肥大性骨关节病病例分析并文献复习

Clinical analysis of hypertrophic osteoarthropathy

目的提高对肥大性骨关节病（HOA）的认识、诊断和鉴别。方法报告我院2例原发性HOA（PHOA）及3例继发性HOA（S／40A）确诊病例，并分析既往国内报道16例文献。结果国内PHOA发病年龄多数在14～24岁，多为男性，最小者1岁起病，最大者为42岁。18例PHOA患者中2例有家族史，2例有近亲结婚史，所有患者均有杵状指（趾）、皮肤增厚粗糙、骨膜增生的临床表现，多汗14例，回状颅皮9例，关节痛和（或）关节积液10例，指（趾）端骨质溶解4例，类风湿因子阳性2例，1例弱阳性。我院报告3例SHOA均继发于肺部肿瘤，中年后起病，病程较短，以关节症状及杵状指（趾）为主要表现，面部及皮肤症状少，全身伴随症状多见。结论PHOA青少年起病多见，男性多，主要表现为杵状指（趾）、皮肤增厚及骨膜反应。与SHOA需从起病年龄、病程及全身伴随症状等方面鉴别。

Objective To help clinicians understanding and better diagnosing of hypertrophic osteoarthropathy （HOA）. Methods Clinical data of five HOA patients in Jishuitan Hospital were analyzed and the literature were reviewed. Results In 18 patients with primary HOA （PHOA）, their age ranged from 14 to 24 years. Seventeen patients were male. Most PHOA occurred in age 1 to 42. Two of them had positive family history. Clubbing fingers, hypertrophic skin changes and radiographic evidence of periostitis were found in all patients. Nine of them had curls vertices gyrate, 14 patients had hyperhydrosis and 10 patients had symmetrical joints swelling. Three secondary HOA （SHOA） patients of our hospital, predominantly manifested as symmetrical joints swelling with mild joint tender and clubbing fingers. There were no skin changes in these 3 patients. Conclusion PHOA predominantly manifests as clubbing fingers, hypertrophic skin changes and periostitis.