ARD:使用甲氨蝶呤治疗类风湿性关节炎,研究疾病活动的变化是否作为降低心血管风险的中介

2021-11-05 MedSci原创 MedSci原创

这篇研究使用边缘结构模型(MSM)检查甲氨蝶呤的使用与类风湿性关节炎(RA)中心血管疾病(CVD)的关联,并确定CVD风险是否通过改变疾病活动来介导。

目的:之前研究表明使用甲氨蝶呤 (MTX) 可降低动脉粥样硬化血栓形成性心血管疾病 (CVD) 的风险,但其对心力衰竭 (HF) 的影响及其心脏保护作用的潜在机制知之甚少。这篇研究使用边缘结构模型(MSM)检查MTX的使用与类风湿性关节炎(RA)中心血管疾病(CVD)的关联,并确定CVD风险是否通过改变疾病活动来介导。

     方法:研究者在一个多中心、前瞻性的RA退伍军人队列中确定了CVD事件(冠状动脉疾病(CAD)、中风、心力衰竭(HF)住院、CVD死亡)。在定期就诊时收集了28个关节疾病活动评分和C反应蛋白水平(DAS28-CRP),并通过链接到药房配药数据来确定药物暴露。MSMs用于评估MTXCVD事件风险的治疗效果,解释了接受MTXCVD事件之间随时间变化的混杂因素。进行中介分析以评估甲氨蝶呤通过改变RA疾病活动度对CVD风险的间接影响。

      结果:在2044RA患者(90%为男性,平均年龄63.9岁,基线DAS28-CRP 3.6)中,发生了378次心血管事件。使用MSMMTX的使用与复合CVD事件风险降低24%HR 0.7695% CI 0.58 -0.99)相关,包括HF住院率降低57%HR 0.4395% CI 0.24 -0.77)。与CAD、中风和CVD死亡的个体关联没有统计学意义。在中介分析中,没有证据表明MTX通过改变疾病活动度对CVD风险产生间接影响(HR 1.0395% CI 0.80-1.32)。

     结论:RA中使用MTX与降低CVD 事件的风险相关,特别是与HF相关的住院治疗。这些关联不是通过降低RA疾病活动度来介导的,这表明其他MTX相关机制可能降低该人群的CVD风险。

 

出处:

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. Annals of the Rheumatic Diseases 2021;80:1385-1392.

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time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483726, encodeId=9c421483e2670, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sun Nov 07 01:23:28 CST 2021, time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067604, encodeId=7c01106e604cc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Nov 06 15:52:17 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067539, encodeId=59ac106e539e4, content=很详细的讲解,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Sat Nov 06 11:35:06 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067229, encodeId=46c1106e229a9, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Nov 05 11:56:18 CST 2021, time=2021-11-05, status=1, ipAttribution=)]
    2021-11-07 lmm397
  5. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Nov 05 11:56:18 CST 2021, time=2021-11-05, status=1, ipAttribution=)]
  6. 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time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483726, encodeId=9c421483e2670, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sun Nov 07 01:23:28 CST 2021, time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067604, encodeId=7c01106e604cc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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  7. 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time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483726, encodeId=9c421483e2670, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sun Nov 07 01:23:28 CST 2021, time=2021-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067604, encodeId=7c01106e604cc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Nov 06 15:52:17 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067539, encodeId=59ac106e539e4, content=很详细的讲解,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Sat Nov 06 11:35:06 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067229, encodeId=46c1106e229a9, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Nov 05 11:56:18 CST 2021, time=2021-11-05, status=1, ipAttribution=)]
    2021-11-06 医鸣惊人

    认真学习了。

    0

  8. 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    2021-11-06 小白努力长高高

    很详细的讲解,谢谢

    0

  9. 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    2021-11-05 yangchou

    好文章,谢谢分享。

    0

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