TNFα抑制剂可减少类风湿关节炎患者的心血管事件发生率

作者：Sattin M,et al. 翻译:金银姬

摘要：目的：类风湿关节炎(RA)与心血管并发症及死亡率密切相关。既往研究表明，TNF－α抑制剂可能减少类风湿关节炎患者的心血管事件 (CVE)。因此，该综述的目的为评估TNF－α抑制剂能否减少类风湿关节炎患者出现心血管事件。本研究将更新既往两篇综述内容。

方法：检索MEDLINE，EMBASE，MEDLINE及其他非索引引用，美国医学期刊社，疗效评价相关文摘数据库，Cochrane中心注册的对照试验等，纳入2009年起报道出现心血管事件的类风湿关节炎患者。我们同时也搜索了2009年至2014年加拿大风湿病协会、ACR、EULAR会议。两名审稿人评估可纳入的摘要，对审稿人选中的摘要进一步行全文阅读。根据先前制定的纳入及排除标准进一步对全文阅读的文献进行评估，使用NOS评估所选中的文献质量。

结果：经过系统性搜索，最终确定了6089篇摘要和14篇文章。所纳入的研究中，8个研究报道了TNFα抑制剂对整体心血管事件的影响，10个研究报道了冠状动脉性疾病，6个研究报道了脑血管疾病，5个研究报道了其他临床心血管事件。

结论：类风湿关节炎患者中，TNFα抑制剂可减少整体心血管事件发生率。本研究的结果与先前两个综述的结果一致，说明TNFα抑制剂可能对于预防类风湿关节炎患者心血管并发症是有用的。

附原文：AbstractOBJECTIVES:Rheumatoid arthritis (RA) is strongly associated with cardiovascular morbidity and mortality. Previous studies have demonstrated that TNFα-inhibitors may reduce cardiovascular events (CVE) in patients with RA. Thus, the purpose of this systematic review was to evaluate the ability of TNFα-inhibitors to reduce the risk of CVE in patients with RA. This study will update the findings of two earlier systematic reviews that synthesized the data up until 2010.METHODS:A search of Medline, Embase, Medline In-Process and Other Non-Indexed Citations, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, and the Cochrane Central Register of Controlled Trials was conducted for observational studies reporting on CVE in RA patients since 2009. Conference proceedings for the Canadian Rheumatology Association, American College of Rheumatology, and European League against Rheumatism were also searched between 2009 and 2014. Abstracts were assessed for inclusion by two reviewers and studies identified by either reviewer were brought forward to full-text review. Studies undergoing full-text review were further assessed based on predefined inclusion and exclusion criteria and the quality of selected papers was evaluated using the Newcastle-Ottawa Scale.RESULTS:The search identified 6089 abstracts and 14 articles were included in the final systematic review. Of the studies included, 8 reported on the effect of TNFα-inhibitors on overall CVE, 10 reported on coronary artery disease (CAD), 6 reported on cerebrovascular disease (CVD), and 5 reported other clinical cardiovascular outcomes.CONCLUSION:TNFα-inhibitors appear to reduce the likelihood of overall CVE in individuals with RA. The reduction is not as pronounced in the individual outcome measures. These results are consistent with two previous systematic reviews suggesting that TNFα-inhibitors are likely useful in the prevention of cardiovascular complications of RA

引自：Sattin M, Towheed T. The effect of TNFα-inhibitors on cardiovascular events in patients with rheumatoid arthritis: an updated systematic review of the literature.Curr Rheumatol Rev. 2016 Apr 4. [Epub ahead of print]