目的 探討阿達(dá)木單抗聯(lián)合美洛昔康治療強(qiáng)直性脊柱炎的療效、安全性以及對(duì)Th17/Treg平衡狀態(tài)的影響。方法 選取2022年3月—2024年3月在新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院診治的強(qiáng)直性脊柱炎患者96例，根據(jù)不同的治療方案將其分為對(duì)照組（48例）和治療組（48例）。對(duì)照組每日口服美洛昔康片劑，每次15 mg,1次/d；而治療組在服用美洛昔康片的基礎(chǔ)上，每?jī)芍芷は伦⑸湟淮伟⑦_(dá)木單抗注射液，劑量為40 mg/次。兩組患者均持續(xù)治療3個(gè)月。觀察兩組患者臨床療效，比較治療前后兩組患者主要臨床癥狀緩解時(shí)間，巴氏強(qiáng)直性脊柱炎功能指數(shù)（BASFI）、巴氏強(qiáng)直性脊柱炎疾病活動(dòng)指數(shù)（BASDAI）和EASi-QoL評(píng)分，輔助性T淋巴細(xì)胞17/調(diào)節(jié)性T淋巴細(xì)胞（Th17/Treg）平衡狀態(tài)，及血清半胱氨酸蛋白酶-1(Caspase-1)、正五聚蛋白3(PTX3)和可溶性腫瘤壞死因子相關(guān)凋亡誘導(dǎo)配體（sTRAIL）水平。結(jié)果 治療結(jié)束后，對(duì)照組與治療組的總有效率分別是83.33%和95.83%，兩組之間的差異在統(tǒng)計(jì)學(xué)上具有顯著性（P<0.05）。治療結(jié)束后，治療組患者外周關(guān)節(jié)疼痛、腫脹以及腰骶部疼痛的緩解時(shí)間顯著短于對(duì)照組（P<0.05）。經(jīng)過治療，兩組患者Th17細(xì)胞比例和Th17/Treg比值均顯著降低，而Treg細(xì)胞比例則明顯上升（P<0.05），且治療組在這些免疫學(xué)指標(biāo)上的改善程度顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組血清Caspase-1、PTX3和sTRAIL水平較治療前顯著降低（P<0.05），且治療后治療組各指標(biāo)改善顯著優(yōu)于對(duì)照組（P<0.05）。結(jié)論 阿達(dá)木單抗與美洛昔康聯(lián)合治療強(qiáng)直性脊柱炎效果顯著，不僅能大幅改善患者的軀體功能、疾病活動(dòng)度及生活質(zhì)量，還能有效促進(jìn)Th17/Treg平衡狀態(tài)的恢復(fù)及血清學(xué)指標(biāo)的改善。

Objective To explore the efficacy, safety, and impact on Th17/Treg balance of adalimumab combined with meloxicam in treatment of ankylosing spondylitis. Methods Patients（96 cases） with ankylosing spondylitis in the First Affiliated Hospital of Xinxiang Medical University from March 2022 to March 2024 were divided into control（48 cases） and treatment（48 cases） group based on different treatments. Patients in the control group were po administered with Meloxicam Tablets, 2 tablets/time, once daily. Patients in the treatment group were sc injection administered with Adalimumab Solution for injection, 40 mg/time, once every two weeks. Patients in two groups were treated for 3 months. After treatment, the clinical evaluations were evaluated, the main clinical symptom relief time, the scores of BASFI, BASDAI, and EASi QoL, Th17/Treg balance status, and the levels of serum Caspase-1, PTX3, and sTRAIL in two groups before and after treatment were compared. Results After treatment, the total effective rate of the control group and the treatment group was 83.33% and 95.83%, respectively, and the difference between the two groups was statistically significant（P＜0.05）. After treatment, the relief time of peripheral joint pain, swelling and lumbosacral pain in treatment group was significantly shorter than that in control group（P＜0.05）. After treatment, the proportion of Th17 cells and Th17/Treg ratio were significantly decreased in both groups, but the proportion of Treg cells was significantly increased（P＜0.05）, and the improvement degree of these immunological indicators in the treatment group was significantly better than that in the control group（P＜0.05）. After treatment, the levels of serum Caspase-1, PTX3 and sTRAIL in two groups were significantly decreased compared with those before treatment（P＜0.05）, and the improvement of indexes in treatment group was significantly better than that in control group after treatment（P＜0.05）. Conclusion The combination of adalimumab and meloxicam has a significant therapeutic effect on ankylosing spondylitis. It can not only significantly improve the physical function, disease activity, and quality of life of patients, but also promote the balance of Th17/Treg and the repair of serological indicators.

R914

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目(LHGJ20210518)