沙利度胺联合柳氮磺吡啶能维持脊柱关节病的临床缓解

Clinical Remission of Spondyloarthropathy Maintained by Sulfasalazine Combined with Thalidomide

目的观察沙利度胺联合柳氮磺吡啶治疗脊柱关节病(Sp A)的疗效,从中探索其是否能使患者达到并维持临床缓解。方法 2011年1月-2013年6月采用前瞻性、非干预、不定期随访的方式,对门诊规则服用沙利度胺联合柳氮磺吡啶同时配合相应的非甾体类抗炎药>24周的70例Sp A患者,进行Bath强直性脊柱炎疾病活动性指数、视觉模拟评分法评分、外周关节炎表现、红细胞沉降率、C反应蛋白的观察评价,并对影响该方案疗效的相关因素进行多因素分析。结果该组合方案治疗24周后,Sp A患者的总临床缓解率为72.9%,其中40例短病程Sp A患者临床缓解率为90.0%,30例非短病程Sp A患者临床缓解率为50.0%。两类患者观察指标治疗前后比较差异有统计学意义(P<0.05)。非短病程Sp A女性患者疗效明显优于男性,短病程Sp A男女患者疗效差异不明显。青年Sp A患者与非青年Sp A患者的临床缓解率相当。二分类logistic回归分析提示是否短病程[OR=3.408,95%CI(1.637,7.437),P=0.001]、是否城镇居民[OR=4.163,95%CI(2.011,8.761),P=0.001]与是否达到临床缓解有关。短病程和城镇居民更容易治疗后达到临床缓解。结论使用沙利度胺联合柳氮磺吡啶的方案能使Sp A患者达到临床缓解,男女均能得到较好的疗效,并能持续维持。该方案的临床缓解率还受病程长短、居住地等因素影响,但年龄、性别因素不会影响该方案疗效。短病程、城镇居民是治疗后达到临床缓解的独立因素。

Objective To investigate the efficacy of sulfasalazine combined with thalidomide in the treatment of spondyloarthropathy （SPA）, and to probe whether the treatment can reach and maintain clinical remission for the patients. Methods Between January 2011 and June 2013, we used a prospective, non-intervention and regular follow- up study to observe and assess 70 SpA patients on their Bath ankylosing spondylitis disease activity index, visual analogue scale score, peripheral arthritis, blood sedimentation, and C-reactive protein. All the patients had taken sulfasalazine, thalidomide and non-steroidal anti-inflammatory drugs for 24 weeks. Multivariate analysis of factors affecting the efficacy of the program was our object of this study. Results After 24 weeks, the total clinical remission rate of these patients was 72.9%. Clinical remission rate of 40 patients with short duration of SpA was 90.0%, while it was 50.0% for the other 30 patients with a non-short duration of SpA. Observation indexes before and after treatment in both groups of patients had significant differences （P 〈 0.05）. For patients with non-short duration SpA, the curative effect for female was obviously better than male, but the difference between male and female patients with short-duration SpA was not so obvious.Clinical remission rate for youth was similar with that for non-youth patients. Binary logistic regression analysis showed that whether the disease had a short duration [OR=3.408, 95%CI （1.637, 7.437）, P=0.001] and whether the patients were urban residents [OR=4.163, 95%CI （2.011, 8.761）, P=0.001] were statistically significant （P 〈0.05）. Conclusions Clinical remission of spondyloarthropathy can be maintain by sulfasalazine combined with thalidomide. Clinical remission rate of the scheme is affected by duration of disease and residency except age and gender of the patients. Short duration and urban residency are independent factors for reaching clinical remission after treatment.