依那西普改善强直性脊柱炎相关性髋关节病变关节功能的临床研究

目的探讨应用依那西普（肿瘤坏死因子拮抗剂）治疗强直性脊柱炎相关髋关节病变的临床疗效及急性炎症期已经得到控制的患者依那西普如何减量维持。方法采用前瞻性开放性临床研究。选取11例伴有髋关节受累的强直性脊柱炎患者,给予依那西普50 u,皮下注射,1次/周,疗程12周,之后改为半量注射（25 u）,1次/周,继续维持疗程12周。评价指标为Harris髋关节评分、BASDAI评分、BASFI评分、血清学检查指标：ESR、CRP以及MRI检查。观察依那西普维持、减量后患者髋关节状况,随时记录观察期间不良事件。结果 11例患者均完成了24周的治疗期并得到完整随访。在治疗期4周后,患者BASDAI评分、BASFI评分明显下降,髋关节活动评分升高,CPR、ESR均降低,与各自基线水平比较差异有统计学意义（P〈0.05）,8、12周时这种情况继续改善,12~24周减量维持能持续保持效果。患者在治疗前、治疗12周、24周各复查髋关节MRI,提示髋关节滑膜炎性病变得到明显改善。所有治疗患者在治疗窗口内均未出现不良反应。结论依那西普可以迅速降低强直性脊柱炎活动度,减轻髋关节炎性反应,改善髋关节的功能,对难治性髋关节病变疗效确切。

Clinical therapeutic effects of etanercept on ankylosing spondylitis-related hip joint diseases

Objective To observe the effects of etanercept （tumor necrosis factor antagonist） on the joint function improvement in treating ankylosing spondylitis hip joint lesion. Methods A prospective and open study was designed. 11 patients with ankylosing spondylitis hip joint diseases were included into the study. Each patient receeived etanercept 50 U, subcutaneous injection, one time per week, for 12 weeks, then changed to 25U injection, one time per week for 12 weeks. The evaluation indices included the Harris hip score, BASDAI score, BASFI score, and the serum indices： ESR CRP and MRI examination. The etanercept maintenace, the hip joint status after the dosage reduction, and adverse events were observed and recorded. Results 11 patients completed the 24-week treatment and the follow-up. In the 4th week, the BASDAI score and BASFI score decreased significantly, while the Harris hip score increased; the CPR, ESR decreased. Compared with the baseline levels respectively, the differences were statistically significant （P 〈0. 05）. In the 8th and 12th weeks, the situation continued to improve. In the 12th week -24th week, after the dosage reduction, the effects still sustained. The MRI results showed that the hip synovitis lesions were obviously improved in the 12th week and 24th week comparing with those before the treatment. No severe adverse reaction was found during the treatment. Conclusion Etanereept can rapidly reduce the inflammation of ankylosing spondylitis in the hip joint, and improve the function of the hip joint.