达标后强直性脊柱炎患者功能动作筛查值对疾病复发的影响研究  

Study on the effect of functional movement on the recurrence of patients with ankylosing spondylitis after treat-to-target therapy

作　　者：李敏[1] 吴晓惠[2] 杨闵[3] 梁翼[1] 许静 王翠平[1] 杨茂益 孙杰培 何栩[5] 黄明明 Li Min;Wu Xiaohui;Yang Min;Liang Yi;Xu Jing;Wang Cuiping;Yang Maoyi;Sun Jiepei;He Xu;Huang Mingming(Department of Rheumatology,Sichuan Orthopedic Hospital,Chengdu 610041,China;Department of Rehabilitation,Sichuan Orthopaedic Hospital,Chengdu 610041,China;Department of Rheumatology and Immunology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Sports Medicine,Chengdu Institute of Physical Education,Chengdu 610041;State Sports General Administration of Traditional Chinese Medicine Prevention and Treatment of Sports Injury Key Laboratory,Chengdu 610041,China;Sports Prescription Training Base of Chinese Sports Science Association,Chengdu 610041,China)

机构地区：[1]四川省骨科医院风湿骨关节病科,成都610041 [2]四川省骨科医院康复科,成都610041 [3]四川大学华西医院风湿免疫科,成都610041 [4]成都体育学院运动医学系,610041 [5]四川省骨科医院国家体育总局中医药防治运动创伤重点实验室,成都610041 [6]中国体育科学学会运动处方培训基地,成都610041

出　　处：《中华风湿病学杂志》2022年第1期9-13,I0002,共6页Chinese Journal of Rheumatology

基　　金：四川省中医药管理局资助项目(2021MS308,2018LC025);成都中医药大学校基金(YYZX1708)。

摘　　要：目的探讨AS达标后运动功能评估对其复发的影响研究。方法收集我院符合成都市大病医疗保险资助的AS患者61例,分别收集其基线期与达标时临床资料,AS疾病活动度(ASDAS),经阿达木单抗治疗24周后,凡ASDAS<1.3者视为治疗达标,并采用功能动作筛查(FMS)记录达标后AS患者运动功能评分,停用阿达木单抗,基线药物继续使用,每月随访1次,直至病情复发或至1年。采用t检验比较2组之间的差异,Cox风险比例模型探讨达标后AS患者运动功能对其复发的影响。结果①达标后AS患者,其达标后FMS值(14.3±2.9),随诊1年的复发率57.4%。②复发组较稳定组年龄偏小[(27±7)岁与(31±6)岁,t=5.96,P=0.02]、达标时ASADAS值偏高[(1.29±0.07)与(0.87±0.16),t=177.31,P<0.01]、达标后FMS值偏低[(12.9±2.7)与(16.2±1.9),t=29.23,P<0.01]、达标时间偏长[(2.9±1.2)个月与(1.7±0.6)个月,t=19.89,P<0.01]。③达标后AS患者FMS测试值的截点值为14.25(灵敏度84.6%,特异度80%),Cox风险比例回归分析,达标时间是是病情复发的危险因素(RR=2.285,P<0.05),达标后FMS值是保护因素(RR=0.625,P<0.05)。结论治疗6个月达标后的AS患者停用阿达木单抗后维持原药治疗近半数患者病情复发,其达标时间和达标时FMS值是影响其复发的因素之一。Objective To investigate the effect of functional movement assessment on the recurrence of patients with ankylosing spondylitis(AS)after treat-to-target therapy.Methods The clinical data of 61 patients with AS in Chengdu were collected including clinical symptoms and AS disease activity(ASDAS).After 24 weeks adalimumab treatment,motor function score of AS patients(ASDAS<1.3)was assessed by functional movement screen(FMS),then adalimumab was discontinued and the rest of the concurrent drugs were continued until the disease relapse or up to 1 year.The data of the two groups were compared using t-test analysis and Cox proportionate hazard model.Results①The recurrence rate of patients with AS after treat-to-target therapy within 1 year follow-up was 57.4%;②The recurrence group was younger[(27±7)vs(31±6),t=5.96,P=0.02],the ASADAS value was at the high end when adalimumab was withdrawal[(1.29±0.07)vs(0.87±0.16),t=177.31,P<0.01],and the FMS value was lower after treat-to-target[(12.9±2.7)vs(16.2±1.9),t=29.23,P<0.01],The time to reaching the treatment target was longer[(2.9±1.2)month vs(1.7±0.6)month,t=19.89,P<0.01]than the stable group;③The cut-off value of the FMS test of AS patients after treat-to-target therapy was 14.25(sensitivity was 84.6%,specificity was 80%).The time to treat-to-target was a risk factor for recurrence(RR=2.285,P<0.05),and the FMS value after treat-to-target was a protective factor(RR=0.625,P<0.05).Conclusion After discontinuing the adalimumab,about half of the patients relapse.The time reaching the treatment target and the FMS value after treat-to-target therapy are the risk factors for disease recurrence.

关 键 词：脊柱炎 强直性 功能运动测试 达标治疗 阿达木单抗 复发 

分 类 号：R593.23[医药卫生—内科学]