Gaydukova I Z, Khondkaryan E V, Aparkina A V, Rebrov A P
V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia, Saratov, Russia.
Ter Arkh. 2017;89(5):38-45. doi: 10.17116/terarkh201789538-45.
To estimate changes in the concentrations of adhesion molecules and vascular endothelial growth factor A after 30-day additional use of amtolmetin guacil (AMG) in patients with active ankylosing spondylitis (AS) who were unresponsive to previous one-year treatment with nonsteroidal anti-inflammatory drugs (NSAIDs).
20 patients with active AS who had not reached a BASDAI score <4.0 at week 52 of NSAID therapy and 10 healthy individuals matched for cardiovascular risk factors were examined. After 52 weeks of NSAID therapy, AMG was administered orally at 1200 mg/day to patients with AS for 30 days. The concentrations of adhesion molecules (sICAM-1 and sVCAM-1) and VEGF-A were measured. BASDAI and ASDAS scores and C-reactive protein (CRP) levels were determined in AS patients. The concentrations of adhesion molecules and VEGF-A were investigated in patients with AS at baseline, at 52 weeks after NSAID treatment start, and at 30 days following AMH initiation (at week 56) and in healthy individuals at baseline and at 30 days.
The concentration of sICAM-1 in patients with AS was 987.0±217.39, 938.98±293.31, and 364.25±363.3 ng/ml at weeks 0, 52, and 56, respectively; that in healthy individuals was 769.25±189.32 and 740.05±225.76 ng/ml at baseline and at 30 days, respectively. The differences from the baseline concentration were significant in patients with AS (p<0.05) and insignificant in healthy subjects (p≥0.05); the differences between the concentrations in patients with AS and the controls were significant at baseline and at 52 weeks (p<0.05). The concentration of sVCAM-1 in patients with AS was 364.25±160.49, 325.34±245.1, and 319.1±248.73 ng/ml at weeks 0, 52 and 56, respectively; that in healthy individuals was 245.13±40.4 and 248.73±34.42 ng/ml, respectively (p<0.05 vs baseline values and values in healthy subjects). The level of VEGF-A in AS patients was not different from that in healthy individuals, but decreased during treatment. Correlations were found between the concentration of adhesion molecules and the level of CRP (p<0.01).
Elevated concentrations of adhesion molecules have been found in AS patients compared with healthy individuals. The study has demonstrated that AMG treatment is efficient in treating patients with AS. NSAID/AMG treatment is associated with lower concentrations of adhesion molecules. Decreased CRP levels serve as predictors for reduced concentration of adhesion molecules. The level of VEGF-A at baseline did not differ from that in healthy subjects, but was decreased during treatment with NSAIDs.
评估在对非甾体抗炎药（NSAIDs）进行了为期一年的治疗仍无反应的活动性强直性脊柱炎（AS）患者中，额外使用安多美汀瓜西（AMG）30天后黏附分子和血管内皮生长因子A浓度的变化。
对20例在NSAID治疗第52周时BASDAI评分未达到<4.0的活动性AS患者以及10名匹配心血管危险因素的健康个体进行检查。在NSAID治疗52周后，给予AS患者口服AMG，剂量为1200mg/天，持续30天。检测黏附分子（sICAM-1和sVCAM-1）和VEGF-A的浓度。测定AS患者的BASDAI和ASDAS评分以及C反应蛋白（CRP）水平。在基线时、NSAID治疗开始后52周、AMG开始使用后30天（第56周）对AS患者的黏附分子和VEGF-A浓度进行研究，并在基线时和30天时对健康个体进行研究。
AS患者的sICAM-1浓度在第0周、第52周和第56周分别为987.0±217.39、938.98±293.31和364.25±363.3ng/ml；健康个体在基线时和30天时分别为769.25±189.32和740.05±225.76ng/ml。AS患者与基线浓度的差异具有统计学意义（p<0.05），而健康受试者差异无统计学意义（p≥0.05）；AS患者与对照组在基线时和52周时的浓度差异具有统计学意义（p<0.05）。AS患者的sVCAM-1浓度在第0周、第52周和第56周分别为364.25±160.49、325.34±245.1和319.1±248.73ng/ml；健康个体分别为245.13±40.4和248.73±34.42ng/ml（与基线值和健康受试者的值相比，p<0.05）。AS患者的VEGF-A水平与健康个体无差异，但在治疗期间降低。发现黏附分子浓度与CRP水平之间存在相关性（p<0.01）。
与健康个体相比，AS患者中黏附分子浓度升高。该研究表明AMG治疗对AS患者有效。NSAID/AMG治疗与较低的黏附分子浓度相关。CRP水平降低是黏附分子浓度降低的预测指标。基线时VEGF-A水平与健康受试者无差异，但在NSAIDs治疗期间降低。
