沙利度胺片联合依托考昔片治疗中轴型强直性脊柱炎的效果及作用机制

Effect and mechanism of thalidomide tablets combined with etocoxib tablets in the treatment of axis type ankylosing spondylitis

目的探究沙利度胺片联合依托考昔片治疗中轴型强直性脊柱炎(AS)患者的临床效果。方法选取我院收治的中轴型AS患者128例,按随机抽签法将其分为观察组和对照组,每组64例。其中有8例因胃肠道反应、嗜睡、效果不佳等各种原因退出试验,8例失访或资料不全,最终112例,观察组58例,对照组54例。对照组口服依托考昔片,观察组在对照组的基础上加用沙利度胺片。比较两组的治疗效果。结果治疗后6、12周,观察组ESR及CRP水平均低于对照组及治疗前,差异具有统计学意义(P<0.05)。治疗后2周,观察组的CRP水平低于对照组及治疗前,差异具有统计学意义(P<0.05)。治疗后12周,对照组ESR水平低于治疗前,差异具有统计学意义(P<0.05)。治疗后6、12周,两组患者BASDAI、BASFI及VAS评分均显著改善,且观察组均优于对照组(P<0.05)。观察组的治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。两组患者胃肠道反应、肝功能异常、合并感染的发生率比较,差异无统计学意义(P>0.05)。观察组患者嗜睡的发生率为15.5%,显著高于对照组的3.7%,差异有统计学意义(P<0.05)。结论沙利度胺片联合依托考昔片治疗中轴型AS,其长期疗效明显优于依托考昔片单药治疗。沙利度胺片主要通过抑制TNF-α改善中轴型AS患者的病情,其不良反应较小,安全有效,治疗费用低廉,值得临床推广。

Objective To explore the clinical effect of thalidomide tablets combined with etocoxib tablets in the treatment of axis type ankylosing spondylitis(AS).Methods A total of 128 patients with axis type AS admitted in our hospital were selected and divided into observation group and control group according to random drawing method,with 64 cases in each group.Among them,there were 8 patients quit the experiment because of gastrointestinal reactions,sleepiness,poor therapeutic effects and other reasons,and 8 patients lost interviews or had incomplete data.The final number was 112 cases,with 58 cases in the observation group and 54 cases in the control group.The control group was given etocoxib tablets orally,while the observation group was given thalidomide tablets on the basis of the control group.The therapeutic effects of the two groups were compared.Results At 6 and 12 weeks after treatment,the levels of ESR and CRP in the observation group were lower than those in the control group and before treatment,and the differences were statistically significant(P<0.05).Two weeks after treatment,the CRP level in the observation group was lower than that in the control group and before treatment,and the differences were statistically significant(P<0.05).At 12 weeks after treatment,the ESR level in the control group was lower than that before treatment,and the difference was statistically significant(P<0.05).At 6 and 12 weeks after treatment,the scores of BASDAI,BASFI and VAS of the two groups improved significantly,and those in the observation group were better than the control group,and the differences were statistically significant(P<0.05).The total effective rate of treatment in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the incidences of gastrointestinal reaction,abnormal liver function and combined infection between the two groups(P>0.05).The incidence of sleepiness in the observation group was 15.5%,which was significantly higher than 3.7%in the control group,and the difference was statistically significant(P<0.05).Conclusion Thalidomide tablets combined with etoricoxib tablets in the treatment of axis type AS can get better long-term efficacy compared with etocoxib tablets alone.Thalidomide tablets mainly improve the condition of patients with axis type AS by inhibiting TNF-α,and it has fewer adverse reactions,high safety and efficacy,with lower treatment cost.It is worthy of clinical promotion.