SAPHO综合征影像表现及临床特点分析

Analysis for the imaging features and clinical characteristics of SAPHO syndrome

目的研究SAPHO综合征影像征象及临床特点,以提高本病的诊断及治疗水平。方法回顾性分析确诊的7例SAPHO综合征患者的影像资料,结合实验室检查、临床诊疗经过并查阅国内外相关文献对该病进行分析、讨论。结果7例患者中皮肤损害4例;前胸壁受累5例,胸骨病变5例、胸锁关节3例、胸肋关节2例、肋骨4例。胸椎受累3例,包括胸、腰椎同时受累1例,共累及9个椎体、5个终板。骶髂关节受累3例共5个骶髂关节受累,单侧受累1例,双侧受累2例,髋关节受累1例。全身骨显像特征性“牛头征”4例。经临床治疗后皮肤损害好转3例,前胸或腰骶部疼痛减轻5例,背部痤疮仍间歇发作1例。结论SAPHO综合征骨关节损伤常累及前胸壁、脊柱、骶髂关节及髋关节,表现为骨质肥厚、硬化、关节软骨面下骨侵蚀,“牛头征”为特征性表现,骨关节损害和皮肤病变常不同步。本病尚无统一治疗指南以非甾体抗炎药、抗风湿药和免疫抑制剂为主,重症者可个体化治疗。

Objective To investigate the imaging signs and clinical manifestations of SAPHO syndrome,so as to improve the diagnosis and treatment levels for the disease.Methods The image data about 7 patients with SAPHO syndrome who were diagnosed in our hospital from March 2008 to December 2019 were retrospectively analyzed.Combining with laboratory examination,clinical signs,curative effect evaluation and reviewing relevant literature at home and abroad,the disease was analyzed and discussed.Results Among the 7 patients,there were 4 cases of skin damage,5 cases of anterior chest wall involvement,5 cases of sternal lesions,3 cases of sternoclavicular joints,2 cases of Sternocostal joints and 4 cases of ribs.Thoracic vertebrae were involved in 3 cases,including 1 case of both thoracic and lumbar vertebrae,involving 9 vertebrae and 5 endplates.And sacroiliac joint was involved in 3 cases,totally 5 sacroiliac joints were involved,1 case was unilateral,2 cases were bilateral,and 1 case was in hip joint,and there were 4 cases of“cattle head sign”.After treatment,the skin damage was improved in 3 cases,the pain of 5 cases in the anterior chest or lumbosacral region was relieved,and 1 case with acne on the back still attacking intermittently.Conclusion SAPHO syndrome has characteristic manifestations in thoracic costal joint,spine,sacroiliac joint and hip joint,and“bull head syndrome”is characteristic.The treatment of the disease is mostly symptomatic support therapy,mainly including non steroidal anti-inflammatory drugs,anti rheumatic drugs,glucocorticoids and immunosuppressants,moreover,the severe cases can be treated individually.