【摘要】 目的：探讨强直性脊柱炎（AS）患者应用阿达木单抗（Ada）治疗对血清吲哚丙酸（IPA）及相关炎症因子的影响。方法：选取菏泽医专附属医院2022年6月—2024年6月期间收治的50例活动性AS患者为研究对象，采用1∶2比例数字化随机系统将患者分为常规药物组18例和Ada组（常规药物+Ada）32例。比较两组治疗前后疾病活动度（BASDAI）、急性时相反应物（ESR,CRP）及血清相关炎症因子的水平，探讨IPA与疾病活动度及相关炎症因子之间的相关性。结果：两组治疗后BASDAI、ESR和CRP水平均低于治疗前（P<0.05），且Ada组低于常规药物组（P<0.05）。此外，两组治疗后IPA和CYP1A1水平均高于治疗前（P<0.05），且Ada组高于常规药物组（P<0.05）；而两组用药后MIF、IL-6和TNF-α的水平均低于治疗前（P<0.05），且Ada组低于常规药物组（P<0.05）。相关性分析表明，IPA与CYP1A呈正相关（r=0.486,P<0.05）;IPA与BASDAI、MIF、IL-6、TNF-α呈负相关（r=-0.421、-0.373、-0.416、-0.383,P<0.05）。结论：Ada联合常规治疗上调了AS患者肠道代谢产物IPA的表达，可能是IPA通过激活AhR/CYP1A1/MIF通路，减少下游促炎症因子释放，延缓AS的炎症进展，这为临床合理选择和应用TNF-α抑制剂治疗AS提供了实验依据。更多还原

【Abstract】 Objective: To investigate the effect of adalimumab(Ada) on serum indole propionic acid(IPA) and related inflammatory factors in patients with ankylosing spondylitis(AS). Methods: A total of 50 patients with active AS admitted to the Affiliated Hospital of Heze Medical College from June 2022 to June 2024 were selected as the study subjects.Patients were randomly assigned to a conventional medication group(n=18) and an Ada group(conventional medication +Ada, n=32) in a 1:2 ratio using a digital randomization system. The levels of disease activity index(BASDAI), acute phase reacter(ESR, CRP) and serum related inflammatory factors were compared between the two groups before and after treatment, and the correlation between IPA and disease activity and related inflammatory factors was explored. Results: The levels of BASDAI, ESR and CRP after treatment were lower than those before treatment in the two groups(P<0.05), and those in the Ada group were significantly lower than those in the conventional drug group(P<0.05). In addition, the levels of IPA and CYP1A1 after treatment were higher than those before treatment in the two groups(P<0.05), and those in the Ada group were higher than those in the conventional drug group(P<0.05). The levels of MIF, IL-6 and TNF-α in the two groups after treatment were lower than those before treatment(P<0.05), and those in the Ada group were lower than those in the conventional drug group(P<0.05). Correlation analysis showed that IPA was positively correlated with CYP1A(r=0.486, P<0.05), IPA was negatively correlated with BASDAI, MIF, IL-6 and TNF-α(r=-0.421,-0.373,-0.416,-0.383, P<0.05). Conclusion: Ada combined with conventional treatment up-regulates the expression of intestinal metabolite IPA in AS patients, which may be related to the activation of the AhR/CYP1A1/MIF pathway to reduce the release of downstream pro-inflammatory factors and delay the progression of inflammation in AS. This study provides an experimental basis for the rational selection and application of TNF-α inhibitors in the treatment of AS.更多还原