ARD：女性AS患者的病情更重、疗效更差

强直性脊柱炎（AS）是一种以炎性腰背痛、肌腱附着点炎及外周关节炎为主要特征的风湿免疫性疾病。既往认为，男性的发病率远高于女性。然而，最近一些研究发现，男女发病率之比仅为2-3:1。为明确性别因素是否对AS患者治疗中的临床症状、躯体功能及自我报告的疾病结局产生影响，来自荷兰阿姆斯特丹VU大学医学中心风湿免疫科的Irene E van der Horst-Bruinsma等人对四个对照性临床试验中的数据进行了研究。研究结果发表于2013年6月的《风湿病年鉴》（Ann Rheum Dis）杂志上。研究认为，女性AS患者的病情更重、疗效更差。

从四个临床对照性研究中，研究者获取了1283例活动性强直性脊柱炎（AS）患者的临床数据，这些患者应用依那西普、柳氮磺吡啶或安慰剂进行治疗。研究对象根据性别进行分组，分析各组患者以下几个方面的异同：基线状态时的人口统计数据、病情特征、AS治疗的疗效评价、安全性评价、12周治疗后中断治疗的比例。

326例女性患者与957例男性患者相比，其基线状态的数据有明显差异。女性患者相较于男性患者，其平均发病年龄更晚（35.0 vs 31.2岁；p＜0.001）、平均病程更短（7.4 vs 9.5；p＜0.001）、C反应蛋白水平更低（13.1 vs 20.9mg/l；p＜0.001），HLA-B27阳性率也更低（76.3% vs 85.2%；p＜0.001）。女性患者经过12周的治疗后，其疗效评估方面的各种积分改善值较男性更小（P＜0.001）（包括AS疾病活动性评分（0.87 vs -1.08）、巴氏AS疾病活动性指数（-19.22 vs -23.41）、巴氏AS躯体功能指数（-13.89 vs -16.88）等）。女性患者与男性相比，在以下几个方面的治疗前后改善值也较小，包括夜间腰背痛（4.04,95%CI 0.77-7.32；p＜0.05）、整体背痛（3.80,95%CI 0.77-7.32；p＜0.05）以及患者整体评分（4.79,95%CI 1.51-8.08；p＜0.01）等。

女性患者相较于男性，其AS疾病的病情更重，疾病改善度也更差，然而女性患者的发病年龄却更晚，病程也较短，此现象背后的机制尚不明确。未来需进行更多的研究，用以明确女性AS患者的疾病特征。

Female patients with ankylosing spondylitis: analysis of the impact of gender across treatment studies.
OBJECTIVES
To examine the impact (if any) of gender on the clinical, functional and patient-reported outcomes of treatment using data pooled from four controlled clinical trials.
METHODS
Study data were pooled from four clinical control trials in which 1283 adult patients with active ankylosing spondylitis (AS) were treated with etanercept, sulfasalazine or placebo. Patients were stratified by gender and analysed for differences/similarities in baseline demographics, disease characteristics, and efficacy in AS outcome measures and safety and discontinuation rates after 12 weeks of therapy.
RESULTS
Significant baseline differences were observed between 326 female patients compared with 957 male patients. Female patients had an older mean age of disease onset (35.0 vs 31.2 years; p<0.001), shorter mean time of disease duration (7.4 vs 9.5 years; p<0.001) and lower mean baseline C-reactive protein (13.1 vs 20.9 mg/l; p<0.001); a lower proportion was HLA-B27 positive (76.3% vs 85.2%; p<0.001) compared with male patients. Women had significantly (p<0.001) smaller differences in all week 12 efficacy assessments including AS disease activity score (0.87 vs -1.08), Bath AS disease activity index (-19.22 vs -23.41) and Bath AS functional index (-13.89 vs -16.88) relative to men. A similar relationship was observed between women and men in the adjusted mean difference of nocturnal back pain (4.04, 95% CI 0.77 to 7.32; p<0.05), total back pain (3.80, 95% CI 0.77 to 7.32; p<0.05) and patient global assessment (4.79, 95% CI 1.51 to 8.08; p<0.01).
CONCLUSIONS
Women had a higher burden of disease and less improvement in AS outcome measures compared with men. This was observed despite women having a later disease onset of shorter duration; the mechanism behind this observation is unclear. Additional research is necessary to better understand female patients with AS and the burden of disease in this population.