高压氧辅助益赛普治疗强直性脊柱炎40例临床疗效观察  

Observation of the clinical efficacy of hyperbaric oxygen-assisted Etanercept in the treatment of 40 cases of ankylosing spondylitis

作　　者：都丽丽[1] 李佳昊 邢瀚 张基梅[3] 姜俊杰[1] Du Lili;Li Jiahao;Xing Han;Zhang Jimei;Jiang Junjie(Yantaishan Hospital,Yantai 264001,China;School of Public Health,Binzhou Medical University,Yantai 264001,China;Yantai Yuhuangding Hospital,Yantai 264001,China)

机构地区：[1]烟台市烟台山医院,烟台264001 [2]滨州医学院公共卫生学院,烟台264001 [3]烟台毓璜顶医院,烟台264001

出　　处：《中华航海医学与高气压医学杂志》2024年第3期330-335,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的:探讨高压氧(HBO)辅助重组人Ⅱ型肿瘤坏死因子(TNF-α)受体Fc抗体融合蛋白(益赛普)治疗强直性脊柱炎(AS)的临床疗效及其作用机制。方法:选取2019年1月至2020年12月烟台山医院骨科收治的AS患者80例,采用随机数字表法分为研究组和对照组,每组40例。对照组在传统治疗的基础上采用益赛普治疗;研究组在对照组治疗的基础上辅以HBO治疗。采集患者治疗前及治疗3个月后清晨静脉血,采用酶联免疫吸附法检测肿瘤坏死因子-α(TNF-α)含量,采用免疫比浊法检测C反应蛋白(CRP)含量,用魏氏法检测红细胞沉降率(ESR)的变化,采用流式细胞仪测定外周血B细胞亚群的变化。对2组患者治疗前后采用巴氏强直性脊柱炎功能指数(PASFI)和巴氏强直性脊柱炎病情活动指数(PASDAI)进行比较,对2组患者治疗前后脊柱痛和夜间痛采用疼痛视觉模拟评分(VAS)进行评估。采用彩色超声诊断仪检测患者治疗前后骨质的变化。结果:研究组患者治疗后的治疗总有效率(95.0%)明显高于对照组(80.0%),差异有统计学意义(χ^(2)=4.841,P<0.05)。治疗后与对照组比较,研究组PASFI、PASDAI和VAS评分均明显降低,晨僵时间缩短、指距地变短、胸廓活动度变大(P<0.05);血清CRP、TNF-a、ESR水平及CD19_(+)CD24 ^(int) CD38 ^(int-)成熟B细胞百分率、CD19^(+)CD24^(hi) CD38--记忆B细胞百分率明显降低(P<0.05)。结论:HBO辅助益赛普治疗AS能明显减轻患者临床症状,其主要是通过降低患者血清炎症因子水平,提高机体免疫功能,修复损伤的骨质实现的。ObjectiveTo investigate the clinical efficacy and mechanism of action of hyperbaric oxygen(HBO)-assisted recombinant human typeⅡtumor necrosis factor-α(TNF-α)receptor Fc fusion protein(Etanercept)in the treatment of ankylosing spondylitis(AS).MethodsA total of 80 AS patients admitted to the Orthopedics Department of Yantaishan Hospital from January 2019 to December 2020 were selected and randomly divided into study group(n=40)and control group(n=40).The control group was treated with Etanercept on the basis of traditional treatment,while the study group received HBO therapy on the basis of the treatment in the control group.Venous blood samples were collected in the morning before treatment and three months after treatment,and TNF-αlevels were measured by enzyme-linked immunosorbent assay(ELISA).The content of C-reactive protein(CRP)was detected by immunoturbidimetry,and the erythrocyte sedimentation rate(ESR)was detected by Westergren method.The changes of peripheral blood B cell subsets were measured by flow cytometry.The results of Bath ankylosing spondylitis functional index(BASFI)and the Bath ankylosing spondylitis disease activity index(BASDAI)were compared between the two groups before and after treatment,and the spinal pain and nocturnal pain in the two groups before and after treatment were evaluated with the Visual Analogue Scale(VAS)before and after treatment.The bone changes before and after treatment were measured by color Doppler ultrasonic diagnostic apparatus.ResultsThe total effective rate of the study group was higher than that of the control group(95.0%vs.80.0%),with a statistically significant difference(χ2=4.841,P<0.05).Compared with the control group after treatment,BASFI and BASDAI scores and VAS score in the study group were significantly reduced after treatment,along with shortened morning stiffness duration,decreased finger-to-floor distance,and increased chest mobility(P<0.05);Serum CRP,TNF-α,ESR,the percentages of CD19_(+)CD24 ^(int) CD38 ^(int-) mature B cells,and the percentag

关 键 词：强直性脊柱炎 益赛普 高压氧 肿瘤坏死因子-Α 骨质破坏 

分 类 号：R459.6[医药卫生—治疗学] R593.23[医药卫生—临床医学]