摘要(加拿大报道): 目的：控制类风湿关节炎可能降低心血管事件发生风险，我们力求对抗TNF治疗与心血管事件发生率关系进行系统评估。

方法 我们从PubMed (1950~2009-11)、EMBASE (1980~2009-11)和会议摘要中查找RA患者使用抗TNF治疗发生心血管事件（心梗、充血性心衰和脑血管事件）的观察性研究和随机临床试验（与传统病情改善药相比），提取其中的相对风险或风险比及其可信区间。如果报道了发生率，则查阅另外的资料来计算发生密度比和其方差。

结果 系统综述和荟萃分析分别包括了16项和13项研究。在队列研究中，抗TNF治疗与所有心血管事件降低相关（汇总调节RR 0.46; 95%CI 0.28-0.77),心梗(汇总调节RR 0.81; 95%CI 0.68-0.96)和脑血管事件(汇总调节RR 0.69; 95%CI 0.53-0.89)。随机临床试验的荟萃分析也产生一种点评估，提示心血管事件发生风险低，但无统计学意义（汇总相对风险为0.85，95%CI 0.28-2.59）。

结论 观察性研究提示，抗TNF治疗与所有心血管事件、心梗和脑血管事件风险降低有关。而队列研究之间结果不同，可能为研究偏倚。来自随机对照实验的点评估效果不足以评估宽的可信区间，且心血管事件为继发性问题，但随机对照试验也显示风险降低的趋势。

附原文 Abstract OBJECTIVE: Control of rheumatoid arthritis (RA) may reduce the risk of cardiovascular (CV) events. We sought to systematically assess the association between anti-tumor necrosis factor alpha (anti-TNF) therapy in RA and CV event rates. METHODS: Observational cohorts and randomized clinical trials (RCTs) reporting on CV events (all events, myocardial infarction (MI), congestive heart failure (CHF), and cerebrovascular accident (CVA)) in RA patients treated with anti-TNF therapy compared to traditional disease modifying drugs were identified from a search of PubMed (1950 to November 2009), EMBASE (1980 to November 2009), and conference abstracts. Relative risks or hazard ratios and confidence intervals (CI) were extracted. If incidence was reported, additional data were extracted to calculate an incidence density ratio and its variance. RESULTS: The systematic review and meta-analysis includes 16 and 13 publications respectively. In cohort studies, anti-TNF therapy was associated with a reduced risk for all CV events (pooled adjusted RR 0.46; 95%CI 0.28-0.77), MI (pooled adjusted RR 0.81; 95%CI 0.68-0.96), and CVA (pooled adjusted RR 0.69; 95%CI 0.53-0.89). Meta-analysis of RCTs also produced a point estimate indicating lower risk of CV events but this was not statistically significant (pooled relative risk of 0.85; 95%CI 0.28-2.59). CONCLUSION: Anti-TNF therapy is associated with a reduced risk of all CV events, MI and CVA in observational cohorts. There was heterogeneity among cohort studies and possible publication bias. The point estimate of effect from RCTs is underpowered with wide confidence intervals, and CV events were secondary outcomes, but RCTs also demonstrated a trend towards decreased risk.

引自：Barnabe C, Martin BJ, Ghali WA. Systematic review and meta-analysis: Anti-tumor necrosis factor alpha therapy and cardiovascular events in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2010 Oct 18. [Epub ahead of print]