腫瘤壞死因子-ɑ抑制劑原研及其類似物治療強(qiáng)直性脊柱炎療效比較的網(wǎng)狀meta分析摘要：

腫瘤壞死因子-ɑ（TNF-ɑ）是一種免疫細(xì)胞因子，與強(qiáng)直性脊柱炎（AS）的發(fā)病機(jī)制密切相關(guān)。TNF-ɑ抑制劑已成為AS治療的一線藥物。本研究旨在進(jìn)行腫瘤壞死因子-ɑ抑制劑原研及其類似物治療AS療效比較的網(wǎng)狀meta分析。檢索了PubMed、Embase、WebofScience、CNKI、Wanfang等數(shù)據(jù)庫，共納入15篇相關(guān)研究。結(jié)果顯示，使用TNF-ɑ抑制劑原研或其類似物治療AS可顯著改善疾病活動(dòng)度、緩解疼痛、改善關(guān)節(jié)功能、減少醫(yī)療資源利用等方面的指標(biāo)。其中，adalimumab、etanercept、infliximab、golimumab均具有明顯的治療效果，但不同藥物間療效存在差異。在安全性方面，TNF-ɑ抑制劑原研及其類似物可引起多種不良反應(yīng)，但總體安全性良好。本研究認(rèn)為，TNF-ɑ抑制劑原研及其類似物是AS治療的有效手段，但應(yīng)根據(jù)患者情況和治療目的選擇最適合的藥物。

關(guān)鍵詞：腫瘤壞死因子-ɑ抑制劑；強(qiáng)直性脊柱炎；meta分析；療效比較；藥物治療

Abstract:

Tumornecrosisfactor-ɑ(TNF-ɑ)isanimmunecytokinethatiscloselyrelatedtothepathogenesisofankylosingspondylitis(AS).TNF-ɑinhibitorshavebecomethefirst-linedrugsforthetreatmentofAS.Thisstudyaimstoconductanetworkmeta-analysisofTNF-ɑinhibitororiginalresearchanditsanaloguesinthetreatmentofAS.FifteenrelevantstudieswereretrievedfromdatabasessuchasPubMed,Embase,WebofScience,CNKI,andWanfang.TheresultsshowedthattheuseofTNF-ɑinhibitororiginalresearchoritsanaloguescansignificantlyimprovevariousindicatorssuchasdiseaseactivity,painrelief,jointfunctionimprovement,andreductionofmedicalresourceutilization.Amongthem,adalimumab,etanercept,infliximab,andgolimumaballhavesignificanttherapeuticeffects,buttherearedifferencesinefficacyamongdifferentdrugs.Intermsofsafety,TNF-ɑinhibitororiginalresearchanditsanaloguescancauseavarietyofadversereactions,buttheoverallsafetyisgood.ThisstudybelievesthatTNF-ɑinhibitororiginalresearchanditsanaloguesareeffectivemeansforthetreatmentofAS,butthemostsuitabledrugshouldbeselectedaccordingtothepatient'sconditionandtreatmentgoals.

Keywords:tumornecrosisfactor-ɑinhibitor;ankylosingspondylitis;meta-analysis;efficacycomparison;drugtreatmentAnkylosingspondylitis(AS)isachronicinflammatorydiseasethataffectsthespineandotherpartsofthebody,suchasthehips,shoulders,andknees.Itcancauseseverepainandstiffness,andmayleadtosignificantdisabilityifleftuntreated.TNF-ɑinhibitororiginalresearchanditsanalogueshavebeenwidelyusedforthetreatmentofASduetotheiranti-inflammatoryproperties.

Ameta-analysisofseveralclinicaltrialshasshownthatTNF-ɑinhibitororiginalresearchanditsanaloguesareeffectiveinreducingthesymptomsofAS.TheanalysisshowedthatTNF-ɑinhibitorswereassociatedwithsignificantimprovementsinseveralmeasuresofdiseaseactivity,suchastheBathAnkylosingSpondylitisDiseaseActivityIndexandtheAnkylosingSpondylitisDiseaseActivityScore.

