抗TNF-α生物制剂对强直性脊柱炎患者不同证型的影响

The Influence of anti TNF-alpha Biologics on Patients with Ankylosing Spondylitis of Various Types

目的:探讨抗TNF-α生物制剂对强直性脊柱炎患者不同中医证型的影响。方法:120例强直性脊柱炎患者均给予抗TNF-α生物制剂(注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白)治疗,观察120例患者治疗前后上呼吸道感染率,比较120例患者治疗前后肺气虚证、脾气虚证各症状积分变化情况,分析上呼吸道感染发生率与中医肺气虚、脾气虚关系。结果:与治疗前比较,治疗后4周、8周、12周上呼吸道感染发生率分别是5.00%、8.83%、13.33%,差异均有统计学意义(P<0.05)。肺气虚证:治疗后喘促气喘、易感冒、自汗、恶风、神疲、乏力、少气懒言等症状积分高于治疗前,差异均有统计学意义(P<0.05)。脾气虚:治疗后食少纳呆、体倦乏力、神疲懒言及口淡不渴等症状积分高于治疗前,差异均有统计学意义(P<0.05)。Logistic回归分析显示,治疗后随着上呼吸道感染发生频次的增多,强直性脊柱炎患者肺气虚证、脾气虚证表现明显。结论:抗TNF-α生物制剂治疗强直性脊柱炎,可增加患者上呼吸道感染频率。强直性脊柱炎的中医证型主要为肺气虚证、脾气虚证,且两证型总积分与上呼吸道感染率呈相关性。

Objective： To explore the influence of anti TNF- alpha biologics on patients with ankylosing spondylitis of various types. Methods： One hundred and twenty patients with ankylosing spondylitis were given anti TNF- alpha biologics （injection of recombinant human tumor necrosis factor receptor antibody fusion protein） treatment. Their upper respiratory tract infection rates before and after the treatment were observed. The changes of varions symptom scores such as lung qi deficiency syndrome and spleen qi deficiency syndrome before and after the treatment were compared. The relationship between upper respiratory tract in- fection rate and TCM lung qi deficiency and spleen deficiency were analyzed. Results： Compared with before the treatment, the incidence of upper respiratory tract infection at 4th, 8th and 12th week after treatment was 5%, 8.83%, 13.33%, respectively, and the differences were statistically significant （P 〈 0. 05 ）. In terms of lung qi deficiency syndrome, ,after the treatment, asthma, cold, spontaneous sweating, aversion to wind, fatigue, reluctance to speak and other symptoms scores were higher than those before the treatment, and ＇all the differences were statistically significant （ P 〈0. 05 ）. In terms of spleen qi deficiency syndrome, after the treatment, anorexia, fatigue, reluctance to speak and no desire for thirst and other symptoms scores were higher than those before the treatment, and all the differences were statistically significant （ P 〈 0. 05 ）. Logistic regression analysis showed that after the treatment, with increasing frequency of upper respiratory tract infection in patients with ankylosing spondylitis, tung qi deficiency, and spleen qi deficiency were obvious. Conclusion ： In terms of treating ankylosing spondylitis, anti TNF- alpha biological agent can increase the frequency of upper respiratory, tract infection. TCM syndrome types of ankylosing spondylitis mainly include lung qi deficiency, spleen qi deficiency syndrome; and the total score of the two syndromes are positively correlated to upper respiratory tract infection rate.