Уровень N-концевого фрагмента предшественника мозгового натрийуретического пептида B-типа и атеросклеротическое поражение брахиоцефальных артерий у больных ревматоидным артритом с неэффективностью и/или непереносимостью базисной противовоспалительной тера
Уровень N-концевого фрагмента предшественника мозгового натрийуретического пептида B-типа и атеросклеротическое поражение брахиоцефальных артерий у больных ревматоидным артритом с неэффективностью и/или непереносимостью базисной противовоспалительной тера
Герасимова Е.В., Попкова Т.В., Мартынова А.В. и др. Уровень N-концевого фрагмента предшественника мозгового натрийуретического пептида B-типа и атеросклеротическое поражение брахиоцефальных артерий у больных ревматоидным артритом с неэффективностью и/или непереносимостью базисной противовоспалительной терапии. Терапевтический архив. 2019; 91 (5): 34–39. DOI: 10.26442/00403660.2019.05.000286
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Gerasimova E.V., Popkova T.V., Martynova A.V., et al. Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti-inflammatory treatment. Therapeutic Archive. 2019; 91 (5): 34–39. DOI: 10.26442/00403660.2019.05.000286
Уровень N-концевого фрагмента предшественника мозгового натрийуретического пептида B-типа и атеросклеротическое поражение брахиоцефальных артерий у больных ревматоидным артритом с неэффективностью и/или непереносимостью базисной противовоспалительной тера
Герасимова Е.В., Попкова Т.В., Мартынова А.В. и др. Уровень N-концевого фрагмента предшественника мозгового натрийуретического пептида B-типа и атеросклеротическое поражение брахиоцефальных артерий у больных ревматоидным артритом с неэффективностью и/или непереносимостью базисной противовоспалительной терапии. Терапевтический архив. 2019; 91 (5): 34–39. DOI: 10.26442/00403660.2019.05.000286
________________________________________________
Gerasimova E.V., Popkova T.V., Martynova A.V., et al. Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti-inflammatory treatment. Therapeutic Archive. 2019; 91 (5): 34–39. DOI: 10.26442/00403660.2019.05.000286
Выявлена высокая прогностическая значимость концентрации N-концевого фрагмента предшественника мозгового натрийуретического пептида В-типа (N-terminal fragment of brain natriuretic peptide progenitor, NT-proBNP) в развитии сердечно-сосудистых заболеваний (ССЗ) при ревматоидном артрите (РА) и в общей популяции. Цель: уточнить значение NT-proBNP у больных РА с неэффективностью и/или непереносимостью базисной противовоспалительной терапии, сопоставить уровень NT-proBNP с атеросклеротическим поражением брахиоцефальных артерий (БЦА), традиционными факторами риска (ТФР) ССЗ и маркерами воспаления. Материалы и методы. Обследовано 28 пациентов с РА (24 женщины и 4 мужчин) с неэффективностью и/или непереносимостью базисных противовоспалительных препаратов (БПВП); медиана возраста составила 55 [46; 61] лет; продолжительность болезни – 114 [60; 168] мес; DAS28 – 6,2 [5,1; 7,0] балла; SDAI – 35,0 [23,9; 51,0], CDAI – 30,0 [21,0; 42,0]. Все больные были серопозитивны по ревматоидному фактору (РФ), 86% – по антителам к циклическому цитруллинированному пептиду (АЦЦП). Внесуставные проявления выявлялись у 54% больных. На момент включения в исследование 47% больных получали метотрексат (медиана дозы 20,2 [18; 25] мг/нед), 11% – лефлуномид, 7% – сульфасалазин, 46% – глюкокортикоиды, 75% – нестероидные противовоспалительные препараты. У 46% пациентов отмечена неэффективность 3 и более БПВП, у 54% – непереносимость предшествовавшей терапии БПВП. В исследование не включались пациенты с РА, имеющие хроническую сердечную недостаточность. У больных РА обнаружена высокая частота ТФР: артериальная гипертензия – у 75%, дислипидемия – 61%, курение – 17%, избыточная масса тела – 61%, отягощенная наследственность по ССЗ – 36%, гиподинамия – 68% больных. Ишемическую болезнь сердца диагностировали у 11% пациентов. Контрольную группу составили 20 здоровых доноров, сопоставимых с больными по возрасту и полу. Концентрацию NT-proBNP определяли в сыворотке крови методом электрохемилюминесценции (Roche Diagnostics, Швейцария). Всем пациентам проведено дуплексное сканирование экстракраниального отдела БЦА с определением толщины комплекса интима–медиа (КИМ). Атеросклеротическое поражение БЦА оценивали по наличию атеросклеротической бляшки (толщина КИМ≥1,2 мм). Результаты. У пациентов с РА выявлены более высокие уровни NT-proBNP (78,7 [41,4; 101,3] пг/мл) по сравнению с группой здорового контроля (55,3 [36,6; 67,3] пг/мл, p<0,05). Пациентов с РА разделили на две