摘要
简介:肿瘤坏死因子(TNF)阻断疗法是一种治疗慢性炎症性关节炎的有效方法。循环TNF可能诱发或加剧充血性心力衰竭(CHF)的发展,一些试验研究了TNF阻断疗法对CHF的影响。然而,由于无效甚至加重心衰的风险,TNF阻断疗法从那时起就一直是晚期充血性心力衰竭患者的禁忌,纽约心脏协会心功能III级和IV级。我们回顾现有的病理生理学机制及TNF对CHF慢性炎症性关节炎患者治疗的安全性。方法:在MEDLINE、 EMBASE和Cochrane 图书馆中对2013年12月前出版的文献进行系统搜索,找出对THF阻断疗法的现有作用和患类风湿关节炎(RA),强直性脊柱炎(AS)和银屑病关节炎(PSA)的心衰患者的风险的研究。本文包括了所有关于在TNF阻断疗法中RA、AS和PsA患者CHF的患病率和发病率的文献报道数据。同时还包括了成像研究和生物标记研究,以及TNF阻断疗法对心功能影响的研究。结果:总共纳入了54个研究。大型前瞻性注册表明: 第一,不能排除TNF 阻滞治疗在老年 RA 患者的CHF 的发生率潜在的有害影响,且没有发现TNF阻断疗法对其他患者的有害作用。第二,我们发现 TNF 阻断疗法可能提高了RA、AS 和 PsA患者心脏功能的几个超声心动图参数,但由于样本量太小,这些结果需要更多的研究验证。第三,我们发现使用TNF阻断治疗RA和AS后 NT-proBNP水平的改善。结论:在现有文献的基础上,在慢性炎性关节炎和伴随症状的轻中度心衰患者(NYHA I或II),与TNF-阻断治疗不冲突。慢性炎症性关节炎患者伴随症状的中度至重度CHF,NYHA III-IV级,TNF阻断治疗应尽量避免。无论如何,TNF阻断疗法还在这些患者的咨询考虑范围内,由一个心脏专家给出建议应在治疗开始前提出。
关键词: 强直性脊柱炎,充血性心力衰竭,幼年特发性关节炎,骨关节炎,银屑病性关节炎,类风湿性关节炎,肿瘤坏死因子
Current Medicinal Chemistry
Title:Tumor Necrosis Factor Blocking Therapy and Congestive Heart Failure in Patients with Inflammatory Rheumatic Disorders: A Systematic Review
Volume: 22 Issue: 16
Author(s): S.C. Heslinga, A.M. Van Sijl, K. De Boer, V.P. Van Halm and M.T. Nurmohamed
Affiliation:
关键词: 强直性脊柱炎,充血性心力衰竭,幼年特发性关节炎,骨关节炎,银屑病性关节炎,类风湿性关节炎,肿瘤坏死因子
摘要: Introduction: Tumour necrosis factor (TNF) blocking therapy is an effective treatment for chronic inflammatory arthritis. As circulating TNF might induce or exacerbate the development of congestive heart failure (CHF), several trials have investigated the effect of TNF blocking therapy on CHF. However, due to inefficacy and even a risk of exacerbation of CHF, TNF blocking therapy has since then been contraindicated in patients with advanced CHF, New York Heart Association class III and IV. We review current knowledge on the pathophysiological mechanisms and safety of TNF blocking therapy in chronic inflammatory arthritis patients with regard to CHF. Methods: A systematic search of the literature published up till December 2013 was conducted in MEDLINE, EMBASE and the Cochrane Library to identify all studies investigating the effect of TNF blocking therapy on the occurrence and risk of CHF in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). All articles reporting data on the prevalence or incidence of CHF during treatment with TNF blocking therapy in patients with in RA, AS or PsA were included. Also imaging studies and studies with biomarkers, investigating the effect of TNF blocking therapy on cardiac function were included. Results: In total, 54 studies were included. Results from large prospective registries suggest that first, a potentially harmful effect of TNF blocking therapy on the incidence of CHF in older RA patients cannot be excluded and that no harmful effect was observed of TNF blocking therapy in other patients. Second, we found that TNF blocking therapy potentially improves several echocardiographic parameters of cardiac function in RA, AS and PsA, but due to small sample sizes, these results require validation in larger studies. Third, we found improvement in NT-proBNP levels after use of TNF blocking therapy in both RA and AS. Conclusion: Based on current literature, in patients with chronic inflammatory arthritis and concomitant symptomatic mild-tomoderate CHF (NYHA class I or II), treatment with TNF blocking therapy is not contraindicated. In chronic inflammatory arthritis patients with concomitant symptomatic moderate-to-severe CHF, NYHA class III-IV, treatment with TNF blocking therapy should be avoided if possible. Whenever, treatment with TNF-blocking therapy is considered in these patients consultation with a cardiologist is recommended before treatment is initiated.
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S.C. Heslinga, A.M. Van Sijl, K. De Boer, V.P. Van Halm and M.T. Nurmohamed , Tumor Necrosis Factor Blocking Therapy and Congestive Heart Failure in Patients with Inflammatory Rheumatic Disorders: A Systematic Review, Current Medicinal Chemistry 2015; 22 (16) . https://dx.doi.org/10.2174/0929867322666150209160701
DOI https://dx.doi.org/10.2174/0929867322666150209160701 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
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