局部X线放射治疗强直性脊柱炎髋关节病变的临床研究  

Clinical study of radiotherapy on hip joint in patients with ankylosing spondylitis

作　　者：韩星海[1] 赵福涛[1] 管剑龙[1] 刘彧[1] 施冶青[1] 戴生明[1] 蔡青[1] 赵东宝[1] 孟济 

机构地区：[1]第二军医大学长海医院风湿免疫科,上海200433

出　　处：《中华风湿病学杂志》2005年第1期8-11,共4页Chinese Journal of Rheumatology

摘　　要：目的观察药物治疗联合直线加速器髋关节局部X线放射性治疗(放疗)对强直性脊柱炎(ankylosingspondylitis,AS)髋关节病变患者的临床疗效,并与单纯药物治疗AS髋关节病变患者进行对照。进行为期3年的随访,评价放疗对AS髋关节病变的安全性及临床疗效,以期为AS髋关节病变提供新的治疗手段。方法从住院的AS髋关节病变患者中选择年龄、性别、病程及病情相匹配各52例分别纳入药物治疗联合放疗组(放疗组)、单纯药物组(对照组)。两组均选择一种非甾体抗炎药联合柳氮磺吡啶和甲氨蝶呤,放疗组在药物治疗基础上行放疗治疗。两组患者出院后继续原药物治疗,并进行为期3年的随访观察,记录相关临床资料,包括临床症状、BathAS活动指数(BASDAI)、BathAS功能指数(BASFI)、髋关节功能评分、髋关节X线分期及炎性指标等实验室检查。结果放疗组髋关节疼痛减轻率明显高于对照组(P<0.05);治疗后2年内髋关节功能评分放疗组显著高于对照组(P<0.05);放疗组胃肠道反应、外周血白细胞降低发生率高于对照组,但两组之间差异无统计学意义,且都为可逆性;随访3年,两组之间BASDAI、BASFI评分及髋关节X线分期差异无统计学意义;无造血系统障碍及恶性肿瘤的发生。结论与单纯药物治疗相比,放疗联合药物治疗对减轻髋关节疼痛疗效显著,在治疗后2年内?Objective To evaluate the efficacy and the safety of X-ray radiotherapy on the hip joint of patients with ankylosing spondylitis (AS). Methods Among the patients suffered from ankylosing spondylitis (AS) with the hip joint involvment admitted to the department of rheumatology from 1999~2001, 52 patients were treated with drug only (control grop, CG) and were matched with 52 X-ray radiotherapy recipients (radiotherapy group, RG). Patients in the CG were treated with NSAID combined with sulfasalazine and methotrexate, while patients in the RG were treated with X-ray radiotherapy in addition to the drug therapy. The total irradiation dose of a single hip joint was 15±4 Gy, divided into 6~15 times once daily. Drug therapy were continued in both groups after patients were discharged and were followed-up for three-year. The observation included symptoms, signs, Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), hip joint function score, X-ray staging of hip joint involvment, inflammatory markers, laboratory tests and side effects. SPSS statistics software was used to analyze the data. Results The rate of hip pain relief was significantly higher in the RG than that in the CG (82.7% vs 63.5%). The hip joint fuction score in the RG was significantly higher than that in the CG during the first year and second year (P<0.05). There was no notable difference between two groups in X-ray staging, BASDAI, BASFI and inflammatory markers. In the RG, the incidence of gastrointestinal symptoms and leucopenia was higher than that in CG, but there was no significant difference between the two groups. All patients had good tolerance to the treatment. No malignant tumor was found in the RG patients during the three-year follow-up. Conclusion X-ray radiotherapy combined with drug therapy can effectively relieve the hip joint pain and improve hip joint function. It is better than drug therapy alone for the involved hip joints of the patients with AS. It is suggested that X-ray radiotherapy is an adjuvant

关 键 词：X线放射治疗 强直性脊柱炎 髋关节病变 髋关节功能 

分 类 号：R593.23[医药卫生—内科学]