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目的观察柳氮磺胺吡啶联合心理干预治疗强直性脊柱炎(ankylosing spondylitis,AS)的临床疗效及对患者焦虑、抑郁心理的影响。方法将63例AS患者随机分为治疗组与对照组,治疗组(口服柳氮磺胺吡啶联合心理干预)33例,其中男16例,女17例,平均年龄(28.5±8.1)岁;对照组(单纯口服柳氮磺胺吡啶)30例,其中男12例,女18例,平均年龄(26.0±9.2)岁。观察两组患者治疗后达到ASAS20疗效改善、治疗前后AS病情活动指数评分变化、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-23(IL-23)的水平变化、肝肾功水平变化,及患者焦虑自评量表(self-reported anxiety scale,SAS)和抑郁自评量表(self-reported depression scale,SDS)的变化情况。结果治疗后4周,两组患者Bath AS病情活动指数(the Bath AS disease activity index,BASDAI)均明显下降,差异有统计学意义(P<0.05);两组患者治疗前后BASDAI评分差值进行比较,差异有统计学意义[(4.66±0.50)vs.(1.88±0.91),P<0.05];两组患者治疗后TNF-α、IL-6、IL-23值均明显下降,差异有统计学意义(P<0.05);两组患者治疗前后SAS[(15.73±0.93)vs.(2.23±1.04)]、SDS[(16.21±1.86)vs.(2.15±1.10)]评分差值比较,差异有统计学意义(P<0.01)。两组患者治疗前后肝肾功比较,差异无统计学意义。结论柳氮磺胺吡啶联合心理干预可降低AS患者TNF-α、IL-6、IL-23炎性因子表达水平,对患者焦虑、抑郁心理具有一定程度的改善作用。
Objective To observe the clinical efficacy of sulfasalazine combined with psychological intervention in the treatment of ankylosing spondylitis (AS) and its effect on anxiety and depression in patients. Methods Sixty-three AS patients were randomly divided into treatment group and control group. The treatment group (oral sulfasalazine combined psychological intervention) 33 cases, including 16 males and 17 females, mean age (28.5 ± 8.1) years; control group (Simple oral sulfasalazine) 30 cases, including 12 males and 18 females, the average age (26.0 ± 9.2) years. The therapeutic effect of ASAS20 was observed after treatment in both groups. The change of AS index, the level of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-23 Changes in liver and kidney function, and self-reported anxiety scale (SAS) and self-reported depression scale (SDS). Results Four weeks after treatment, Bath AS disease activity index (BASDAI) decreased significantly in both groups, with significant difference (P <0.05). The differences of BASDAI scores between the two groups before and after treatment were compared , The difference was statistically significant [(4.66 ± 0.50) vs. (1.88 ± 0.91), P <0.05]. The levels of TNF-α, IL-6 and IL-23 in both groups were significantly decreased (15.73 ± 0.93 vs. 2.23 ± 1.04) and SDS [(16.21 ± 1.86) vs. (2.15 ± 1.10)], respectively, before and after treatment in the two groups Statistical significance (P <0.01). Two groups of patients before and after treatment of liver and kidney function, the difference was not statistically significant. Conclusion Sulfasalazine combined with psychological intervention can reduce the expression of inflammatory cytokines TNF-α, IL-6 and IL-23 in patients with AS, which can improve anxiety and depression in patients with AS.