柳氮磺胺吡啶联合心理干预治疗强直性脊柱炎临床疗效及对患者心理的影响

摘要

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-ɑ(TNF-ɑ)、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-ɑ、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-ɑ、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 effects of sulfasalzine combined with mental intervention therapy in the treatment of ankylosing spondylitis ( AS ) and its influence on patients' anxiety and depression. Methods A total of 63 patients with AS were randomly divided into observation group and control group. The control group [ 30 patients, male: 12, female: 18, the average age: ( 26.0 ± 9.2 ) y ] was given sulfasalzine only, and the observation group [ 33 patients, male: 16, female: 17, the average age: ( 28.5 ± 8.1 ) y ] were given sulfasalzine combined with mental intervention therapy. The assessment of Spondylo Arthritis international society ( ASAS ) 20, bath ankylosing spondylitis disease activity index ( BASDAI ), tumor necrosis factor-ɑ ( TNF-ɑ ), interleukin-6 ( IL-6 ) and IL-23 levels, function of the liver and kidney, self-reported anxiety scale ( SAS ) and self-reported depression scale ( SDS ) were recorded before and after the treatment. Results At 4 weeks after the treatment, BASDAI scores of both groups were positively decreased compared with that before the treatment, and the differences were statistically significant ( P < 0.05 ). The difference value of BASDAI score of observation group was significant compared with that of control group. The difference values of BASDAI scores of both groups were respectively 4.66 ± 0.50 and 1.88 ± 0.91 before and after the treatment ( P < 0.05 ). The levels of TNF-ɑ, IL-6 and IL-23 of both groups were positively decreased compared with that before the treatment, and the differences were statistically significant ( P < 0.05 ). The differences of SAS and SDS in observation group before and after the treatment were significant compared with that in control group ( P < 0.01 ). The difference values of SAS in both groups were respectively 15.73 ± 0.93 and 2.23 ± 1.04, and the difference values of SDS in both groups were respectively 16.21 ± 1.86 and 2.15 ± 1.10. The differences of liver and kidney function in both groups were significant before and after the treatment. Conclusions The sulfasalzine combined with mental intervention therapy can reduce TNF-ɑ, IL-6 and IL-23 levels of AS patients and ease the degree of anxiety and depression.