王健;张洋;史占军;

• 1:南方医科大学南方医院关节外科

摘要(Abstract)：

[目的]观察肿瘤坏死因子(TNF)拮抗剂(恩利、益赛普)对强直性脊柱炎(AS)髋关节置换术(THA)后患者的有效性及安全性。[方法]回顾性分析2008年6月~2011年12月,具有明显髋关节症状的AS患者,所有患者在THA术后4周内仅使用非甾体镇痛药物控制症状,4周后分别采用恩利/益赛普和普通方案治疗。其中TNF拮抗剂组16例,术后4周给予常规剂量恩利或益赛普2次/周;普通治疗方案组23例,采用非甾体抗炎止痛药(NsAIDs)、抗风湿药(DMARDs)和糖皮质激素治疗。术后第4、12周,第6、12个月进行临床评估和实验室指标检测;术后第3、6、12个月两组均进行X线检查。[结果](1)不论是TNF拮抗剂组还是对照组,治疗后的BASDAI评分都有所下降,且TNF拮抗剂组较对照组改善更明显;前者的CRP下降更明显,但两组ESR下降的差异无统计学意义;(2)TNF拮抗剂组的非置换侧髋Harris评分、活动度以及VAS评分等都有改善,且较对照组明显;(3)对照组置换侧髋的VAS评分及功能改善,均显著优于TNF拮抗剂组非置换侧髋;(4)TNF拮抗剂组置换侧髋与对照组置换侧髋相比,术后Harris评分有明显提高,但在活动度和疼痛方面则没有明显差异;(5)两组所有患者均未发现明显的假体松动透亮线;(6)两组之间不良反应发生率的差异无统计学意义。[结论]从短期随访结果来看TNF拮抗剂对髋关节受累的晚期AS患者确有疗效,虽然单纯使用TNF拮抗剂治疗尚不能达到THA的效果,但THA术后继续使用TNF拮抗剂可以进一步改善髋关节功能,而对疼痛和活动度则没有明显改善;同时,THA术后使用TNF拮抗剂不会增加不良反应发生率。

关键词(KeyWords)： TNF拮抗剂;强直性脊柱炎;髋关节置换术;安全性;有效性

Abstract:

Keywords:

基金项目(Foundation): 国家临床重点专科建设经费;; 广东省中国科学院全面战略合作项目资助(编号:2011B090300016)

作者(Author): 王健;张洋;史占军;

Email:

DOI:

参考文献(References)：

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