风湿

AS肥胖患者对TNF抑制剂疗效可能欠佳

作者:作者:Ibáñez Vodnizza SE,et al 翻译/发布:北医三院柴静,校正:赵金霞 来源:中国风湿病公众论坛 日期:2017-08-12
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         前沿进展 | 强直性脊柱炎肥胖患者对TNF抑制剂疗效可能欠佳

        目的:评价强直性脊柱炎(AS)患者身体成分(BC)与对肿瘤坏死因子(TNF-α)拮抗剂应答反应之间的关系。我们的次要目的是在考虑性别和年龄的情况下评价治疗后BC的变化。

        方法:所有纳入的患者均符合改良的AS纽约标准且从未使用过TNF-α拮抗剂。开始依那西普或阿达木单抗治疗后随访至少6个月。记录强直性脊柱炎疾病活动分数,包括C反应蛋白(ASDAS-CRP)和Bath强直性脊柱炎疾病活动度指数(BASDAI)。通过全身双能X线吸收法测量BC。按绝对值和百分数记录体脂百分数(BF%),脂肪组织指数(FMI),和非脂肪组织指数(FFMI)。

        结果:共纳入41例患者(61%男性)。中位随访时间为14.3月(四分位数范围8.4-19.4)。多价回归分析后,基线时脂肪越多(BF%, FMI, 或者FMI 百分数)与治疗后达到ASDAS-CRP或BASDAI临床显著改善的几率低明显相关。治疗后身体组成无明显改变,但是男性患者有肌肉恢复的趋势(FFMI从34.0百分位到37.4百分位)。

        结论:基线时高体脂含量与TNF-α拮抗剂治疗反应差(以ASDAS-CRP和BASDAI 变化衡量)独立相关,可能与女性患者低应答率有关。另外,治疗后男性患者也有肌肉量恢复的趋势。

        附原文:OBJECTIVE:Our mainobjective was to assess the relationship between body composition (BC)and response to tumor necrosis factor-α (TNF-α) blocker treatment in patientswith ankylosing spondylitis (AS). Our secondary objective was to evaluate thechange of BC after treatment, accounting for sex and age.METHODS:All included patients fulfilled the modified New York criteriafor AS and were naive to TNF-α blocker. They were followed for at least 6months after the start of etanercept or adalimumab. The Ankylosing SpondylitisDisease Activity Score containing C-reactive protein (ASDAS-CRP) and the BathAnkylosing Spondylitis Disease Activity Index (BASDAI) were reported. BC wasassessed by whole body dual-energy X-ray absorptiometry.Body fat percentage (BF%), fat mass index (FMI), and fat freemass index (FFMI) were reported as absolute values and as percentiles.RESULTS:Forty-one patients were included (61% men). The median followupwas 14.3 months (interquartile range 8.4-19.4). Aftermultivariate regression analysis, more fat at baseline (BF%, FMI, or FMIpercentile) was significantly related with a lower chance ofachieving a clinically important improvement of the ASDAS-CRP or BASDAI aftertreatment. The body composition did not change significantly after treatment,but there was a trend toward muscle recovery in men (FFMI change from 34.0th to37.4thpercentile).CONCLUSION:Higher body fat content at baseline wasindependently associated with a worse response to treatment with TNF-αblockers, measured by ASDAS-CRP and BASDAI change, andmight contribute to the lower response rates in female patients. Also, there isa trend toward muscle mass recovery in male patients after treatment.

        引自:Ibáñez Vodnizza SE, Nurmohamed MT, Visman IM,et al.Fat Mass Lowers the Response toTumor Necrosis Factor-α Blockers in Patients with Ankylosing Spondylitis.JRheumatol. 2017 Jul 15. [Epub ahead of print]

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