传统抗风湿药物对强直性脊柱炎的疗效:十年临床观察

目的 观察长期应用传统抗风湿药物(cDMARDs)治疗AS患者的疗效与药物相关不良反应情况,为临床诊疗提供参考.方法 回顾性分析北京大学深圳医院风湿免疫科随诊记录10年以上的AS患者,选取其中全程仅用过cDMARDs、NSAIDs、糖皮质激素,至少连续治疗3年以上者为治疗组,未治疗或治疗不超过3个月者为对照组.收集所有患者10年前后的临床症状、炎症指标、影像学结果、药物相关不良反应等数据进行统计学分析.计数资料进行χ^2检验,符合正态分布的计量资料采用t检验,非正态分布的计量资料用Mann-Whitney U检验,治疗前后对照应用配对t检验进行统计处理.结果 共纳入符合条件患者166例,治疗组111例,对照组55例,2组患者的平均随访时间、初次就诊的主诉病程、年龄、性别比、HLA-B27阳性率、晨僵时间、夜间痛、外周关节炎、ESR、CRP、影像等基线资料对比差异无统计学意义.10年后,治疗组较对照组的晨僵时间更短[(8±18)与(22±34),U=2 228,P=0.008],夜间痛比例更低[(2/1.9%)与(19/36.5%),χ^2=37.037,P<0.01],外周关节炎发生率更低[(23/20.7%)与(25/45.5%),χ^2=10.946,P=0.001),ESR更低[(14±13)与(20±19),t=2.249,P=0.026],CRP更低[(6±6)与(10±11),t=2.154,P=0.033],骶髂关节炎进展比例更低[(28/25.2%)与(46/83.6%),χ^2=50.922,P<0.01],脊柱进展比例更低[(8/7.2%)与(51/92.7%),χ^2=117.407,P<0.01],2组比较差异有统计学意义.治疗组患者主要用药及占比情况:柳氮磺吡啶(100%),甲氨蝶呤(86.5%),NSAIDs(98.2%,其中87.3%自行按需服药),糖皮质激素(78.4%),沙利度胺(62.2%)等.治疗过程中出现过的药物相关不良反应主要有:恶心、呕吐、头晕、月经异常、可逆的肝功能异常.结论 不治疗的AS患者几乎均有骶髂关节与脊柱影像学进展.cDMARDs联合用药可有效控制大部分AS患者的临床症状、降低炎症指标、延缓骶髂关节与脊柱影像学进展,同时无严重药物相关不良反应.

Effect of traditional anti-rheumatic drugs on ankylosing spondylitis:10 years clinical observation

Objective To observe the long-term effects of conventional disease modifying anti-rheumatic drugs(cDMARDs)in the treatment of ankylosing spondylitis(AS)and drug-related adverse reactions,and provide reference to clinical treatment and assessment.Methods Retrospective analysis was performed for AS patients with more than 10 years follow-up records in the Department of Rheumatology and Immunology,Peking University Shenzhen Hospital.The AS patients enrolled were treated with cDMARDs,non-steroid anti-inflammatory Drugs(NSAIDs),and glucocorticoidsonl only.The treatment group was treated continuously for at least 3 years,and the control group was untreated or treated for less than 3 months.Clinical symptoms,inflammatory indicators,imaging results and drug-related adverse reactions of all patients were collected for statistical analysis.The counting data were tested by χ2 test,the measurement data in normal distribution was tested by t test,and the measurement data that not normally distributed was tested by mann-whitney U test.Paired test was used for statistical processing before and after treatment.Results A total of 166 eligible patients were included,including 111 in the treatment group and 55 in the control group.There were no statistical significant differences between the treatment group and the control group at baseline including the mean follow-up time,symptomatic disease course,age,sex ratio,human lymphocyte antigen(HLA)-B27 positive rate,duration of morning stiffness,pain at night,peripheral arthritis,ESR,CRP and imaging data.After 10 years,the treat-ment group had shorter morning stiffness[(8±18)vs(22±34),U=2228,P=0.008],less nocturnal pain[(2/1.9%)vs(19/36.5%),χ2=37.037,P<0.01],lower ESR level[(14±13)vs(20±19),t=2.249,P=0.026],lower CRP level[(6±6)vs(10±11),t=2.154,P=0.033],lower incidence of peripheral arthritis[(23/20.7%)vs(25/45.5%),χ2=10.946,P=0.001]and lower sacroiliac arthritis progression rate[(28/25.2%)vs(46/83.6%),χ2=50.922,P<0.01],and lower spinal progression rate[(8/7.2%)vs(51/92.7%),χ2=117.407,P<0.01]compared with the control group.The differences between the two groups was statistically significant.The main medications and drug proportions in the treatment group were as follows:sulfasalazine(100%),methotrexate(86.5%),NSAIDs(98.2%),glucocorticoid(78.4%)and thalidomide(62.2%).The main drug-related adverse reactions that occurred during the treatment included dizziness,abnormal menstruation,and reversible liver dysfunction.Conclusion The combination of cDMARDs can effectively control the clinical symptoms of most AS patients,reduce inflammation indicators,delay the progression of sacroiliac joint and spinal damage,and have no serious drug-related adverse reactions.Almost all of the untreated AS patients have radiographic progression of the sacroiliac joint and spine.