目的 分析结缔组织病(CTD)合并沙门菌骨、关节感染患者的临床特征.方法 回顾性分析宁波市第一医院确诊的1例及文献报道10例,共11例CTD合并沙门菌骨、关节感染患者的临床表现、实验室检查、诊治及预后.结果 11例CTD合并沙门菌骨、关节感染的患者中,系统性红斑狼疮(SLE)合并6例,类风湿关节炎(RA)合并4例,成人Still病(AOSD)合并1例.患者均长期使用糖皮质激素或免疫抑制剂治疗,4例RA患者起病前均予生物制剂治疗,3例患者起病前曾行关节置换术,2例患者起病前曾有不洁饮食史,1例患者起病前有劳累史.常见临床表现包括骨痛11例,发热9例,消化道症状2例;感染部位包括下肢长骨6例,髋关节3例,耻骨联合1例,左肘1例.11例患者均有不同程度的C反应蛋白(CRP)升高,平均(132.0±26.2)mg/L;9例患者白细胞计数(WBC)正常,2例患者WBC升高;3例患者为肠炎沙门菌感染,2例为鼠伤寒,1例为D组沙门菌,1例为非伤寒沙门菌.3例患者行骨活检明确诊断,其他8例根据关节腔穿刺培养或滑膜活检结合影像学检查明确诊断.患者均予以抗生素保守治疗,6例患者联合手术治疗.5例患者痊愈,1例复发,3例遗留骨/关节功能障碍.结论 CTD合并沙门菌骨髓炎并非罕见,其中以SLE合并常见,多长期应用糖皮质激素及免疫抑制剂,使用生物制剂及关节置换手术可能亦为发生沙门菌骨病的危险因素;最常见受累部位为下肢长骨,多伴有CRP水平升高;该病致残率高,需早期发现、积极治疗.%Objective To assess the clinical features of connective tissue disease(CTD) combined with salmonella arthritis and osteomyelitis.Methods The clinical manifestations,laboratory findings,diagnosis,treatment and prognosis of 11 patients with CTD with salmonella arthritis and osteomyelitis were retrospectively analyzed,including 1 from Ningbo First Hospital and 10 reported by articles.Results The main data of the 11 cases were as follows:6 were accompanied with systemic lupus erythematosus (SLE),4 were with rheumatoid arthritis (RA),1 was with adults-onset Still's disease (AOSD);all received long-term treatment with corticosteroids or immunosuppressive agents,and before the onset of the disease,the 4 RA cases received treatment with biological agents,3 underwent joint replacement,2 patients had a history of unclean diet, 1 had a fatigue history;common clinical manifestations:all had bone pain,9 had fever and 2 had digestive tract symptoms;site of involvement:long bone of the lower extremity(6 cases),the hip joint(3 cases),pubic symphysis(1 case), left elbow(1 case);laboratory findings:the level of CRP increased to varying degrees in all cases with the average level of (132.0±26.2) mg/L,the WBC level was normal in 9 cases,elevated in 2 cases;pathogenic bacteria:3 were infected by salmonella enteritidis,2 by salmonella tphimurium,1 by group D salmonella,and 1 by nontyphoid salmonella;accessory examination:bone biopsy was performed in 3 cases,the others underwent joint aspiration or synovial biopsy combined with imaging examination;treatment:all were treated with antibiotics,6 of them additionally received surgery;outcome:5 were cured,1 had recurrence,3 had bone/joint dysfunction.Conclusion CTD with salmonella osteomyelitis is not rare,especially in SLE.It is mostly caused by long period use of corticosteroids and immunosuppressive agents,and may also caused by the treatment with biological agents and joint replacement surgery.Long bone of the lower extremity is the most common affected site,and elevated CRP level can often be found.The disease has a high disability rate,so early detection and active treatment are needed.
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