Effect Of Tumor Necrosis Factor-α Inhibitor On Blood Lipid Level And The Atherogenic Index Of Plasma In Rheumatoid Arthritis Patients

Objective: To explore the changes of blood lipids in patients with rheumatoid arthritis(RA)by comparing the levels of blood lipids in RA patients and healthy controls.By comparing the changes of blood lipids and plasma atherogenic index(AIP)in patients with RA treated with traditional antirheumatic drugs(DMARDs)and tumor necrosis factor-α(TNF-α)inhibitors,to explore the effects of TNF-α inhibitors on blood lipids and AIP in patients with RA.Methods: A total of 120 patients with RA treated in Shengjing Hospital from 2012 to2019 were collected as rheumatoid group(RA group)and 120 healthy subjects in physical examination center in the same period as healthy control group.The general data and total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),apolipoprotein A1(Apo-A1),apolipoprotein B(Apo-B)and AIP;were collected and compared between the two groups.The correlation between DAS28 score and blood lipid index in patients with RA was analyzed,and according to the different treatment methods,120 patients in RA group were divided into traditional DMARDs group and TNF-α inhibitor group,with 60 patients in each group.The changes of ESR(ESR),C-reactive protein(CRP),DAS28 score,TC,TG,HDL,LDL,Apo-A1,Apo-B and AIP were compared between the two groups before and after treatment.Results: There was no statistical difference between the RA group and the healthy control group in terms of sex,age,BMI and so on(P>0.05).In the RA group,45% of the subjects had increased TC,60% of the subjects had increased TG,46.7% of the subjects had increased TC,3.33% of the subjects in the RA group had increased TC,and 78.3% of the subjects in the healthy control group had decreased Apo-A1.Before treatment,TC(P<0.001),TG(P<0.001),LDL(P<0.001),Apo-B(P=0.001),AIP(P<0.001)in RA group were significantly higher than those in healthy control group,HDL(P<0.001)and Apo-A1(P<0.001)were significantly lower than those in healthy control group.In the rheumatoid group,the DAS28 score was negatively correlated with HDL(r = 0.890,P<0.001)and Apo-A1(r = 0.627,P<0.001),positively correlated with AIP(r = 0.744,P<0.001),but weakly correlated with TC(r = 0.358,P<0.001),and no correlation was found with other blood lipid indexes such as TG,LDL and Apo-B.There was no significant difference in DAS28 score,inflammation and blood lipid indexes between traditional DMARDs group and TNF-α inhibitor group before treatment(P>0.05).After treatment,in the traditional DMARDs group,DAS28 score,TC,TG,LDL and AIP decreased significantly(P < 0.001),Apo-B decreased(P=0.002),and HDL increased significantly(P < 0.001).In the TNF-αinhibitor group,DAS28 score(P < 0.001),ESR(P=0.049)and CRP(P < 0.001)were significantly lower after treatment,TC,TG,LDL and AIP were significantly lower(P< 0.001),and HDL and Apo-A1 were significantly higher(P < 0.001).Compared with the post-treatment data of traditional DMARDs group and TNF-α inhibitor group,the DAS28 score(P < 0.001)and CRP decreased(P=0.049)were more significant in the TNF-inhibitor group,while the HDL(P=0.046)and Apo-A1(P=0.031)increased more significantly.Conclusion: RA patients are prone to dyslipidemia and AIP is higher than that of healthy people,TNF-α inhibitors can effectively control inflammation,improve blood lipid status and reduce AIP in patients with RA.