阿达木单抗治疗强直性脊柱炎合并葡萄膜炎患者的临床疗效及对NLR、PLR的影响

Clinical efficacy and the effect on NLR and PLR of Adamumab in the treatment of ankylosing spondylitis complicated with uveitis

目的 探讨强直性脊柱炎(Ankylosing spondylitis,AS)合并葡萄膜炎患者应用阿达木单抗的有效性及对中性粒细胞/淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞比值(Platelet to lymphocyte ratio,PLR)的影响,并探讨NLR和PLR在疾病活动性评估中的价值。方法 回顾性分析我院2019年1月至2021年4月收治的36例AS合并葡萄膜炎患者,比较阿达木单抗治疗前后视力、眼部疼痛及畏光症状、晨僵时间、腰背痛视觉模拟评分(Visual analogue score,VAS)、疾病活动度[Bath强直性脊柱炎病情活动指标(Bath ankylosing spondylitis disease activity index,BASDAI评分),强直性脊柱炎疾病活动评分-C反应蛋白指标(Ankylosing spondylitis disease activity score-C-reactive protein,ASDAS-CRP评分)]、C反应蛋白(C-reactive protein,CRP)、血沉(Erythrocyte sedimentation rate,ESR)、NLR及PLR的变化,对NLR、PLR与BASDAI、ASDAS-CRP、CRP、ESR进行相关性分析,并统计不良反应的发生情况。结果 治疗后,患者眼部体征方面,最佳矫正视力显著提高,疼痛及畏光症状改善明显,差异有统计学意义(P<0.05);临床指标方面,晨僵持续时间明显减少,腰背痛程度显著减轻,BASDAI及ASDAS-CRP也明显降低,差异均具有统计学意义(P<0.05);血清炎性指标方面,与治疗前相比较,CRP、血沉、NLR及PLR水平均明显下降,差异有统计学意义(P<0.05);NLR对BASDAI、ASDAS、CRP、ESR呈正相关(P<0.05);PLR与BASDAI、ASDAS、CRP、ESR也有显著相关性(P<0.05)。共发生3例不良反应,其中注射部位皮疹2例,肝功能异常1例。结论 强直性脊柱炎合并葡萄膜炎患者进行阿达木单抗治疗,能够显著改善临床症状,控制疾病活动,降低CRP、血沉、NLR及PLR等炎性指标,且具有良好的安全性,能提高患者生活质量。NLR和PLR对评估病情活动情况有一定的临床价值。

Objective To observe the efficacy of Adamumab and its effects on neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) in patients with ankylosing spondylitis(AS) complicated with uveitis,and to investigate the value of NLR and PLR in disease assessment.Methods Totally 36 patients with AS complicated with uveitis treated in our hospital from January 2019 to April 2021 were analyzed retrospectively.The changes of visual acuity,eye pain and photophobia,morning stiffness time,VAS score of low back pain,disease activity score(BASDAI score and ASDAS-CRP score),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),NLR and PLR were compared before and after Adamumab treatment.The correlation between NLR,PLR and BASDAI,ASDAS,CRP and ESR was analyzed,and the adverse reactions were observed.Results Compared with before treatment,the best corrected visual acuity,pain and photophobia were significantly improved after treatment(P<0.05).In terms of clinical indexes,compared with those before treatment,the duration of morning stiffness was significantly shorter,the degree of low back pain was significantly reduced,and BASDAI and ASDAS-CRP were also significantly decreased after treatment(P<0.05).In terms of serum inflammatory indexes,compared with those before treatment,the levels of CRP,ESR,NLR and PLR decreased significantly after treatment(P<0.05).NLR correlated positively with BASDAI,ASDAS,CRP and ESR(P<0.05);PLR was significantly associated with BASDAI,ASDAS,CRP and ESR(P<0.05).A total of 3 cases of adverse reactions occurred,including 2 cases of skin rash at the injection site and 1 case of abnormal liver function.Conclusion Adamumab therapy in patients with ankylosing spondylitis complicated with uveitis can significantly improve clinical symptoms,control disease activity,reduce inflammatory indexes such as CRP,ESR,NLR and PLR,and has good safety,which can improve the quality of life of the patients.NLR and PLR have certain clinical value in evaluating disease activity.