【摘要】 目的分析肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)抑制剂间隔给药治疗强直性脊柱炎的临床效果及其对复发率的影响。方法选取青岛大学医学院第二附属医院2011年2月至2014年1月收治的84例强直性脊柱炎患者为研究对象,所有患者入院后均给予TNF-α抑制剂治疗,病情稳定后逐渐减量、延长给药间隔,逐渐过度至采用非甾体抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)治疗,按照依从性调查问卷评分结果将患者分为依从性好组(49例)和依从性差组(35例)。比较两组患者的临床治疗效果,治疗前后指地距、枕墙距、晨僵时间、腰背疼痛程度视觉模拟评分法(visual analogue scale,VAS)评分、髋关节功能Harris评分、红细胞沉降率(erythrocyte sedimentation rate,ESR)及C反应蛋白(C-reactive protein,CRP)水平的变化,以及停药3个月、6个月及1年的疾病复发率。结果依从性好组临床总有效率明显高于依从性差组(P<0.05)。治疗后,依从性好组患者的指地距、枕墙距、晨僵时间较依从性差组均明显缩短(P<0.05);依从性好组患者VAS评分明显低于依从性差组(P<0.05),Harris评分明显高于依从性差组(P<0.05);依从性好组患者ESR、CRP水平均明显低于依从性差组(P<0.05)。停药6个月及1年后,依从性好组患者复发率明显低于依从性差组(P<0.05)。结论 NSAIDs治疗依从性好的患者其TNF-α抑制剂治疗效果更佳,患者指地距、枕墙距、晨僵时间、髋关节功能、腰背疼痛均明显改善,ESR、CRP水平均降低,停药后复发率明显下降。更多还原

【Abstract】 Objective To analyze the effect of interval-dose tumor necrosis factor-α(TNF-α) inhibitor in treating ankylosing spondylitis(AS) and the effect on recurrence rate. Method 84 patients with AS treated in the Second Hospital Affiliated to Qingdao University Medical College from February 2011 to January 2014 were selected as study subjects and were treated with TNF-α inhibitor after admission. After the condition of patients being medically stable, the dose was gradually reduced and the dosing interval was prolonged. Non-steroidal anti-inflammatory drugs(NSAIDs) were gradually used for treatment. In accordance with the compliance questionnaire scores patients were divided into good compliance group(n = 49) and poor compliance group(n = 35). Compared clinical treatment effect, finger-floor distance, occiput to wall distance, time of morning stiffness, visual analogue scale(VAS) of back pain, Harris hip score, erythrocyte sedimentation rate(ESR) and c-reactive protein(CRP) before and after treatment, and the relapse rate at stop taking the pill 3 months, 6 month and 1 year. Result Clinical effective rate of good compliance group was significantly higher than poor compliance of group(P < 0.05). After treatment, finger-floor distance, occiput to wall distance and time of morning stiffness were significantly shorter than that of poor compliance group(P < 0.05); VAS score in good compliance group was significantly lower than that in poor compliance group(P < 0.05), Harris score was significantly higher than that in poor compliance group(P < 0.05); ESR and CRP level of good compliance group were significantly lower than those of poor compliance group(P < 0.05); 6 months and 1 year after stopping drugs, the relapse rates of good compliance group were significantly lower than poor compliance group(P < 0.05). Conclusion The therapeutic effect of TNF-α inhibitor is better in patients with good compliance of NSAIDs. The improvement of hip joint function, low back pain, finger-floor distance, occiput to wall distance and time of morning stiffness are more obvious. The decrease in levels of ESR and CRP and the recurrence rate after drug withdrawal are reduced significantly.更多还原