强直性脊柱炎达标治疗.ppt

感谢大家观看第64页,共64页，2024年2月25日，星期天**Predictionofamajorclinicalresponse(BASDAI50)totumournecrosisfactoralphablockersinankylosingspondylitis.AbstractBACKGROUND:TNFalphablockershavebeenshowntobehighlyefficaciousinpatientswithactiveankylosingspondylitis(AS).OBJECTIVE:ToidentifyparameterspredictingtheclinicalresponsetoTNFblockersinAS.METHODS:PatientswithactiveASparticipatedintwoplacebocontrolled,randomisedtrialsconductedinGermanywithinfliximab(n=69)andetanercept(n=30),respectively.Forinclusionineithertrialpatientshadtohavehighdiseaseactivity(BASDAI>or=4)andaspinalpainscore(numericalratingscale0-10)>or=4despitetreatmentwithNSAIDs.Amajorclinicalresponsewasdefinedasa50%improvementoftheinitialBASDAI(BASDAI50)after12weeks'treatmentwithactivedrug.Logisticregressionlikelihoodratiotests(univariateandmultivariate),Student'sttest,andchi(2)testswereperformed.RESULTS:Univariateanalysisshowedthefollowingtobepredictorsofamajorresponse(BASDAI50)totreatment:shorterdiseaseduration(p=0.003);lowerBASFI(p=0.007);youngerage(p=0.009);raisedESR(p=0.033);raisedCRP(p=0.035).Afteradjustmentfordiseaseduration,BASFI,ESR,andCRP,butnotage,remainedsignificantlyassociated.AfteradjustmentfordiseasedurationandforBASFI,ESR,CRP,andinaddition,ahigherBASDAIweresignificantlyassociatedwithresponse.Thebestmultivariatemodelbuiltbystepwiseregressioncontainedthecovariablesdiseaseduration,BASFI,BASDAI,andCRP.CONCLUSION:Ashorterdiseaseduration,youngerage,andalowerBASFIarepredictorsofamajorclinicalresponsetoTNFblockersinactiveAS.RaisedCRPandahigherBASDAImayalsobevaluablepredictors.Thesedataneedtobeconfirmedinfurtherstudies.***2010年国际脊柱关节炎评估协会针对AS应用TNF抑制剂的推荐如上。对于确诊AS，疾病处于活动期，中轴型患者，在接受2种NSAIDs充分治疗后效果不佳，则可选择TNF抑制剂治疗；以外周关节炎表现为主的患者，除了NSAIDs充分治