沙利度胺治疗强直性脊柱炎的临床疗效及其对炎症因子表达水平的影响

Clinical efficacy of thalidomide in the treatment of ankylosing spondylitis and its effect on inflammatory factor expression

目的观察沙利度胺治疗强直性脊柱炎（AS）的临床疗效及其对炎症因子表达水平的影响。方法将80例活动期AS患者按随机数字表法分为观察组和对照组,对照组给予常规药物治疗,观察组在此基础上给予沙利度胺,起始剂量100mg/d,1周后150~200mg/d,疗程半年。观察2组患者治疗前后活动性指数、功能性指数、疼痛水平、晨僵时间、指地距、Schober实验、扩胸度、枕壁距、15m步行时间、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-23水平。结果观察组患者治疗后活动性指数、功能性指数、疼痛水平（全身痛、脊柱痛）、晨僵时间均显著低于对照组,差异有统计学意义（t=7.751,t=5.171,t=4.939,t=3.508,t=2.368,P〈0.01）。观察组患者Schober实验、扩胸度均显著高于对照组,差异有统计学意义（t=3.348,t=2.219,P〈0.01）,指地距、枕壁距、15m步行时间显著低于对照组,差异有统计学意义（t=2.816,t=4.824,t=3.864,P〈0.01）。观察组患者治疗后TNF-α、IL-6、IL-23水平显著低于对照组,差异有统计学意义（t=7.951,t=5.253,t=4.044,P〈0.01）。结论沙利度胺通过改善患者炎症因子水平而减轻AS临床症状,具有良好疗效。

Objective To observe the clinical efficacy of thalidomide in the treatment of ankylosing spondylitis（AS）and its effect on the expression of inflammatory factor level.Methods Eighty patients with active ankylosing spondylitis were randomly divided into observation group and control group,40 patients in each group.The control group was given routine drug treatment,and observation group were given thalidomide on the basis of basic treatment（initial dose of 100mg/d,a week after 150-200mg/d,treatment course for a half year）.The BASDAI,BASFI,pain level,time of morning stiffness,finger to floor distance,Schober test,chest expansion,the pillow wall distance,15 m walking time,TNF-α,IL-6and IL-23 level were compared between two groups.Results After treatment,the BASDAI,BASFI,pain level,time of morning stiffness in patients of observation group were significantly lower than those of the control group（t=7.751,t=5.171,t=4.939,t=3.508,t=2.368,P0.01）.The Schober test,the chest wall distance and 15 mwalking time in observation group were significantly lower than those in the control group（P0.01）.The levels of IL-6,IL-23 and TNF-αin the observation group were significantly lower than those in the control group（t=7.951,t=5.253,t=4.044,P0.01）.ConclusionThalidomide can relieve the clinical symptoms of AS by reducing the level of inflammatory factors of patients.It has good curative effect.