依那西普联合甲氨蝶呤治疗强直性脊柱炎的近期放射学进展与生活质量相关分析

Radiological progression and life quality analysis in ankylosing spondylitis patients using etanercept/methotrexate combination therapy

目的 探讨依那西普联合甲氨蝶呤治疗强直性脊柱炎患者的影像学进展和生活质量的相关性.方法 2006年11月至2009年1月中山大学附属第一医院,153例符合1984年修订的强直性脊柱炎纽约标准的强直性脊柱炎患者接受依那西普联合甲氨蝶呤治疗,随访1年,分别在基线状态、治疗后3、6和12个月时以mSASSS评价影像学进展,应用SF-36量表来评价生活质量,并记录其临床缓解,分析三者之间相互关联.结果 所有患者影像学进展不明显.大部分患者生活质量治疗后改善明显.BASDAI指数、CRP和ESR等指标均有相同倾向.生活质量和mSASSS评分之间无相关性,但与临床症状缓解显著相关.结论 依那西普联合甲氨蝶呤可显著提高强直性脊柱炎患者的生活质量,但临床症状缓解和疼痛控制并不能提示影像学进展的好转.即使生活质量指数已达较高水平,仍需影像学随访.

Objective To analyze the relationship between the radiological progression and quality of life in ankylosing spondylitis （AS） patients using etanercept/methotrexate （MTX） combination therapy. Methods A total of 153 AS cases fulfilling the 1984 modified New York diagnostic criteria were reviewed. All patients received radiological evolution at baseline and during a follow-up period. Radiological progression, clinical remission and life quality were recorded and analyzed for their relations. Results The radiological assessments of mSASSS （modified Stoke ankylosing spondylitis spine score） were recorded at baseline, 3, 6 ＆ 12 months after treatment. Life quality assessments were recorded with SF （short-form） -36simultaneously. No significant radiological improvement was observed at the end points. However, most patients reported a significant improvement of life quality after a combination therapy of etanercept/MTX. BASDAI （Bath ankylosing spondylitis disease activity index）, C-reactive protein and erythrocyte sedimentation rate demonstrated similar trends. With no relevance with mSASSS, life quality was significantly correlated with disease activity and pain control. Conclusion The combination therapy of etanercept/MTX greatly improves lfie quality in AS patients. Yet clinical remission and pain control offer no hint of a suspension of radiological progression. Routine radiological assessment is required throughout the follow-up period of AS even if life quality index reaches a high level.