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抗TNF-α治疗对睡眠障碍的疗效观察

作者: 译者:邓伟明 来源:广东省第二人民医院风湿免疫科 日期:2017-09-09
导读

          强直性脊柱炎(Ankylosing spondylitis,AS)是一种主要侵犯脊柱并累及骶髂关节和周围关节的慢性进行性炎性疾病,多累及年轻人,尤其是青年男性。在治疗过程中,我们一般只关注患者的疼痛及炎症指标的改善情况,往往忽视了疾病对患者睡眠的影响。

关键字:  抗TNF-α 

        研究目的:本研究旨在探讨强直性脊柱炎(AS)患者睡眠质量(SQ)与疾病活动(DA)之间的关系,并评估抗肿瘤坏死因子α(抗TNF-α)治疗对睡眠障碍的疗效。

        研究材料与方法:本研究共纳入了34名符合AS修订的纽约分类标准的患者。患者分为以下两组:I组(n = 15),DA高,接受抗TNF-α治疗,Ⅱ组(n= 19)病情缓解。 DA通过BASDAI(Bath AS Disease Activity Index,疾病活动指数)进行评估。2组在基线期及第I组在抗TNF-α治疗的3个月后分别使用匹兹堡睡眠质量指数(PSQI)和多导睡眠监测(PSG)来确定睡眠障碍及其模式。

        研究结果:基线期结果评估显示,在所有患者中,有57.9%的患者存在SQ。 PSG结果显示患者中表现为阻塞性睡眠呼吸暂停综合征,打鼾和周期性腿部运动的比率分别是73.7%,74.4%和26.3%。在抗TNF-α治疗之前,I组的PSQI和打鼾评分明显较高(P= 0.0001,P = 0.012)。虽然抗TNF-α治疗第3个月I组PSQI评分明显降低(P=0.005),但PSG参数无变化(P> 0.05)。

        研究结论:AS患者,特别是DA患者,抗TNF-α治疗可改善SQ,但是PSG没有任何改善。因此,可以得出结论,PSG参数可能与AS本身的疾病发病机制相关,而不与疾病活动相关。

        附注:多导睡眠监测(PSG)是一种综合记录睡眠期间发生的生物物理变化的方法。PSG在睡眠期间监测许多身体功能,包括脑(EEG),眼睛运动(EOG),肌肉活动或骨骼肌活化(EMG)和心律(ECG)等等。

        Abstract

        INTRODUCTION: This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders.

        MATERIALS AND METHODS: A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n=15) with high DA and receiving anti-TNF-α therapy, and Group II (n=19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I.

        RESULTS: Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P=0.0001, P=0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P=0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P>0.05).

        CONCLUSION: Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

        参考文献:Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-αtherapy on sleep problems: A polisomnographic study.International Journal of Rheumatic Diseases 2017

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