中西医结合治疗SAPHO综合征1例

吕文丽 史周薇 林昌松

[摘要] 滑膜炎、痤疮、脓疱病、骨肥厚和骨炎（SAPHO）综合征是一种累及皮肤、骨和关节的罕见慢性病，其皮肤病变具有特征性，包括掌跖部脓疱病、膿疱性牛皮癣、暴发性痤疮、聚合性痤疮及化脓性汗腺炎等，但皮肤表现并非必须。骨关节改变中胸肋锁区的骨肥厚和骨硬化，也就是“牛头征”，具有高度特征性。SAPHO综合征具有误诊概率大、诊断花费时间长、无公认诊疗指南等特点，给本病患者造成巨大的负担和困扰。而中医辨证论治在控制SAPHO综合征患者疾病活动度、改善患者生存质量方面有明显疗效。本文结合1例SAPHO患者的中西医诊治过程，并进行文献回顾，以期加强对本病的认识，同时探索中医药治疗本病的优势。

[关键词] SAPHO综合征;中西医结合;诊断;治疗

[中图分类号] R593          [文献标识码] A          [文章编号] 1673-7210（2020）07（c）-0173-04

Treatment of SAPHO syndrome with combination of Chinese and Western medicine： a case report

LYU Wenli1   SHI Zhouwei2   LIN Changsong3

1.The First Clinical Medical College， Guangzhou University of Chinese Medicine， Guangdong Province， Guangzhou   510006， China; 2.Department of Rheumatology， the First Affiliated Hospital of Guangzhou University of Chinese Medicine， Guangdong Province， Guangzhou   510405， China

[Abstract] Synovitis， acne， pustulosis， hyperostosis， and osteitis （SAPHO） syndrome is a type of rare disease involving skin， bone and joint lesions. Its skin lesions are characteristic， including palmoplantar pustular disease， pustular psoriasis， fulminant acne， acne conglobata and hidradenitis suppurativa， but skin manifestations are not necessary. Osteoarticular changes in the middle sternal rib clavicle area of bone fat thickness and bone sclerosis， that is， “tau sign” has a high degree of characteristics. Due to the characteristics of SAPHO syndrome， such as high misdiagnosis rate， long diagnosis time， and no recognized diagnosis and treatment guidelines， SAPHO syndrome has caused huge burden and trouble to patients with this disease. The diagnosis and treatment based on TCM syndrome differentiation can give patients with SAPHO syndrome a significant effect in controlling disease activity and improving quality of life. This paper reports a case of SAPHO syndrome treated with traditional Chinese and Western medicine and reviews related literature， so as to increase the understanding of SAPHO syndrome， at the same time to explore the advantages of TCM in treating this disease.

[Key words] SAPHO syndrome; Combination of Chinese and Western medicine; Diagnosis; Treatment

滑膜炎、痤疮、脓疱病、骨肥厚和骨炎（synovitis，acne，pustulosis，hyperostosis，and osteitis，SAPHO）综合征是关于皮肤病和骨关节病的一组临床证候，其诊断颇具挑战性，极易误诊、漏诊。目前为止，我国病例报道不超过200例，且尚无规范的诊治指南，在国内报道较少，关于联合中医药治疗的报道更是鲜见。SAPHO综合征男女老幼均可发病，疾病的早期症状可不典型，首发症状可为隐匿的关节痛，全身骨扫描可见“牛头征”，为该病特征性表现。皮肤组织与关节症状可不同步，但其出现对于SAPHO综合征的诊断及鉴别具有重要意义。SAPHO综合征患者常需经历更换数个门诊医师，才能得以确诊，易被误诊为骨结核、强直性脊柱炎、皮肤性病等。……