
- 葡萄糖皮质类药物对PCSK9的影响在风湿因子,抗CCP抗体或ANA阳性患者中被放大.
- 这些发现表明,一种潜在的机制将葡萄糖皮质激素治疗,PCSK9升高和RA心血管风险增加联系在一起.
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