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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (5): 934-940. doi: 10.19723/j.issn.1671-167X.2025.05.018

• 论著 • 上一篇    下一篇

生物制剂的长期应用对中重度斑块型银屑病患者代谢性生化指标的影响

刘相贤1,2,*, 林毅1,2,*, 郭金竹1,*()   

  1. 1. 北京大学第三医院皮肤科，北京 100191
    2. 北京大学医学部，北京 100191
  • 收稿日期:2024-11-12 出版日期:2025-10-18 发布日期:2025-08-28
  • 通讯作者: 郭金竹
  • 作者简介:*These authors contributed equally to this work
  • 基金资助:
    国家重点研发计划项目(2023YFC2508106); 北京健康促进会医学科学研究基金项目(Z2022023058008)

Influence of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis

Xiangxian LIU1,2, Yi LIN1,2, Jinzhu GUO1,*()   

  1. 1. Department of Dermatology, Peking University Third Hospital, Beijing 100191, China
    2. Peking University Health Science Center, Beijing 100191, China
  • Received:2024-11-12 Online:2025-10-18 Published:2025-08-28
  • Contact: Jinzhu GUO
  • Supported by:
    the National Key Research and Development Program of China(2023YFC2508106); the Beijing Health Promotion Association Medical Science Research Fund(Z2022023058008)

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摘要： 目的: 评价生物制剂的长期应用对中重度斑块型银屑病患者代谢性生化指标的影响。方法: 连续选择2015年11月至2024年1月长期使用(至少24周)生物制剂治疗中重度斑块型银屑病的成年患者的病例资料进行回顾性分析。根据生物制剂使用情况，分为白介素(interleukin，IL)-17抑制剂组、IL-23和IL-12/23抑制剂组与肿瘤坏死因子-α (tumor necrosis factor-α，TNF-α)抑制剂组三组，并分别比较各组用药前后的代谢性生化指标。结果: 共纳入患者174例，男性127例(73.00%)，女性47例(27.00%)，年龄中位数为38.00(31.50，49.00)岁，患者银屑病病程中位数为12.00(10.00，20.00)年，应用生物制剂治疗时间26~301周，中位数为61.00(49.00，96.25)周。按生物制剂使用情况分组，IL-17抑制剂组101例，IL-23和IL-12/23抑制剂组38例，TNF-α抑制剂组35例。IL-17抑制剂组治疗后，体重、体重指数(body mass index，BMI)、丙氨酸氨基转移酶(alanine aminotransferase，ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase，AST)、空腹血糖(fasting glucose，GLU)、总胆固醇(total cholesterol，TC)、甘油三酯(total cholesterol，TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)较治疗前差异均无统计学意义(P>0.05), 低密度脂蛋白胆固醇(low-density lipoprotein cholesterol，LDL-C)较治疗前显著降低[(2.90±0.75) mmol/L vs. (3.05±0.79) mmol/L, t=－2.100, P=0.038]，尿酸(uric acid，UA)较治疗前显著升高[(401.13±99.13) μmol/L vs. (364.94±91.11) μmol/L，t=5.215, P＜0.001]，治疗前UA正常者在长期应用生物制剂治疗后UA水平较治疗前显著升高[(370.69±89.59) μmol/L vs. (324.66±64.50) μmol/L, t=5.856, P＜0.001]；IL-23和IL-12/23抑制剂组治疗后，体重、BMI、ALT、AST、GLU、TC、TG、HDL-C、UA与治疗前相比，差异均无统计学意义(P>0.05)，LDL-C较治疗前显著降低[(2.85±0.74) mmol/L vs. (3.12±0.68) mmol/L, t=-2.082, P=0.045]；TNF-α抑制剂组治疗后，体重、BMI、ALT、AST、GLU、TC、TG、HDL-C、LDL-C、UA与治疗前相比，差异均无统计学意义(P>0.05)。结论: 应用IL-17抑制剂长期治疗中重度斑块型银屑病成年患者，可能出现尿酸水平升高，尤其在治疗前尿酸水平正常的患者；应用IL-17抑制剂、IL-23和IL-12/23抑制剂长期治疗，可能降低LDL-C水平。

