成人SAPHO综合征的临床及影像表现分析

The clinical and imaging manifestations of SAPHO syndrome

目的:探讨SAPHO综合征的影像学及临床特征,分析男女差异,提高对本病的认识及诊断正确率。方法:回顾性分析2015—2018年期间在陆军军医大学第一附属医院诊断的27例(男8例,女19例)SAPHO综合征患者的临床及影像特征,并进行文献复习。结果:SAPHO综合征主要表现为骨、关节肿痛(27例)及皮肤脓疱病、痤疮、化脓性汗腺炎(8例)等。影像表现均为骨及关节的骨质破坏、硬化、肥厚,髓腔狭窄、消失等慢性炎症性改变,骨显像出现典型“牛头征”等。主要累及前胸壁、脊柱及骶髂关节,分别为23例、11例、8例,而累及其他部位骨质者仅2例为男性。皮肤受累者2例男性均为痤疮。而脓疱病仅发生于女性。结论:SAPHO综合征影像表现为炎症病变与骨质肥厚等硬化性病变并存,前胸壁病变最为特征性;男女患者在皮肤病变与骨质累及部位上可能存在一定差异;工作中应结合临床及影像表现综合分析,提高对本病的认识及诊断正确率。

Objective:To explore the clinical and imaging features of SAPHO syndrome and analyze the differences between men and women,so as to improve the understanding and diagnostic accuracy of SAPHO syndrome.Methods:The clinical and imaging manifestations(including X-ray,CT,MRI,^(18)F-FDG PET/CT and bone scintigraphy)of 27 cases(8 males and 19 females)diagnosed in the First Affiliated Hospital of Army Military Medical University from 2015 to 2018 were retrospectively analyzed.And the literature was reviewed.Results:Of the 27 patients with SAPHO syndrome,27 presented with bone and joint swelling and pain,and 8 presented with skin pustules,acne and hidradenitis suppurativa.The imaging manifestations were bone destruction,sclerosis,hypertrophy,spinal cavity stenosis,disappearance and other chronic inflammatory changes in bone and joint.The patients with vertebral involvement showed inflammation of vertebral angle,end-plate osteochondritis and osteosclerosis.^(18)F-FDG PET/CT showed increased uptake of FDG in bone and typical“bovine head sign”in bone imaging.The anterior chest wall,spine,and sacroiliac joints were mainly involved in 23 cases,11 cases,and 8 cases,respectively,while only 2 cases of other bone involved were male.In the patients of skin involvement,acne was only found in 2 males and pustule was only found in females.Conclusion:The imaging manifestations of SAPHO syndrome include inflammatory lesions and sclerotic lesions such as hypertrophy of bone,with anterior chest wall lesions being the most characteristic.There may be some differences between male and female patients in skin lesions and bone involvement sites.In order to improve the recognition and diagnostic accuracy of this disease,it is necessary to combine the comprehensive analysis of clinical and imaging manifestations.