基于国内文献的SAPHO临床特征及治疗研究探讨

发布时间：2018-04-17 02:07

  本文选题：SAPHO + 临床特征　； 参考：《世界中西医结合杂志》2017年04期

【摘要】：目的总结国内SAPHO患者的临床特征及治疗方法。方法计算机检索中国知网、万方数据库,检索词为"SAPHO",时间限定为1999年1月至2016年5月,排除重复文献及不完整病例文献。纳入文献相关信息,包括一般资料、临床表现、实验室指标、影像学检查、病理结果、治疗药物及疗效。结果共纳入62篇文献,报道SAPHO患者75例。75例患者男女比例为1∶1.5,发病年龄17~66岁。临床滑膜炎89.3%、痤疮24%、脓疱疮78.7%、骨肥厚96%、骨炎100%,其中胸骨、胸锁、锁骨疼痛90.7%,腰、骶髂、髋关节疼痛66.7%;实验室指标提示C反应蛋白水平升高占45.3%,红细胞沉降率加快占62.7%,人体白细胞抗原B27(HLA-B27)阴性占94.7%。影像学(X线)检查提示胸骨、胸锁、锁骨关节局部增生硬化,关节间隙变小。胸骨、胸锁、锁骨CT检查32例,提示胸骨局部不同程度密度增高,胸锁关节及胸骨改变;腰、骶髂、髋关节38例可见骶髂关节间隙模糊、变窄;骨扫描前胸壁骨关节有异常示踪剂浓集者15例,骶髂关节有异常示踪剂浓集者13例;病理检查提示皮肤脓疱疮病理53例,均可见表皮不同程度角化,表皮内可见脓疱,真皮浅层胶原纤维增生及慢性炎细胞浸润,骨活检病理13例,可见纤维组织增生及肉芽组织样改变。治疗方案及药物提示两种药物联合治疗占50.7%,两种以上药物治疗占41.3%,其中单用或联合糖皮质激素治疗30.7%,单用或联合免疫抑制剂(或抗风湿药)治疗85.3%,单用或联合生物制剂治疗13.3%,单用或联合非甾体消炎药18.7%。结论 SAPHO发病率较低,各年龄段均可发病,男性稍低于女性,但婴幼儿少见。目前诊断以临床症状及影像学特异性表现为依据,药物治疗以免疫抑制剂联合方案为主,中药治疗有效,可能会成为治疗SAPHO的一个新的方向。
[Abstract]:Objective to summarize the clinical features and treatment of SAPHO patients in China.Methods A computer search was carried out for Chinese Zhiwang, Wanfang database with the key word "SAPHO", the time limit was from January 1999 to May 2016, and duplicated literature and incomplete case literature were excluded.Include literature related information, including general information, clinical manifestations, laboratory indicators, imaging, pathological results, therapeutic drugs and efficacy.Results A total of 62 articles were included. It was reported that the male / female ratio of 75 / 75 patients with SAPHO was 1: 1.5 and the onset age was 17 to 66 years old.Clinical synovitis 89. 3, acne 24, pustule 78. 7, bone hypertrophy 96, osteositis 100, sternum, chest lock, clavicle pain 90.7, waist, sacroiliac,The laboratory index showed that the level of C-reactive protein was increased in 45.33.The erythrocyte sedimentation rate was 62.7%, and the negative rate of HLA-B27 was 94.7%.X-ray examination showed that sternum, sternoclavicular, clavicular joint local hyperplasia and sclerosis, joint space become smaller.Ct examination of sternum, sternoclavicular and clavicle showed that the local density of sternum was increased, the sternoclavicular joint and sternum were changed, the space of sacroiliac joint was blurred and narrowed in 38 cases of lumbar, sacroiliac and hip joints.Abnormal tracer concentration was found in 15 cases and abnormal tracer concentration in sacroiliac joint in 13 cases before bone scan, pathological examination showed that skin pustular ulcers in 53 cases, epidermis keratosis was seen in all cases, and pustule could be seen in epidermis.Superficial dermal collagen proliferation and chronic inflammatory cell infiltration, bone biopsy in 13 cases, fibrous tissue proliferation and granulomatous tissue changes can be seen.Treatment regimen and drug cues account for 50.7%, and more than two drugs account for 41.3%, including 30.7 for single or combined glucocorticoid therapy, 85.3 for single or combined immunosuppressive agents (or antirheumatic drugs), and 85.3 for single or combined use or combination of glucocorticoids.Substance preparation for treatment of 13. 3%, single or combined with non-steroidal anti-inflammatory drug 18. 7.Conclusion the incidence of SAPHO is lower in all age groups, slightly lower in males than in females, but rare in infants.At present, the diagnosis is based on clinical symptoms and imaging characteristics. The combination of immunosuppressive drugs and traditional Chinese medicine is effective, which may become a new direction in the treatment of SAPHO.
【作者单位】： 北京中医药大学东方医院风湿科;
【基金】：国家中医药管理局重点学科开放课题“中医痹病学”(2013-ZDXKKF-39)
【分类号】：R259
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本文编号：1761574