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姚血明 三甲
姚血明 主任医师
贵州中医药大学第二附属医院 风湿免疫科

尽早长期用TNF-α抑制剂可延缓AS患者影像学进展

摘要(美国)目的:旨在研究肿瘤坏死因子α(TNF-α)抑制剂对于强直性脊柱关节炎(AS)患者脊柱损伤进展情况的影响。

方法:纳入的总共334例AS患者均符合改良的纽约诊断标准,并且接受病情监测的同时至少在间隔1年半的时间内有2次脊柱影像学检查。所有患者均接受标准治疗,使用的药物包括非甾体抗炎药和TNF-α抑制剂。影像学严重程度的评估采用改良斯托克强直性脊柱炎评分(mSASSS)。每年mSASSS进展大于1个单位的患者视为病情进展患者。采用单变量和多变量的回归分析。同时进行倾向性评分匹配和敏感性分析。应用ZINB模型分析TNFα抑制剂对不同随访时间患者的mSASSS变化的影响。诸如疾病活动度、血沉、C反应蛋白、HLA-B27阳性、性别、发病年龄、吸烟及基线时脊柱损伤情况等可能的混杂因素均纳入此模型。贵州中医药大学第二附属医院风湿免疫科姚血明

结果:TNF-α抑制剂的治疗与50%的疾病进展可能性的降低有关,相应的比值比(OR)为0.52(95%的置信区间0.30–0.88, P=0.02)。发病10年以后才起始治疗的患者较发病早期即开始治疗的患者更易出现病情的进展。在ZINB模型中,TNF-α抑制剂显著延缓了疾病的进展。经过倾向性评分匹配以后,TNF-α抑制剂的保护效应更为显著。

结论:TNF-α抑制剂可以延缓AS患者影像学进展,尤其是对于尽早使用和长期维持的患者来说保护效应更佳。

附原文:Objective. To study the effect of tumor necrosis factor _ (TNF_) inhibitors on progressive spinal damage in patients with ankylosing spondylitis (AS). Methods. All AS patients meeting the modified New York criteria who had been monitored prospectively and had at least 2 sets of spinal radiographs a minimum of 1.5 years apart were included in the study (n=334). The patients received standard therapy, which included nonsteroidal antiinflammatory drugs and TNF_ inhibitors. Radiographic severity was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients with a rate of AS progression that was >1 mSASSS unit/year were considered progressors. Univariable and multivariable regression analyses were done. Propensity score matching and sensitivity analysis were performed. A zero-inflated negative binomial (ZINB) model was used to analyze the effect of TNF_ inhibitors on the change in the mSASSS with varying followup periods. Potential confounders, such as disease activity (as assessed by the Bath Ankylosing Spondylitis Disease Activity Index), the erythrocyte sedimentation rate, C-reactive protein level, HLA– B27 positivity, sex, age at onset, smoking burden (number of pack-years), and baseline damage, were included in the model. Results. TNF inhibitor treatment was associated with a 50% reduction in the odds of progression, with an odds ratio (OR) of 0.52 (95% confidence interval [95% CI] 0.30–0.88, P=0.02). Patients with a delay of >10 years in starting therapy were more likely to experience progression as compared to those who started earlier (OR 2.4 [95% CI 1.09–5.3], P=0.03). In the ZINB model, the use of TNF_ inhibitors significantly reduced disease progression when the gap between radiographs was >3.9 years. The protective effect of TNF_ inhibitors was stronger after propensity score matching. Conclusion. Treatment with TNF_ inhibitors appears to reduce radiographic progression in AS patients, especially with early initiation and with longer duration of followup.

引自:Nigil Haroon, Robert D. Inman, Thomas J. Learch, Michael H. Weisman, MinJae Lee, Mohammad H. Rahbar, Michael M. Ward, John D. Reveille, and Lianne S. Gensler. The Impact of Tumor Necrosis Factor _ Inhibitors on Radiographic Progression in Ankylosing Spondylitis. ARTHRITIS & RHEUMATISM Vol. 65, No. 10, October 2013, pp 2645–2654

姚血明
姚血明 主任医师
贵州中医药大学第二附属医院 风湿免疫科
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