糖皮质激素在强直性脊柱炎治疗中的临床观察

Clinical observation of glucocorticoid treatment in ankylosing spondylitis

目的观察糖皮质激素(GCs)对强直性脊柱炎(AS)的疗效及不良反应,以了解GCs在强直性脊柱炎治疗中的利弊。方法回顾分析我院风湿免疫科2005年11月至2014年2月门诊规律随访≥3年的患者中明确诊断为AS患者的临床表现、炎症指标、影像学表现、治疗情况及转归。结果 2005年11月至2014年2月门诊患者确诊AS患者并且随访时间≥1年的患者共有523例。确诊后用非甾体抗炎药(NSAIDs)及传统改善病情抗风湿药(DMARDs)的有79例;用过GCs的441例,分析连续规律治疗及随访的患者,其中连续随访≥3年的102例,最长随访时间8年零3个月。用过GCs的86例(剂量5～30 mg,包括治疗开始及治疗中间效果不理想加用的),未用过GCs的16例,对照2组的症状缓解情况、红细胞沉降率(ESR)、C反应蛋白(CRP)、骶髂关节及脊柱影像学情况,用GCs组症状缓解迅速、明显,ESR及CRP下降理想,2组比较差异有统计学意义(P<0.05);GCs累计用药时间6～24个月,无一例出现严重不良反应,GCs组与非GCs组2组不良反应差异无统计学意义。结论在AS患者的治疗中,短期加用GCs,可以迅速缓解疼痛,控制炎症,改善生活质量,不良反应不明显,性价比高。

Objective To observe the curative effect and side effect of glucocorticoid on ankylosing spondylitis and understand the value of GCs in the treatment of ankylosing spondylitis. Methods The clinical manifestations, inflammatory indicators, imaging manifestations, treatment conditions and outcomes of patients diagnosed AS were analyzed retrospectively in patients who were followed up regularly for 3 years or more between November 2005 and February 2014 in the rheumatology department of our hospital. Results From November 2005 to February 2014, 523 patients were diagnosed of AS patients in outpatient department and followed up for more than 1 year. There were 79 cases of NSAIDS and DMARDs after diagnosis, among which 102 patients were followed up for more than 3 years, with the longest follow-up time of 8 years and 3 months. Eighty-six cases were treated with GCs which was not used in 16 cases of GCs, comparison of two groups of symptoms, blood sedimentation, C-reactive protein (CRP), sacroiliac joint and spine imaging, with GCs group of symptoms quickly, obviously, blood sedimentation and the decline in CRP ideal, was not a group of comparison with GCs, differences between the two groups was statistically significant (P<0.05);The cumulative treatment time of GCs was 6 months to 24 months, with no serious side effects, and no statistically significant difference in side effects between the GCs group and the non-GCs group. Conclusion In the treatment of patients with ankylosing spondylitis, short-term use of glucocorticoid can rapidly relieve pain, control inflammation, improve quality of life, with less side effects and high cost performance.