Observation of the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis and its regulating effect on patients' serum interleukin-17/ interleukin-4 / 中国医师进修杂志

ABSTRACT

Objective:To explore the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis (AS) and its regulation of serum interleukin (IL)-17/IL-4.Methods:A total of 117 patients with AS in the First Hospital of Baoding from July 2016 to June 2019 were selected as prospective research subjects, and they were simply randomized into three groups, with 39 cases in each group. The control group A was treated with methotrexate, the control group B was treated with methylprednisolone, and the observation group was treated with methotrexate combined with methylprednisolone. The chi-square test was used to compare the clinical efficacy and the incidence of adverse reactions in the three groups. F-test was used to compare the thoracolumbar spine mobility, Bath AS disease activity index (BASDAI), Bath AS function index (BASFI) scores, the levels of serum high mobility protein 1 (HMGB1), matrix metalloproteinase-3 (MMP-3), interleukin (IL)-4, IL-17, and IL-17/IL-4 before and after the treatment of the three groups. Results:The total effective rate of treatment in the observation group was better than that in the control groups A and B92.31%(36/39) vs. 74.36%(29/39) and 69.23%(27/39), P<0.05. After the course of treatment, the BASDAI and BASFI scores in the observation group were lower than those in the control group A and B, and the thoracolumbar spine mobility were higher than those in the control group A and B (3.36 ± 1.03) scores vs. (4.62 ± 1.19), (4.98 ± 1.25) scores; (3.70 ± 0.89) scores vs. (4.36 ± 0.96), (4.64 ± 0.95) scores; (4.96 ± 1.17) cm vs. (4.18 ± 1.02), (3.98 ± 1.15) cm, (5.93 ± 1.32) cm vs.(5.02 ± 1.15), (4.92 ± 1.25)cm, P<0.05. After the course of treatment, serum HMGB1, MMP-3, IL-17, IL-17/IL-4 in the observation group were lower than those in the control group A and B (20.25 ± 6.41) μg/L vs. (27.81 ± 7.63), (29.26 ± 7.31) μg/L; (4.83 ± 1.06) μg/L vs. (9.26 ± 1.25), (9.71 ± 1.28) μg/L; (13.41 ± 5.06)ng/L vs.(17.62 ± 5.61), (19.06 ± 6.14) ng/L; 0.51 ± 0.27 vs. 0.92 ± 0.41, 1.04 ± 0.45, P<0.05; and IL-4 was higher than that in the control groups A and B (26.15 ± 4.94) ng/L vs. (19.16 ± 5.14), (18.32 ± 5.26) ng/L, P<0.05. There was no significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:The combination of methylprednisolone and methotrexate in the treatment of AS can significantly reduce serum HMGB1 and MMP-3 levels, regulate serum IL-17/IL-4 and further improve the therapeutic effect, and it has high safety.