关键词: 银屑病, 生物制剂, 代谢, 回顾性研究

Abstract: Objective: To assess the impact of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis patients. Methods: The study included patients over 18 years old who had been treated by biological agents for at least 24 weeks for moderate to severe plaque psoriasis from Novermber 2015 to January 2024. According to the biological agents the patients used, they were divided into three groups: interleukin-17 (IL-17) inhibitor group, IL-23 and IL-12/23 inhibitor group and tumor necrosis factor-α (TNF-α) inhibitor group. The metabolic biochemical parameters of each group were evaluated and compared before and after the administration of the biologic therapies. Results: A total of 174 patients with moderate to severe plaque psoriasis were included in the long-term treatment with biologics, including 127 males (73.00%), 47 females (27.00%), with a median age of 38.00 (31.50, 49.00) years and a median duration of psoriasis of 12.00 (10.00, 20.00) years. The median duration of biologic treatment was 61.00 (49.00, 96.25) weeks, ranging from 26 to 301 weeks. There were 101 patients in the IL-17 inhibitor group, 38 patients in the IL-23 and IL-12/23 inhibitor group, and 35 patients in the TNF-α inhibitor group. After long-term treatment with IL-17 inhibitors, no statistically significant changes were observed in body weight, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting glucose (GLU), total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) compared with baseline measurements (P>0.05). However, low-density lipoprotein cholesterol (LDL-C) levels were significantly reduced [(2.90±0.75) mmol/L vs. (3.05±0.79) mmol/L, t=－2.100, P=0.038], while uric acid (UA) levels showed a significant increase [(401.13±99.13) μmol/L vs. (364.94±91.11) μmol/L, t=5.215, P < 0.001]. The group with normal UA levels before treatment showed a significant increase after long-term application of biological agents compared with before treatment [(370.69± 89.59) μmol/L vs. (324.66±64.50) μmol/L, t=5.856, P < 0.001]. Following long-term application of IL-23 and IL-12/23 inhibitors, no statistically significant differences were observed in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C and UA levels when compared with baseline measurements (P> 0.05). However, LDL-C levels exhibited a significant reduction from baseline [(2.85±0.74) mmol/L vs. (3.12±0.68) mmol/L, t=－2.082, P=0.045]. After long-term treatment with TNF-α inhibitor, there were no significant differences in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C, LDL-C and UA compared with baseline measurements (P>0.05). Conclusion: Long-term application of IL-17 inhibitors in moderate to severe plaque psoriasis patients may result in elevated uric acid levels, particularly in patients with normal uric acid levels before treatment. The long-term use of IL-17 inhibitors, IL-23 inhibitors or IL-12/23 inhibitors might reduce LDL-C levels.

Key words: Psoriasis, Biologics, Metabolic, Retrospective study

中图分类号: 

  • R758.63

表1

IL-17抑制剂组、IL-23和IL-12/23抑制剂组、TNF-α抑制剂组基线情况比较"

Items IL-17 (n=101) IL-23 & IL-12/23 (n=38) TNF-α (n=35) F/H/χ2 P
Psoriasis duration/years 12.00 (8.50, 20.50) 12.50 (9.75, 18.50) 12.50 (10.00, 20.00) 0.721b 0.697
Duration of treatment/weeks 64.00 (90.00, 91.50) 58.00 (49.00, 95.00) 55.00 (40.00, 105.00) 0.309b 0.857
Age/years 38.00 (31.50, 51.00) 37.00 (31.00, 45.50) 39.00 (32.00，51.00) 1.281b 0.527
Male 72 (71.3) 26 (68.4) 29 (82.9) 1.135c 0.324
Weight at baseline/kg 74.07±15.15 70.87±15.06 73.05±14.73 0.881a 0.417
BMI at baseline/(kg/m2) 25.11±4.08 24.45±3.86 24.70±4.26 2.855a 0.063
ALT at baseline/(U/L) 22.00 (13.00, 37.25) 19.00 (13.50, 31.50) 26.00 (13.00, 36.00) 0.425b 0.809
ALT elevated cases 21 (21.9) 6 (17.1) 7 (20.0) 0.359c 0.836
AST at baseline/(U/L) 21.00 (18.00, 29.00) 21.00 (17.50, 25.50) 24.54±7.36 1.241b 0.538
AST elevated cases 5 (5.2) 2 (5.7) 2 (5.7) 0.020c 0.990
GLU at baseline/(mmol/L) 5.40 (4.90, 5.70) 5.40 (5.05, 5.80) 5.48±0.78 0.754b 0.686
GLU elevated cases 14 (14.9) 7 (20.6) 4 (14.3) 0.678c 0.712
TC at baseline/(mmol/L) 4.74±0.95 4.94±0.88 4.76±0.94 0.502a 0.606
TC elevated cases 29 (30.5) 15 (40.5) 9 (29.0) 1.429c 0.490
TG at baseline/(mmol/L) 1.38 (0.91, 2.19) 1.22 (0.77, 2.10) 1.40 (0.94, 1.85) 0.461b 0.794
TG elevated cases 33 (34.4) 17 (45.9) 12 (38.7) 1.534c 0.464
HDL-C at baseline/(mmol/L) 1.11 (0.98, 1.32) 1.15 (1.02, 1.40) 1.19±0.26 1.479b 0.477
HDL-C lowered cases 37 (38.5) 10 (27.0) 8 (25.8) 2.613c 0.271
LDL-C at baseline/(mmol/L) 3.05±0.79 3.12±0.68 3.30 (2.56, 3.68) 0.947b 0.623
LDL-C elevated cases 22 (23.2) 9 (24.3) 9 (29.0) 0.437c 0.804
UA at baseline/(μmol/L) 364.94±91.11 367.78±101.13 406.34±110.71 1.805a 0.168
UA elevated cases 24 (25.3) 12 (33.3) 12 (41.3) 2.994c 0.224

