依那西普治疗中轴脊柱关节炎停药后复发因素的分析

Analysis of recurrence factors of axial-spondyloarthritis after withdrawal of etanercept

目的分析依那西普(ETN)短期联合非甾类抗炎药(NSAIDs)治疗中轴脊柱关节炎(ax-SpA)停药后的复发率及复发危险因素。方法选取125例NSAIDs治疗效果不佳的ax-SpA患者,给予ETN(50mg/周)12周的持续治疗,同时维持应用原有剂量NSAIDs。记录患者的年龄、性别、病程、骶髂关节炎X线分级、脊柱骨赘形成等基线资料;分析患者第0~48周的病情缓解和复发情况以及Bath强直性脊柱炎病情活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、C-反应蛋白(CRP)、红细胞沉降率(ESR)的变化情况,记录不良事件。采用二元logistic回归模型及Cox生存函数模型分析ax-SpA患者ETN停药后复发的危险因素。结果 ETN治疗前28例(22.4%)患者已有骨赘形成,骶髂关节炎X线分级3级者最为多见(58例,46.4%)。经12周ETN治疗后120例(96.0%)患者达到临床缓解,BASDAI、BASFI、CRP及ESR均下降(P<0.05)。48周内29例(23.2%)患者复发,临床缓解维持时间平均为(36.8±12.3)周。二元logistic回归模型分析示骨赘形成是ax-SpA患者停用ETN后复发的危险因素(OR=70,P<0.001)。Cox生存分析结果示骶髂关节炎X线分级越高,维持缓解期越短,且骨赘形成可能是影响维持缓解的重要因素(OR=8.77,P=0.006)。结论对NSAIDs治疗效果不佳的ax-SpA患者,短期足量ETN联合NSAIDs治疗有效。骶髂关节破坏的严重程度及脊柱椎体骨赘形成是引起复发的危险因素。

ObjectiveTo investigate the recurrence rate of patients with axial spondyloarthritis(ax SpA)treated with etanercept(ETN)combined with non steroidal anti inflammatory drugs(NSAIDs)and to explore its related risk factors.MethodsA total of125patients with ax SpA,who responded poorly to NSAIDs,were treated additionally with ETN(50mg per week)for12weeks and simultaneously received original dosage of NSAIDs.We recorded the baseline data,including age,gender,disease duration and grading of sacroiliac joint X ray,formation of syndesmophyte;and we analyzed the changes of the remission and recurrence conditions,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis functional index(BASFI),C reactive protein(CRP)level,erythrocyte sedimentation rate(ESR)and adverse events in the follow up from week0to week48.Risk factors of relapse after ETN withdrawl in patients with ax SpA were analyzed using binary logistic regression model and Cox regression model.ResultsBefore treatment,28(22.4%)patients showed syndesmophyte formation and58(46.4%)had graded3X ray sacroiliac joint classification.After continuous treatment with ETN for12weeks,120(96.0%)patients achieved clinical remission,with BASDAI,BASFI,ESR and CRP decreasing significantly(P<0.05).Within48weeks of follow up,29(23.2%)patients had relapse,and the maintenance of remission lasted for(36.8±12.3)weeks.Binary logistic regression model analysis showed that syndesmophyte formation was a risk factor of relapse(OR=70,P<0.001).Cox regression model analysis showed that the higher the grade of sacroiliac joints X ray classification,the shorter the maintenance remission duration,and syndesmophyte formation might be a significant factor of relapse(OR=8.77,P=0.006).ConclusionShort term and full dose ETN combined with NSAIDs is effective for ax SpA patients who responded poorly to NSAIDs.The damage of sacroiliac joints and formation of syndesmophyte are predictors of recurrence.