Effect of TNF-α antagonist on quality of life of patients with ankylosing spondylitis who respond poorly to traditional treatments
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摘要: 目的 观察TNF-α拮抗剂对传统治疗方案缺乏反应的强直性脊柱炎(ankylosing spondylitis,AS)患者的疗效及对其生活质量的影响。 方法 采用非盲自身对照方法,随机选取2015年5月—2016年10月上海市光华中西医结合医院收治的符合观察标准的AS患者60例,均使用益赛普治疗,疗程24周,疗程结束后继续随访至48周末。观察患者SF-36量表、医院焦虑抑郁量表(HADS)、匹茨堡睡眠质量指数量表(PSQI)及疾病活动度的变化,并评估其ASAS20、ASAS40疗效。 结果 经治疗24周后,有50例(83.3%)达到ASAS20标准,36例(60.0%)达到ASAS40标准,部分患者在24周益赛普减量后亦能维持稳定的疗效。在患者的疾病活动度及疼痛得到充分改善的同时,患者的SF-36各个维度(除MH外)及PSQI评分较治疗前均有显著改善(均P<0.01),其中尤以BP、SF36-PCS改善得最为明显。虽然在治疗前患者的HA、HD评分均高于健康对照,但患者在治疗后24周、48周的HA、HD评分较治疗前未见显著改善(均P>0.05)。ASDAS-CRP、BASDAI等疾病活动度指标与SF-36某些维度呈负相关,但与HA、HD、MH无关。 结论 益赛普对传统治疗方案缺乏反应的AS患者疗效显著且安全性较好,可显著改善其在生理功能方面的生活质量及睡眠质量,但对患者的HADS及MH无改善作用。Abstract: Objective To observe the effect of TNF-α antagonist on quality of life of patients with ankylosing spondylitis(AS) who lacked response to traditional treatments. Methods Sixty patients with AS who met the criteria were randomly selected and observed by non-blind self-controlled trials from May 2015 to October 2016 in the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine. All patients were treated with Yisaipu for 24 weeks and continued to follow up to 48 weeks. SF-36 scale, hospital anxiety and depression scale(HADS), Pittsburgh sleep quality index scale(PSQI) and disease activity were observed and the efficacy of ASAS20 and ASAS40 criteria were evaluated. Results After treatment for 24 weeks, 50 patients(83.3%) have met ASAS20 efficacy criteria and 36 patients(60.0%) achieved ASAS40 efficacy criteria. Some patients still maintained a stable efficacy after the reduction of Yisaipu during the following 24 weeks. While the disease activity and pain of patients were fully improved, the SF-36 scale(except MH) and PSQI scores were significantly improved(all P<0.01), especially BP and sf36-pcs improved the most obviously. Although the scores of HA and HD of patients before treatment were higher than those of healthy controls, there was no significant improvement at 24 and 48 weeks after treatment(all P>0.05). The disease activity indicators such as ASDAS-CRP and BASDAI indexes were negatively correlated with some dimensions of SF-36, but not with HA, HD, MH. Conclusion Yisaipu is effective and safe in treating AS patients who lack response to traditional therapy. It can significantly improve their quality of life and sleep, but has no effect on HADS and MH.
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