甲泼尼龙联合甲氨蝶呤治疗强直性脊柱炎的疗效及对患者血清白细胞介素-17/白细胞介素-4的调节作用

Observation of the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis and its regulating effect on patients'serum interleukin-17/interleukin-4

目的探讨甲泼尼龙联合甲氨蝶呤治疗强直性脊柱炎(AS)的疗效及对患者血清白细胞介素(IL)-17/IL-4的调节作用。方法选取2016年7月至2019年6月河北省保定市第一医院117例AS患者作为研究对象,应用简单随机化分组方法分为三组,每组39例。三组均予以环磷酰胺治疗,在此基础上,对照A组予以甲氨蝶呤治疗,对照B组予以甲泼尼龙治疗,观察组予以甲氨蝶呤联合甲泼尼龙治疗,三组均连续治疗12周。比较三组的临床疗效、不良反应发生情况;比较三组治疗前后胸、腰椎活动度,Bath AS病情活动指数量表(BASDAI)、Bath AS功能指数量表(BASFI)评分,血清高迁移率蛋白1(HMGB1)、基质金属蛋白酶-3(MMP-3)、IL-4、IL-17水平和IL-17/IL-4。结果观察组治疗总有效率高于对照A、B组[92.31%(36/39)比74.36%(29/39)、69.23%(27/39)](P<0.05)。治疗12周后,观察组BASDAI、BASFI评分低于对照A、B组,胸、腰椎活动度大于对照A、B组[(3.36±1.03)分比(4.62±1.19)和(4.98±1.25)分、(3.70±0.89)分比(4.36±0.96)和(4.64±0.95)分、(4.96±1.17)cm比(4.18±1.02)和(3.98±1.15)cm、(5.93±1.32)cm比(5.02±1.15)和(4.92±1.25)cm](P<0.05);治疗12周后,观察组血清HMGB1、MMP-3、IL-17、IL-17/IL-4低于对照A、B组[(20.25±6.41)μg/L比(27.81±7.63)和(29.26±7.31)μg/L、(4.83±1.06)μg/L比(9.26±1.25)和(9.71±1.28)μg/L、(13.41±5.06)ng/L比(17.62±5.61)和(19.06±6.14)ng/L、0.51±0.27比0.92±0.41和1.04±0.45](P<0.05),IL-4高于对照A、B组[(26.15±4.94)ng/L比(19.16±5.14)、(18.32±5.26)ng/L](P<0.05);三组不良反应发生率比较差异无统计学意义(P>0.05)。结论甲泼尼龙联合甲氨蝶呤治疗AS,可明显降低血清HMGB1、MMP-3水平,调节血清IL-17/IL-4,进一步提高治疗效果,且安全性较高。

Objective To explore the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis(AS)and its regulation of serum interleukin(IL)-17/IL-4.Methods A total of 117 patients with AS in the First Hospital of Baoding from July 2016 to June 2019 were selected as prospective research subjects,and they were simply randomized into three groups,with 39 cases in each group.The control group A was treated with methotrexate,the control group B was treated with methylprednisolone,and the observation group was treated with methotrexate combined with methylprednisolone.The chi-square test was used to compare the clinical efficacy and the incidence of adverse reactions in the three groups.F-test was used to compare the thoracolumbar spine mobility,Bath AS disease activity index(BASDAI),Bath AS function index(BASFI)scores,the levels of serum high mobility protein 1(HMGB1),matrix metalloproteinase-3(MMP-3),interleukin(IL)-4,IL-17,and IL-17/IL-4 before and after the treatment of the three groups.Results The total effective rate of treatment in the observation group was better than that in the control groups A and B:92.31%(36/39)vs.74.36%(29/39)and 69.23%(27/39),P<0.05.After the course of treatment,the BASDAI and BASFI scores in the observation group were lower than those in the control group A and B,and the thoracolumbar spine mobility were higher than those in the control group A and B:(3.36±1.03)scores vs.(4.62±1.19),(4.98±1.25)scores;(3.70±0.89)scores vs.(4.36±0.96),(4.64±0.95)scores;(4.96±1.17)cm vs.(4.18±1.02),(3.98±1.15)cm,(5.93±1.32)cm vs.(5.02±1.15),(4.92±1.25)cm,P<0.05.After the course of treatment,serum HMGB1,MMP-3,IL-17,IL-17/IL-4 in the observation group were lower than those in the control group A and B:(20.25±6.41)μg/L vs.(27.81±7.63),(29.26±7.31)μg/L;(4.83±1.06)μg/L vs.(9.26±1.25),(9.71±1.28)μg/L;(13.41±5.06)ng/L vs.(17.62±5.61),(19.06±6.14)ng/L;0.51±0.27 vs.0.92±0.41,1.04±0.45,P<0.05;and IL-4 was higher than that in the control groups A and B:(26.15±4.94)ng/L vs.(19.16±5.14),(18.32±5.26)ng/L,P<0.05.There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusions The combination of methylprednisolone and methotrexate in the treatment of AS can significantly reduce serum HMGB1 and MMP-3 levels,regulate serum IL-17/IL-4 and further improve the therapeutic effect,and it has high safety.