中轴型脊柱关节炎患者临床达标和影像学缓解的现状调查及影响因素分析

Current situation investigation of clinical and imaging remission in patients with axial spondyloarthritis and analysis of relevant impacted factors

目的调查中轴型脊柱关节炎(axSpA)患者临床达标和影像学缓解的现状并分析其影响因素。方法根据既往治疗方案、基于C反应蛋白(CRP)计算的强直性脊柱炎疾病活动度评分(ASDAScrp)及加拿大脊柱关节炎研究协会(SPARCC)评分,分别对233例axSpA患者进行分组并比较其临床资料。采用多因素logistic回归分析评估axSpA患者临床达标和影像学缓解的影响因素。结果axSpA患者临床达标率为25.3%,临床达标组影像学未缓解率(32.2%)低于临床未达标组(56.3%,P<0.05)。临床达标组CRP低于临床未达标组,接受抗肿瘤坏死因子(TNF)-α治疗患者比例高于临床未达标组(P<0.05)。影像学缓解组ASDAScrp低于影像学未缓解组,接受抗TNF-α治疗患者比例高于影像学未缓解组(P<0.05)。未正规治疗组患者临床达标率和影像学缓解率均低于抗TNF-α治疗组(P<0.05)。多因素logistic回归分析结果显示,CRP升高是axSpA患者临床未达标的危险因素(P<0.001);ASDAScrp升高是axSpA患者影像学未缓解的危险因素(P<0.05);抗TNF-α治疗既是axSpA患者临床达标也是其影像学缓解的保护因素(P<0.05)。结论axSpA患者的治疗达标率仍偏低。CRP和ASDAScrp升高分别为axSpA临床未达标和影像未学缓解的危险因素,而抗TNF-α治疗可促进其临床达标和影像学缓解。

Objective To investigate the current situation of clinical and imaging remission in patients with axial spondyloarthritis(axSpA) and analyze relevant impacted factors.Methods According to past treatment programs,ankylosing spondylitis disease activity scores based on C-reactive protein(CRP)(ASDAScrp)and Spondyloarthritis Research Consortium of Canada(SPARCC) scores,233 patients-with axSpA were divided into different groups respectively.Clinical data of each group were compared.Risk factors for clinical and imaging remission were analyzed by multivariate logistic regression analysis.Results Rate of clinical remission was 25.3% in patients with axSpA.Rate of imaging non-remission in clinical standard group(32.2%) was lower than that in clinical non-standard group(56.3%,P<0.05).CRP in clinical standard group was lower than that in clinical non-standard group,and ratio of patients receiving anti-tumor necrosis factor(TNF)-α treatment was higher than that in clinical non-standard group(P<0.05).ASDAScrp in imaging remission group was lower than that in imaging non-remission group,and ratio of patients receiving anti-TNF-α treatment was higher than that in imaging non-remission group(P<0.05).Rate of clinical standard and imaging remission in non-standard treatment group were lower than those in anti-TNF-α treatment group(P<0.05).Results of multivariate logistic regression analysis showed that CRP rise was risk factor for clinical non-remission in axSpA(P<0.001),while ASDAScrp rise was risk factor for imaging non-remission(P<0.05).Anti-TNF-α treatment was protective factor for both clinical and imaging remission(P<0.05).Conclusion Rate of clinical remission in axSpA is still low.CRP and ASDAScrp rise are risk factors for clinical and imaging non-remission in axSpA respectively,while anti-TNF-α treatment can promote clinical and imaging remission.