■关于肿瘤坏死因子-α(TNF-α)抑制剂对银屑病患者血脂谱的影响尚无共识。本研究旨在研究TNF-α抑制剂对血脂(甘油三酯,总胆固醇,低密度脂蛋白,或高密度脂蛋白)牛皮癣患者。
■我们搜索了PubMed,Embase,和Cochrane图书馆数据库,用于2023年10月17日之前发表的文章。四种TNF-α抑制剂(英夫利昔单抗,依那西普,阿达木单抗,和certolizumab)被纳入我们的研究。(PROSPEROID:CRD42023469703)。
■共20项试验。总体结果显示,TNF-α抑制剂升高了银屑病患者的高密度脂蛋白水平(WMD=2.31;95%CI:0.96,3.67;P=0.001),这得到了排除降脂药物作用的敏感性分析结果的支持.亚组分析表明,小于或等于3个月组的高密度脂蛋白水平显着增加(WMD=2.88;95%CI:1.37,4.4;P<0.001),依那西普组(WMD=3.4;95%CI=1.71,5.09,P<0.001),银屑病组(WMD=2.52;95%CI=0.57、4.48,P=0.011)。3~6个月组甘油三酯水平显著升高(WMD=4.98;95%CI=1.97、7.99,P=0.001),6个月及以上组显著降低(WMD=-19.84;95%CI=-23.97、-15.7,P<0.001)。此外,银屑病组甘油三酯水平显著升高(WMD=5.22;95%CI=2.23,8.21,P=0.001)。
■我们的结果显示,TNF-α抑制剂可能会暂时增加银屑病患者的高密度脂蛋白水平。然而,甘油三酯的变化在不同治疗持续时间之间不一致,治疗3至6个月后显著增加。未来的前瞻性试验和长期随访有助于证实和扩展我们的发现。
■https://www.crd.约克。AC.英国/PROSPERO/,标识符CRD42023469703。
There is no consensus on the effect of tumor necrosis factor-alpha (TNF-alpha) inhibitors on lipid profiles in patients with psoriasis. This study aimed to investigate the effects of TNF-alpha inhibitors on lipid profiles (triglycerides, total cholesterol, low-density lipoprotein, or high-density lipoprotein) in patients with psoriasis.
We searched PubMed, Embase, and Cochrane Library databases for articles published before October 17, 2023. Four TNF-alpha inhibitors (infliximab,
etanercept, adalimumab, and certolizumab) were included in our study. (PROSPERO ID: CRD42023469703).
A total of twenty trials were included. Overall results revealed that TNF-alpha inhibitors elevated high-density lipoprotein levels in patients with psoriasis (WMD = 2.31; 95% CI: 0.96, 3.67; P = 0.001), which was supported by the results of sensitivity analyses excluding the effect of lipid-lowering drugs. Subgroup analyses indicated that high-density lipoprotein levels were significantly increased in the less than or equal to 3 months group (WMD = 2.88; 95% CI: 1.37, 4.4; P < 0.001), the
etanercept group (WMD = 3.4; 95% CI = 1.71, 5.09, P < 0.001), and the psoriasis group (WMD = 2.52; 95% CI = 0.57, 4.48, P = 0.011). Triglyceride levels were significantly increased in the 3 to 6-month group (WMD = 4.98; 95% CI = 1.97, 7.99, P = 0.001) and significantly decreased in the 6-month and older group (WMD = -19.84; 95% CI = -23.97, -15.7, P < 0.001). Additionally, Triglyceride levels were significantly increased in the psoriasis group (WMD = 5.22; 95% CI = 2.23, 8.21, P = 0.001).
Our results revealed that TNF-alpha inhibitors might temporarily increase high-density lipoprotein levels in patients with psoriasis. However, changes in triglycerides were not consistent among the different durations of treatment, with significant increases after 3 to 6 months of treatment. Future prospective trials with long-term follow-up contribute to confirming and extending our findings.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023469703.