группы по уровню NT-proBNP: >100 пг/мл – 1-я группа (n=6) и ≤100 пг/мл – 2-я группа (n=22). Группы больных РА не различались по полу, возрасту, активности РА, частоте выявления ТФР. Атеросклеротическое поражение БЦА выявлено у 3 (50%) пациентов 1-й группы и у 8 (36%) больных 2-й группы (р>0,05). У пациентов с РА уровень NT-proBNP положительно коррелировал с возрастом (r=0,39; p<0,05), с толщиной КИМ БЦА (r=0,43; p<0,05). У больных РА 2-й группы наблюдалась корреляционная связь между концентрацией NT-proBNP и уровнем антител к АЦЦП (r=0,42; p<0,05) и антител к модифицированному цитруллинированному виментину (анти-MCV; r=0,56; p<0,05). Связи концентрации NT-proBNP с активностью РА (DAS28, CDAI, CDAI), маркерами воспаления (С-реактивный белок, скорость оседания эритроцитов), ТФР и проводимой терапией установлено не было. Заключение. Уровень NT-proBNP в крови больных РА с неэффективностью и/или непереносимостью базисной противовоспалительной терапии выше, чем в группе контроля. У каждого пятого больного РА концентрация NT-proBNP была выше 100 пг/мл. Продемонстрирована связь NT-proBNP с возрастом, иммунологическими показателями (АЦЦП и анти-МСV). Корреляция между концентрацией NT-proBNP и толщиной КИМ БЦА может свидетельствовать о возможной роли данного биомаркера в прогрессировании атеросклеротического поражения периферических артерий у больных РА. Значение NT-proBNP в развитии ранних проявлений атеросклероза при РА требует дальнейшего уточнения.
The high prognostic significance of the concentration of the N-terminal-pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. Aim: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti-inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. Materials and methods. The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti-inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti-cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension – in 75%, dyslipidemia – 61%, smoking – 17%, overweight – 61%, family history of cardiovascular diseases – 36%, hypodynamia – 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs – in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% – leflunomide, 7% – sulfasalazine, 46% – glucocorticoids, 75% – non-steroidal anti-inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima-media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). Results. NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p<0.05). RA pts were divided into two groups according to the level of NT-proBNP: >100 pg/ml – 1 group (n=6) and ≤100 pg/ml – 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p<0.05), with the IMT BCA (r=0.43; p<0.05). In RA pts of the 2 group, a correlation was observed between the concentration of NT-proBNP and the level of ACCP (r=0.42; p<0.05) and antibodies to modified citrullinated vimentin (anti-MCV; r=0.56; p<0.05). No association of NT-proBNP with PA activity (DAS28, CDAI, CDAI), inflammatory markers (C-reactive protein, erythrocyte sedimentation rate), traditional risk factors and therapy was found. Conclusion. The level of NT-proBNP in the blood of RA pts with ineffectiveness and/or intolerance to basic anti-inflammatory therapy is higher than in the control group. In every fifth RA patient, the concentration of NT-proBNP was higher than 100 pg/ml. The association of NT-proBNP with age and immunological parameters (ACCP and anti-MCV) was demonstrated. The correlation between the concentration of NT-proBNP and the IMT BCA may indicate the possible role of this biomarker in the progression of atherosclerotic lesions of arteries in RA pts. The significance of NT-proBNP in the development of early manifestations of atherosclerosis in RA requires further study.
Keywords: N-terminal-pro-B-type natriuretic peptide, rheumatoid arthritis, atherosclerotic damage of brachocephalic arteries, traditional risk factors, cardiovascular diseases.
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1. Popkova TV, Novikova DS, Nasonov EL. Atherosclerosis in rheumatic diseases. In: Rheumatology: clinical guidelines. Pod red. EL. Nasonov. Moscow: GEOTAR-Media, 2010:678-702 (In Russ.).
2. Corrales A, Dessein PH, Tsang L, et al. Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study. Arthritis Res Ther. 2015;17:55. doi: 10.1186/s13075 -015-0576-7
3. Popkova TV, Novikova DS, Nasonov EL. Сardiovascular diseases in rheumatoid arthritis: latest data. Rheumatology Science and Practice. 2016;54(2):122-8 (In Russ.). doi: 10.14412/1995-4484-2016-122-128
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