Chitul A, Voiosu A M, Marinescu Mădălina, Caraiola Simona, Nicolau Adriana, Badea Georgeta Camelia, Pârvu Magda Ileana, Ionescu R A, Mateescu B R, Voiosu M R, Băicuş C R, Rimbaş M
Rom J Intern Med. 2017 Mar 1;55(1):44-52. doi: 10.1515/rjim-2017-0001.
BACKGROUND & AIMS: Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients.
Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream.
The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively).
Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).
鉴于抗TNFα药物能够减轻炎症性肠病（IBD）患者的肠道炎症负担，且IBD与强直性脊柱炎（AS）在肠道炎症累及方面具有相似性，我们旨在研究抗TNFα生物疗法对AS患者亚临床肠道炎症的影响。
2008年1月至2013年12月期间，38例AS患者和23例对照纳入本研究，接受小肠胶囊内镜检查和回结肠镜检查。根据图像流计算Lewis评分，对小肠的每三分位（近端、中段和远端）进行评估。
与对照组相比，AS组的Lewis评分显著更高（580.9±818 vs. 81±121，p<0.001）。16例患者（42.1%）接受抗TNFα治疗（阿达木单抗（n = 5）、英夫利昔单抗（n = 5）或依那西普（n = 6））。其中31.3%的患者同时使用非甾体抗炎药，而其他患者中这一比例为77.3%（p<0.01）。他们整个小肠的Lewis评分低于其他患者（306±164 vs. 790±1038，p = 0.015），小肠近端和远端三分位的评分也较低（分别为238±154 vs. 560±543，p = 0.021，以及140±189 vs. 300±220，p = 0.027）。接受阿达木单抗/英夫利昔单抗治疗的患者，其整个肠道及其远端三分位的Lewis评分也低于接受依那西普治疗的患者（分别为262±165 vs. 380±148，p = 0.069，以及62±101 vs. 273±236，p = 0.060）。
AS患者接受抗TNFα治疗可减轻亚临床肠道炎症，但减轻程度似乎取决于所使用的抗TNFα药物类别（临床试验.gov NCT00768950）。
