阿达木单抗在强直性脊柱炎治疗中的临床效果

Clinical Effect of Adalimumab in the Treatment of Ankylosing Spondylitis

目的探讨阿达木单抗在强直性脊柱炎(AS)治疗中的临床效果。方法选取2019年5月至2020年5月郑州人民医院收治的84例AS患者作为研究对象,按随机数表法分为对照组和观察组,各42例。对照组接受来氟米特、柳氮磺胺吡啶联合甲氨蝶呤治疗,观察组在对照组基础上接受阿达木单抗治疗。比较两组Bath AS疾病活动性指数(BASDAI)、Barthel指数(BI)评分、C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞介素-23(IL-23)、B细胞亚群水平及骨质情况。结果两组患者治疗后BASDAI均低于治疗前,BI评分均高于治疗前(P<0.05),且观察组患者治疗后BASDAI低于对照组,BI评分高于对照组(P<0.05)。两组患者治疗后CRP、ESR、IL-23水平均低于治疗前,且观察组患者治疗后CRP、ESR、IL-23水平低于对照组(P<0.05)。两组患者治疗后CD19^(+)CD24^(int) CD38^(int)成熟B细胞水平均低于治疗前,CD19^(+)CD24^(hi)CD38^(-)记忆性B细胞水平均高于治疗前(P<0.05),且观察组患者治疗后CD19^(+)CD24^(int) CD38^(int)成熟B细胞水平低于对照组,CD19^(+)CD24^(hi)CD38^(-)记忆性B细胞水平高于对照组(P<0.05)。两组患者治疗后骨质情况(骨侵蚀/肌腱增厚/关节积液/异常血流速/滑膜增生/骨赘/滑囊炎/肌腱钙化)均优于治疗前,且观察组患者治疗后骨质情况优于对照组(P<0.05)。结论将阿达木单抗用于治疗AS,能改善患者脊柱功能、生活质量及骨质情况,调节CRP、ESR、IL-23及B细胞亚群水平。

Objective To explore the clinical effect of adalimumab in the treatment of ankylosing spondylitis(AS).Methods A total of 84 AS patients admitted to Zhengzhou People’s Hospital from May 2019 to May 2020 were selected as the research objects,and they were divided into a control group and an observation group according to the random number table method,with 42 cases in each group.The control group received leflunomide,sulfasalazine and methotrexate,the observation group received adalimumab on the basis of the control group.The Bath AS disease activity index(BASDAI),Barthel index(BI)score,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-23(IL-23),B cell subgroup levels and bone quality were compared between the two groups.Results After treatment,the BASDAI of the two groups of patients were lower than before treatment,and the BI score was higher than before treatment(P<0.05).The BASDAI of the observation group was lower than the control group,and the BI score was higher than the control group(P<0.05).After treatment,the levels of CRP,ESR,and IL-23 of the two groups were lower than before treatment,and the levels of CRP,ESR,and IL-23 in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of CD19^(+)CD24^(int) CD38^(int) mature B cells of the two groups were lower than before treatment,and the levels of CD19^(+)CD24^(hi)CD38^(-) memory B cells were higher than before treatment(P<0.05).The level of CD19^(+)CD24^(int) CD38^(int) mature B cells in the observation group was lower than that of the control group,and the level of CD19^(+)CD24^(hi)CD38^(-) memory B cells was higher than that of the control group(P<0.05).The bone quality(bone erosion,tendon thickening,articular effusion,abnormal blood flow rate,synovial hyperplasia,osteophytes,bursitis,tendon calcification)after treatment of the two groups was better than before treatment,and the bone quality of the observation group was better than that of the control group after treatment(P<0.05).Conclusion Adalimumab used in the treatment of AS can improve the spinal function,quality of life and bone quality of patients,and regulate the levels of CRP,ESR,IL-23 and B cell subsets.