英夫利西单抗治疗强直性脊柱炎患者的效果及其血清CRP、B淋巴细胞亚群水平的变化

Effect of infliximab in the treatment of ankylosing spondylitis and its effect on the levels of CRP,B lymphocytes

目的观察英夫利西单抗治疗强直性脊柱炎患者的临床效果及对血清C反应蛋白(CRP)、B淋巴细胞亚群水平的影响。方法将2016年2月—2017年1月邵阳市中心医院风湿免疫科收治的强直性脊柱炎患者96例作为研究对象,按照随机数字表法分为观察组和对照组各48例。对照组给予来氟米特片20 mg/次口服,1次/d;柳氮磺胺吡啶肠溶片1 g/次口服,2次/d;甲氨蝶呤片10 mg/次口服,1次/周;观察组在对照组治疗基础上给予英夫利西单抗3.0 mg/kg静脉滴注,分别于第1、2、5周应用,以后每隔8周用药1次,共用药6次。2组患者疗程均为30周观察2组患者临床症状改善情况,治疗前后CRP、红细胞沉降率(ESR)、外周血B淋巴细胞亚群、骨硬化蛋白(SOST)、骨形态发生蛋白-2(BMP-2)水平变化情况,并记录2组患者不良反应发生情况。结果治疗后观察组总有效率为91.7%高于对照组的75.0%(χ~2=4.800,P=0.028);观察组晨僵持续时间、疼痛程度评分低于对照组(t=9.066、9.769,P=0.000、0.000),CRP、ESR、CD19^+CD24^(int)CD38^(in)、BMP-2水平低于对照组,CD19^+CD24^(hi)CD38^-、SOST高于对照组(t=14.278、15.773、12.745、2.154、4.493、2.147,P<0.05,P<0.01);2组间发生胃肠道反应、转氨酶升高、皮肤红肿瘙痒、上呼吸道感染不良反应发生率比较,差异无统计学意义(χ~2=1.098.0.723、1.435、2.192,P=0.295、0.395、0.231、0.139)。结论英夫利西单抗治疗强直性脊柱炎疗效显著,可减轻炎性反应,改善外周血B细胞水平,抑制骨增生,安全可靠,值得临床推广应用。

Objective To observe the effect of infliximab in the treatment of ankylosing spondylitis and its effect on CRP,B lymphocytes.Methods Ninety-six cases of patients with ankylosing spondylitis were selected,which were treated in department of rheumatology of Shaoyang Central Hospital from February 2016 to February 2017,and they were divided into the observation group （48 cases） and control group （48 cases）.The patients of control group were treated with leflunomide tablets （20 mg / time,1 time / d）,sulfasalazine pyridin enteric coated tablets （1g / time,2 time / d）,methotrexate tablets （10 mg / time,1 time / week）.On the basis of control group,the patients of observation group were treated with infliximab （3.0 mg / kg for intravenous drip in the 1st,2nd,5th week,then medication 1 time every 8 weeks,all for 6 times）.The patients of two groups were all treated for 30 weeks in a row.Compare the clinical symptoms improved,the incidence of adverse reactions and changes of the levels of CRP,ESR,peripheral blood B cell subsets,SOST,BMP-2 of two groups.Results The total efficiency rate of the observation group were significantly higher than those of the control group （91.7% vs.75.0%,χ^2=4.800,P=0.028）;After the appropriate treatment for 30 weeks,the morning stiffness duration,pain scores of the observation group were significantly lower than those of the control group （t=9.066,t=9.769;P=0.000,P=0.000）,The CRP,ESR,CD19^＋CD24^int CD38^in,BMP 2 levels of the observation group were significantly lower than those of the control group,and the CD19^＋CD24^hi CD38^-,SOST levels of the observation group were significantly higher than those of the control group （t=14.278,t=15.773,t=12.745,t=2.154,t=4.493,t=2.147;P〈0.05,P〈0.01）;There were gastroin-testinal reactions,elevated transaminases,erythrocytosis,upper respiratory tract infections and other adverse reactions occurred in both two groups,but there were no statistically significant between the two groups （χ^2=1.098,χ^2=0.723,χ^2=1.435,χ^2=2.192;P=0.295,P=0.395,P=0.231,P=0.139）.Conclusion With treating patients with ankylosing spondylitis,infliximab can achieve significant efficacy,reduce inflammation,improve peripheral blood B lymphocytes levels,inhibit bone hyperplasia,and it is also safe and reliable,which makes it worthy of clinical application.