上海口腔医学

上海口腔医学 ›› 2025, Vol. 34 ›› Issue (5): 483-489.doi: 10.19439/j.sjos.2025.05.006

• 论著 • 上一篇    下一篇

涉及下颌骨的青少年慢性非细菌性骨髓炎35例临床分析

王菡韶1, 王轶雯1, 魏文斌1, 霍亮1, 李江2, 陈敏洁1   

  1. 1.上海交通大学医学院附属第九人民医院 口腔外科,2.口腔病理科, 上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心, 上海市口腔医学重点实验室, 上海市口腔医学研究所,上海 200011
  • 收稿日期:2024-07-22 修回日期:2024-09-15 出版日期:2025-10-25 发布日期:2025-10-31
  • 通讯作者: 陈敏洁,E-mail：chenmj_9hospital@126.com
  • 作者简介:王菡韶（1997-）,女,硕士,E-mail：wang217@outlook.com
  • 基金资助:
    国家自然科学基金（82370981）; 上海市科学技术委员会“科技创新行动计划”医学创新研究专项(21Y11903500); 上海交通大学医学院附属第九人民医院罕见病项目（JYHJB202204）

Clinical analysis of chronic nonbacterial osteomyelitis involving the mandible in 35 adolescents

Wang Hanshao1, Wang Yiwen1, Wei Wenbin1, Huo Liang1, Li Jiang2, Chen Minjie1   

  1. 1. Department of Oral Surgery, 2. Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicin; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011, China
  • Received:2024-07-22 Revised:2024-09-15 Online:2025-10-25 Published:2025-10-31

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摘要： 目的:总结分析青少年慢性非细菌性骨髓炎（chronic nonbacterial osteomyelitis, CNO）的临床病理特征,为该疾病更好的诊断和治疗提供参考。方法:对2013年9月—2023年12月间于上海交通大学医学院附属第九人民医院诊断为CNO的青少年患者进行回顾分析。整理患者基本资料、实验室检查、影像学检查、病理表现和治疗结果。通过临床症状、实验室检查和影像学检查评价临床治疗效果。结果:共纳入35例患者,其中,男14例,女21例,男女比例为1∶1.5。45.7%的患者有多发性病变。既往诊断包括纤维结构不良、腮腺炎、感染性骨髓炎和特发性关节炎。实验室检查指标异常升高包括白细胞（20%）、红细胞沉降率（60%）、C反应蛋白（40%）、白细胞介素6（22.9%）等。CT表现有溶骨性、硬化性和增生性,骨扫描显示5例患者出现多发病灶。药物治疗中,非甾体类抗炎药物及抗风湿类药物的有效率超过50%。结论:部分CNO患者的白细胞介素6升高,其与发病机制的关系需要进一步研究。刮治术复发率很高,药物治疗较手术治疗效果可能更好。

关键词: 慢性非细菌性骨髓炎, 慢性复发性多灶性骨髓炎, 自身炎症性疾病, 药物治疗, 下颌骨

Abstract: PURPOSE: To summarize and analyze the clinicopathological features of chronic nonbacterial osteomyelitis (CNO) in adolescents, and to provide opinions for better diagnosis and treatment of the disease. METHODS: A retrospective study was conducted on adolescent patients diagnosed with CNO in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from September 2013 to December 2023. The demographic data, laboratory examination, imaging examination, pathological manifestations and treatment results of the patients were summarized. Clinical symptom evaluations, laboratory tests and imaging examinations were used to evaluate the effect of clinical treatment. RESULTS: Thirty-five patients were included, including 14 males and 21 females, with a male to female ratio of 1∶1.5. 45.7% patients had multiple lesions. Diagnoses prior to diagnosis of CNO included fibrous dysplasia, parotitis, infectious osteomyelitis and idiopathic arthritis. Abnormal increases in laboratory test indicators included white blood cells (20%), erythrocyte sedimentation rate (60%), C-reactive protein (40%), interleukin-6 (22.9%) and so on. CT findings showed osteolytic, sclerosing and hyperostosis. Bone scans showed multiple lesions in 5 patients. In drug therapy, the effective rate of NSAIDs and DMARDs exceeded 50%. CONCLUSIONS: Interleukin-6 is elevated in some CNO patients, and its relationship with pathogenesis needs to be further studied. The recurrence rate of decortication is high, and drug therapy may be more effective than surgical treatment.

Key words: Chronic nonbacterial osteomyelitis, Chronic recurrent multifocal osteomyelitis, Autoinflammatory disease, Drug therapy, Mandible

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