表2

IL-17抑制剂组患者用药前后代谢性生化指标变化"

Items n At baseline After treatment t/Z P
Weight/kg 78 74.07±15.15 74.79±14.55 1.260a 0.211
BMI/(kg/m2) 78 25.11±4.08 25.38±4.02 1.452a 0.151
ALT/(U/L) 96 22.00(13.00, 37.25) 23.00(15.75, 42.25) -1.901b 0.057
AST/(U/L) 96 21.00(18.00, 29.00) 23.00(18.00, 30.25) -1.730b 0.084
GLU/(mmol/L) 94 5.40(4.90, 5.70) 5.30(5.00, 5.75) -0.410b 0.682
TC/(mmol/L) 95 4.74±0.95 4.64±0.97 -1.052a 0.295
TG/(mmol/L) 96 1.38(0.91, 2.19) 1.35(1.01, 1.87) -0.226b 0.821
HDL-C/(mmol/L) 96 1.11(0.98, 1.32) 1.11(0.94, 1.29) -1.128b 0.259
LDL-C/(mmol/L) 95 3.05±0.79 2.90±0.75 -2.100a 0.038
UA/(μmol/L) 95 364.94±91.11 401.13±99.13 5.215a ＜0.001

表3

IL-23和IL-12/23抑制剂组患者用药前后代谢性生化指标变化"

Items n At baseline After treatment t/Z P
Weight/kg 26 70.87±15.06 71.37±14.40 0.953a 0.350
BMI/(kg/m2) 26 24.45±3.86 24.65±3.71 1.119a 0.274
ALT/(U/L) 35 19.00 (13.50, 31.50) 21.00 (16.00, 36.75) -0.659b 0.510
AST/(U/L) 35 21.00 (17.50, 25.50) 22.00 (19.00, 28.50) -1.065b 0.287
GLU/(mmol/L) 34 5.40 (5.05, 5.80) 5.40 (5.10, 5.80) -0.236b 0.814
TC (mmol/L) 37 4.94±0.88 4.77±0.76 -1.454a 0.155
TG/(mmol/L) 37 1.22 (0.77, 2.10) 1.23 (0.84, 2.04) -0.158b 0.874
HDL-C/(mmol/L) 37 1.15 (1.02, 1.40) 1.19 (1.00, 1.34) -0.883b 0.377
LDL-C/(mmol/L) 37 3.12±0.68 2.85±0.74 -2.082a 0.045
UA/(μmol/L) 36 367.78±101.13 371.00±91.79 0.287a 0.768

表4

TNF-α抑制剂组患者用药前后代谢性生化指标变化"

Items n At baseline After treatment t/Z P
Weight/kg 31 73.05±14.73 73.77±14.73 1.160a 0.255
BMI/(kg/m2) 31 24.70±4.26 24.96±4.31 1.252a 0.220
ALT/(U/L) 35 26.00(13.00, 36.00) 25.00(18.00, 31.00) -0.094b 0.925
AST/(U/L) 35 24.54±7.36 22.00(18.00, 29.00) -0.322b 0.747
GLU/(mmol/L) 28 5.48±0.78 5.40(5.00, 6.10) -0.013b 0.990
TC/(mmol/L) 31 4.76±0.94 4.72±0.88 -0.282a 0.780
TG/(mmol/L) 31 1.40(0.94, 1.85) 1.70±0.86 0.075a 0.940
HDL-C/(mmol/L) 31 1.19±0.26 1.13(1.01, 1.26) -1.358b 0.174
LDL-C/(mmol/L) 31 3.30(2.56, 3.68) 3.08±0.81 -0.392b 0.695
UA/(μmol/L) 29 406.34±110.71 378.14±77.45 -1.572a 0.127

表5

IL-17抑制剂组患者用药前后尿酸水平差异"

Items n At baseline After treatment t P
Normal uric acid group/(μmol/L) 71 324.66±64.50 370.69±89.59 5.856 ＜0.001
Male in normal uric acid group/(μmol/L) 46 353.35±51.08 406.74±81.34 4.930 ＜0.001
Female in normal uric acid group/(μmol/L) 25 271.88±52.66 304.36±62.69 3.329 0.003
High uric acid group/(μmol/L) 24 489.08±38.01 491.17±66.44 0.538 0.596

表6

IL-17抑制剂组患者用药前后尿酸水平差异的影响因素分析"

Items Ixekizumab Secukinumab
n r P n r P
Age 21 -0.185 0.423 74 -0.014 0.909
Gender 21 0.382 0.087 74 -0.003 0.977
Duration of treatment 21 0.267 0.242 74 0.027 0.819
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ISSN 1671-167X
CN 11-4691/R
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