肿瘤坏死因子拮抗剂治疗强直性脊柱炎伴发葡萄膜炎的临床疗效评价

Evaluation of the Therapeutic Effect of Tumor Necrosis Factor Inhibitor in the Treatment of Ankylosing Spondylitis Combined with Uveitis

目的：探讨肿瘤坏死因子拮抗剂治疗强直性脊柱炎（AS）伴发葡萄膜炎的临床效果和安全性。方法：将2011年6月~2013年6月我院收治的80例AS伴发葡萄膜炎的患者随机分为研究组和对照组。研究组患者给予肿瘤坏死因子拮抗剂皮下注射25 mg,每周2次,甲氨蝶呤10 mg口服,每周一次,同时眼科局部用药;对照组患者给予柳氮磺吡啶片0.75 g,每日3次口服,甲氨蝶呤10 mg口服,每周一次,同时局部眼科局部用药（剂量、疗程同前）,治疗12周。观察和比较两组患者治疗前后眼部情况、ESR、CRP、BASDAI、BASFI评分改善情况。结果：治疗后,两组患者各项指标较治疗前比较均显著改善（P均〈0.05）;研究组的改善程度与对照组相比无显著差异（P〉0.05）,但研究组葡萄膜炎病程较对照组显著缩短（P〈0.05）。治疗过程中,两组患者均未发生严重不良反应。结论：肿瘤坏死因子拮抗剂和甲氨蝶呤联合眼科局部治疗AS伴发葡萄膜炎疗效显著,能缩短葡萄膜炎病程,耐受性和安全性良好。

Objective：To investigate the therapeutic effect and safety of tumor necrosis factor inhibitor in the treatment of ankylosing spondylitis （AS） associated with uveitis.Methods：Eighty patients with uveitis associated with AS hospitalized from June 2011 to June 2013 were randomly divided into the observation group and control group.Forty cases in the observation group received subcutaneously injection of tumor necrosis factor inhibitor 25mg twice per week,in combination with oral methotrexate 10mg per week and ophthalmologic local application for 12 weeks.Forty cases in the control group received oral sulfasalazine 750mg three times per day,in combination with oral methotrexate and ophthalmologic local application with the same dosage and course.The ocular condition,ESR,CRP,BASDAI and BASFI index were evaluated and compared before and after treatment between two groups.Results：The assessment indexes were significantly improved in both groups after treatment （P〈0.05）.The improvement was not significant between observation group and control group （P〉0.05）,while uveitis course was significantly shorter in observation group than that in control group （P〈0.05）.During the treatment process,no severe adverse event happened in both groups.Conclusion：Tumor necrosis factor inhibitor in combination with methotrexate and ophthalmologic local application treatment had prominent effect,which could shorten the uveitis course and was well tolerable and safe.