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目的 评价反应停治疗强直性脊柱炎 (AS)的有效性与安全性 ,探讨反应停治疗AS的价值。方法 采用队列研究方法 ,选用柳氮磺吡啶 (SASP)和单用非甾体抗炎药 (NSAIDs)作为对照。三组共治疗AS患者 98例 ,其中反应停治疗 2 9例 (反应停组 ) ,SASP治疗 37例 (SASP组 ) ,单用非甾体抗炎药 (NSAIDs)治疗 32例(NSAIDs组 ) ,疗程均为 6个月 ,三组患者的病情相似 ,其中反应停组的AS患者 ,是自愿而且排除孕妇及未婚未育者。结果 治疗 6个月 ,晨僵时间、关节疼痛数和血沉 (ESR)在三组均显著改善 (P <0 0 1和P <0 0 5 ) ,而C反应蛋白 (CRP)的显著下降仅见于反应停组和SASP组 (P均 <0 0 1)。三组间比较 ,关节疼痛数、ESR和CRP在反应停组及SASP组改善程度显著高于NSAIDs组 (P <0 0 5 )。临床缓解、显效、有效和无效率在反应停组分别为4 1%、2 8%、2 1%和 10 % ;在SASP组分别为 38%、2 7%、2 2 %和 13% ;在NSAIDs组分别为 10 %、34%、31%和2 5 %。对比三组疗效 ,反应停组与SASP组疗效相当 ,均优于NSAIDs组 (P <0 0 5 )。不良反应在反应停组主要是嗜睡和胃肠道不适 ,多为一过性 ,其发生率为 5 5 % ,明显高于SASP组 19%和NSAIDs组 16 % (P <0 0 5 ) ;反应停组无 1例出现白细胞减低和转氨酶升高 ,而在SASP组各有 1例
Objective To evaluate the efficacy and safety of reaction therapy in the treatment of ankylosing spondylitis (AS), and to explore the value of reaction therapy in the treatment of AS. Methods A cohort study was conducted using SASP and NSAIDs as controls. A total of 98 AS patients were treated in the three groups. Among them, 29 patients responded to stop-treatment (response group), 37 patients received SASP (SASP) and 32 patients (NSAIDs) received NSAIDs alone. The course of treatment was 6 months. The patients in the three groups had similar illness. Among them, AS patients responding to stop group were voluntary and excluded pregnant women and unmarried non-pregnant women. Results After 6 months of treatment, morning stiffness, joint pain and erythrocyte sedimentation rate (ESR) were significantly improved in all three groups (P <0.01 and P <0.05), while significant decreases in C-reactive protein (CRP) Response group and SASP group (all P <0 01). The joint pain, ESR and CRP were significantly higher in response group and SASP group than those in NSAIDs group (P <0.05). Clinical remission, effective, effective and inefficacy were 41%, 28%, 21% and 10%, respectively; in the SASP group, 38%, 27%, 22% and 13%, respectively The NSAIDs group was 10%, 34%, 31% and 25% respectively. Comparing the efficacy of three groups, response group and SASP group had similar curative effect, which were better than NSAIDs group (P <0.05). Adverse reactions were mainly lethargy and gastrointestinal upset in response group, mostly transient, the incidence was 55%, significantly higher than SASP group 19% and NSAIDs group 16% (P <0 05); response None of the patients in the stop group had leucopenia and elevated aminotransferases, one in the SASP group