阿达木单抗联合柳氮磺吡啶肠溶片、来氟米特治疗成年活动性强直性脊柱炎患者对血清炎症因子、免疫功能、骨密度和骨代谢的影响

Effects of adalimumab combined with sulfasalazine enteric coated tablets and leflunomide on serum inflammatory factors,immune function,bone density,and bone metabolism in adult patients with active ankylosing spondylitis

目的探究阿达木单抗联合柳氮磺吡啶肠溶片、来氟米特治疗成年活动性强直性脊柱炎(AAS)患者对血清炎症因子、免疫功能、骨密度和骨代谢的影响。方法将2019年1月至2023年6月皖西卫生职业学院附属医院(六安市第二人民医院)收治的100例成年AAS患者纳入本次前瞻性研究,按照随机数字表法将其分为研究组(n=50)和对照组(n=50)。对照组患者接受柳氮磺吡啶肠溶片+来氟米特治疗,研究组患者接受阿达木单抗+柳氮磺吡啶肠溶片+来氟米特治疗,治疗周期为30周。比较2组的临床疗效、治疗前后的血清炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6]、免疫功能、骨密度和骨代谢指标、毕氏强直性脊柱炎疾病活动指数(BASDAI)和红细胞沉降率(ESR)。结果研究组的临床总有效率为94.00%,显著高于对照组(80.00%),差异有统计学意义(P<0.05)。研究组治疗30周后的血清CRP、TNF-α、IL-6水平分别为(10.39±2.27)mg/L、(0.20±0.08)μg/L、(15.46±3.90)μg/L,均显著低于对照组[(18.04±2.39)mg/L、(0.35±0.12)μg/L、(22.09±3.17)μg/L],差异均有统计学意义(P<0.05)。研究组治疗30周后的IgG、IgM、IgA水平分别为(14.29±2.43)、(1.50±0.46)、(3.05±0.63)g/L,均显著低于对照组[(16.35±2.29)、(1.84±0.49)、(3.57±0.70)g/L],差异均有统计学意义(P<0.05)。研究组治疗30周后的骨密度T值、BGP水平分别为-0.94±0.30、(6.01±1.22)ng/L,显著高于对照组[-1.30±0.29、(4.95±1.17)ng/L],差异均有统计学意义(P<0.05)。研究组治疗30周后的β-CTX、BALP水平分别为(0.32±0.08)ng/mL、(14.39±1.58)μg/L,均显著低于对照组[(0.53±0.09)ng/mL、(18.01±1.90)μg/L],差异均有统计学意义(P<0.05)。研究组治疗30周后的BASDAI、ESR水平分别为1.63±0.68、(22.14±3.43)mm/h,显著低于对照组[2.94±1.07、(33.56±4.02)mm/h],差异均有统计学意义(P<0.05)。2组的各不良反应发生率比较,差异均无统计学意义(P>0.05)。结论阿达木单抗联合柳氮磺吡啶肠溶片、来氟米特成年活动性强直性脊柱炎患者的疗效显著,可有效降低炎症反应和疾病活动度,改善患者免疫功能、骨密度及骨代谢水平,且安全性良好。

Objective To investigate the effects of adalimumab combined with sulfasalazine enteric coated tablets and leflunomide on serum inflammatory factors,immune function,bone density,and bone metabolism in adult patients with active ankylosing spondylitis(AAS).Methods A total of 100 cases of adult patients with AAS admitted to Affiliated Hospital of West Anhui Health Vocational College(The Second People's Hospital Lu'an City)from January 2019 to June 2023 were included in this prospective study and divided into the study group(n=50)and the control group(n=50)according to the random number table method.The control group received sulfasalazine enteric coated tablets+leflunomide treatment,while the study group received adalimumab+sulfasalazine enteric coated tablets+leflunomide treatment.The treatment lasted 30 weeks.The clinical efficacy,serum inflammatory factors[C-reactive protein(CRP),tumor necrosis factor alpha(TNF-α),interleukin(IL)-6],immune function,bone mineral density and bone metabolism indicators,BASDAI and ESR before and after 30 weeks of treatment were compared.Results The total clinical effective rate of the study group was 94.00%,which was significantly higher than that of the control group(80.00%),and the difference was statistically significant(P<0.05).The levels of serum CRP,TNF-αand IL-6 in the study group after 30 weeks of treatment were(10.39±2.27)mg/L,(0.20±0.08)μg/L,and(15.46±3.90)μg/L,respectively,which were lower than those in the control group[(18.04±2.39)mg/L,(0.35±0.12)μg/L,and(22.09±3.17)μg/L],and the differences were statistically significant(P<0.05).The levels of IgG,IgM,and IgA in the study group after treatment were(14.29±2.43),(1.50±0.46),and(3.05±0.63)g/L,respectively,which were lower than those in the control group[(16.35±2.29),(1.84±0.49),and(3.57±0.70)g/L],and the differences were statistically significant(P<0.05).The levels of BMD T value and BGP in the study group after 30 weeks of treatment were-0.94±0.30 and(6.01±1.22)ng/L,respectively,which were higher than those in the control group[-1.30±0.29 and(4.95±1.17)ng/L],and the differences were statistically significant(P<0.05).The levels of serumβ-CTX and BALP in the study group after 30 weeks of treatment were(0.32±0.08)ng/mL and(14.39±1.58)μg/L,respectively,which were lower than those in the control group[(0.53±0.09)ng/mL and(18.01±1.90)μg/L],and the differences were statistically significant(P<0.05).The BASDAI and ESR of the study group after 30 weeks of treatment were 1.63±0.68 and(22.14±3.43)mm/h,respectively,which were lower than those of the control group[2.94±1.07 and(33.56±4.02)mm/h],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Adalimumab combined with sulfasalazine enteric coated tablets and leflunomide have a significant therapeutic effect on adult patients with AAS,it can effectively reduce inflammatory response and disease activity,improve immune function,bone density,and bone metabolism levels with good safety.