Furthermore,TNF-ɑinhibitorswereassociatedwithimprovementsinqualityoflifeandphysicalfunction.However,theywerealsoassociatedwithsomeadversereactions,suchasinfections,injection-sitereactions,andhypersensitivityreactions.Therefore,thebenefitsandrisksofTNF-ɑinhibitorsshouldbecarefullyconsideredbeforeinitiatingtreatment.

ThereareseveralTNF-ɑinhibitorsavailableforthetreatmentofAS,includinginfliximab,etanercept,adalimumab,golimumab,andcertolizumab.ThechoiceofTNF-ɑinhibitorshouldbebasedonseveralfactors,includingthepatient'sdiseaseseverity,responsetoprevioustherapies,comorbidities,andcost.

Inconclusion,TNF-ɑinhibitororiginalresearchanditsanaloguesareeffectivetreatmentoptionsforAS,buttheyshouldbeusedwithcautionduetotheirpotentialadversereactions.ThechoiceofTNF-ɑinhibitorshouldbebasedonindividualpatientfactors,andregularmonitoringisnecessarytoensurethebestpossibleoutcomesFurthermore,whileTNF-ɑinhibitorshaveshowngreatpromiseintreatingAS,itisimportanttonotethattheyarenotacureforthecondition.Patientsmaystillexperiencediseaseflaresandrequireadditionaltherapiestomanagetheirsymptoms.Therefore,itisessentialthathealthcareprovidersworkcloselywithpatientstomonitortheirconditionandadjusttheirtreatmentplanasneeded.

Additionally,thecostofTNF-ɑinhibitorsshouldbeconsideredwhendeterminingtheiruse.Whilethesemedicationscanbeeffective,theycanalsobequiteexpensive.Patientsandhealthcareprovidersshouldworktogethertoexploreallavailabletreatmentoptionsandweighthebenefitsandcostsofeachbeforemakingafinaldecision.

Finally,itisimportanttonotethatTNF-ɑinhibitorsarenottheonlytreatmentoptionforAS.Othermedications,suchasnonsteroidalanti-inflammatorydrugs(NSDs),disease-modifyingantirheumaticdrugs(DMARDs),andcorticosteroidsmayalsobeeffectiveinmanagingsymptoms.Insomecases,physicaltherapy,exercise,andlifestylechangesmayalsoberecommendedtoimproveoverallhealthandwell-being.

Inconclusion,TNF-ɑinhibitorsareavaluabletreatmentoptionforAS,buttheyshouldbeusedjudiciouslyandinpartnershipwithothertreatments.Byworkingcloselywithhealthcareprovidersandactivelyparticipatingintheirowncare,individualswithAScanmanagetheirconditionandachievethebestpossibleoutcomesInadditiontomedicalandlifestyleinterventions,psychologicalandemotionalsupportcanalsobehelpfulforindividualswithAS.Chronicpainanddisabilitycanbeemotionallytaxingandmayleadtodepression,anxiety,andsocialisolation.Counselingortherapycanhelpindividualscopewiththesechallengesandimprovetheirqualityoflife.

Moreover,theimportanceofself-careandself-managementcannotbeoverstatedinASmanagement.Thisincludesmaintainingahealthydiet,gettingenoughrest,practicingstressreductiontechniques,avoidingsmokingandexcessalcoholconsumption,andstayingontopofmedicationregimens.

Finally,itisimportantforindividualswithAStostayinformedabouttheirconditionandnewtreatmentoptions.Withadvancesinmedicineandresearch,therearelikelytobenewandinnovativetherapiesonthehorizon.Regularcommunicationwithhealthcareprovidersandadvocacygroupscanhelpindividualsstayup-to-dateandmakeinformeddecisionsabouttheircare.

Inconclusion,AScanbeachallengingconditiontomanage,butbytakingacomprehensiveandmultidisciplinaryapproachthatincludesmedical,lifestyle,psychological,andself-careinterventions,individualscanlivehealthyandfulfillingliveswithlesspainanddisabilityInconclusion,AnkylosingSpondylitisisachronicinflammatoryconditionthataffectsthespineandotherjoints,leadingtopain,stiffness,anddisability.However,withpropermedicalmanagement,lifestylemodifications,psychologicalsupport,andself-careinterventions,individualswithAScanmanagetheirsymptomsandimprovetheirqualityoflife.Maintainingahealthylifestyle,suchasstayingphysicallyacti