Ann Rheum Dis:使用甲氨蝶呤治疗类风湿性关节炎可降低心血管疾病风险

2021-11-05 xiangting MedSci原创

RA患者使用 MTX 治疗与 CVD 事件的风险降低相关,尤其是心衰住院率。

类风湿性关节炎(RA) 是一类常见的自身免疫病,目前发病机理尚未完全明了,一般认为与患者免疫功能障碍导致的免疫炎症因子失调有关。甲氨蝶呤仍为治疗RA患者的一线药物,但是甲氨蝶呤对心血管系统疾病的影响仍不清楚。最近一项发表在风湿病学顶级期刊Ann Rheum Dis上的研究分析了类风湿性关节炎患者使用甲氨蝶呤 (MTX) 与心血管疾病 (CVD) 的相关性,并确定了CVD 风险是否通过改变疾病活动性介导的。

研究使用一个多中心、前瞻性 RA 退伍军人队列,确定了该队列中的偶发性CVD事件(冠脉疾病 (CAD)、卒中、心力衰竭 (HF) 住院、CVD 死亡)。就诊时收集基于C反应蛋白的28关节疾病活动性评分(DAS28-CRP),并通过与药房配药数据联网确定用药情况。使用边缘结构模型(MSM)评估 MTX 对 CVD 风险的影响。进行中介分析以评估甲氨蝶呤通过改变 RA 疾病活动性对 CVD 风险的间接影响。

2044 名 RA 患者中(90% 男性,平均年龄 63.9 岁,基线 DAS28-CRP 3.6),发生了 378 次CVD事件。使用 MSM,使用MTX与复合 CVD 事件风险降低24%相关(HR 0.76,95% CI 0.58-0.99),其中HF 住院率降低 57%(HR 0.43,95% CI 0.24-0.77)。与 CAD、卒中和 CVD 死亡率的相关性没有统计学差异。在中介分析中,没有证据表明 MTX 通过改变疾病活动性对 CVD 风险有间接影响(HR 1.03,95% CI 0.80-1.32)。

                                            图甲氨蝶呤对CVD事件影响的森林图

由此可见,RA患者使用 MTX 治疗与 CVD 事件的风险降低相关,尤其是心衰住院率。这种相关性不是通过降低 RA 疾病活动性介导的,这表明另一种与MTX 相关的机制会改变该人群的 CVD 风险。

 

原始出处:

Tate M Johnson. Investigating changes in disease activity as a mediator of cardiovascular risk reduction with methotrexate use in rheumatoid arthritis. Ann Rheum Dis. November 2021.

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    2021-11-25 ms9000001578237549

    希望每篇文章的最后来一个浅显易懂的概括就好了,毕竟我们都是患者或者患者家属,很多专业性知识不懂。

    0

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    2021-11-05 ms6000000025610258

    不错

    0

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    2021-11-05 ms1000001940293226

    非常重要的知识,学习

    0

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    2021-10-22 lmm397
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