原发性干燥综合征多学科诊疗专家共识（2024版）

内科理论与实践››2024,Vol. 19››Issue (06): 357-362.doi:10.16138/j.1673-6087.2024.06.01

• 指南与共识 •下一篇

原发性干燥综合征多学科诊疗专家共识（2024版）

程昉^1a, 赵福涛^1a(), 沈雪敏^1b, 李瑾^1c, 陈向军^2a, 王桂芳^2b, 李慧凛³, 薛鸾⁴, 齐军元⁵()

1.开云网页登录医学院附属第九人民医院 a. 风湿免疫科；b. 口腔黏膜科；c. 眼科，上海 200011
2.复旦大学附属华山医院 a. 神经内科；b. 呼吸内科，上海 200040
3.海军军医大学附属上海市浦东新区公利医院肾内科，上海 200135
4.上海中医药大学附属岳阳中西医结合医院风湿免疫科，上海 200437
5.中国医学科学院血液病医院血液内科，天津 300020

收稿日期:2024-11-27出版日期:2024-12-26发布日期:2025-03-11
通讯作者:齐军元 E-mail： qijy@ihcams.ac.cn ；赵福涛 E-mail： ftzhao@moisten.org

Expert consensus on multidisciplinary diagnosis and treatment of primary Sjögren syndrome (2024 edition)

CHENG Fang^1a, ZHAO Futao^1a(), SHEN Xuemin^1b, LI Jin^1c, CHEN Xiangjun^2a, WANG Guifang^2b, LI Huilin³, XUE Luan⁴, QI Junyuan⁵()

1a. Department of Rheumatology and Immunology; b. Department of Oral Medicine; c. Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
2a. Department of Neurology; b. Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
3. Department of Nephrology, Gongli Hospital of Shanghai Pudong New Area, Naval Military Medical University, Shanghai 200135, China
4. Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
5. Department of Hematology, Blood Diseases Hospital, Chinese Academy of Medical Science, Tianjin 300020, China

Received:2024-11-27Online:2024-12-26Published:2025-03-11

摘要/Abstract

摘要：

原发性干燥综合征（primary Sjögren syndrome, PSS）是一种以外分泌腺和其他器官淋巴细胞浸润为特征的自身免疫性疾病。PSS临床表现异质性强，可出现不同程度的局部和系统受累，需通过多学科协作制定治疗方案。然而，目前我国缺乏统一的诊疗规范。多名相关学科专家基于国内外诊治经验和指南共识，通过名义群体法形成本共识，旨在为PSS患者的规范化诊疗提供指导和参考依据。

关键词:干燥综合征,多学科协作,诊断,治疗

Abstract:

Primary Sjögren syndrome (PSS) is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands and other organs. PSS shows strong clinical heterogeneity, presents different degrees of topical and systemic damage, and multidisciplinary collaboration are required to develop PSS treatment strategies. However, our country currently has not unified diagnosis and treatment consensus for PSS. Based on domestic and foreign diagnosis and treatment experience, consensus and guideline, experts from multiple related disciplines achieved consensus using the nominal group technique, providing guidance and reference for standardized diagnosis and treatment of PSS.

Key words:Sjögren syndrome,Multiple-disciplinary team,Diagnosis,Treatment

中图分类号:

R593.2

程昉, 赵福涛, 沈雪敏, 李瑾, 陈向军, 王桂芳, 李慧凛, 薛鸾, 齐军元. 原发性干燥综合征多学科诊疗专家共识（2024版）[J]. 内科理论与实践, 2024, 19(06): 357-362.

CHENG Fang, ZHAO Futao, SHEN Xuemin, LI Jin, CHEN Xiangjun, WANG Guifang, LI Huilin, XUE Luan, QI Junyuan. Expert consensus on multidisciplinary diagnosis and treatment of primary Sjögren syndrome (2024 edition)[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(06): 357-362.

图/表1

表1

干燥综合征的辩证论治[16]

辨证分型	证候特点及舌脉	治则治法	推荐方剂	常用中药
阴虚津亏证	口干舌燥，眼干无泪，咽干，鼻干，皮肤干燥，大便干或数日一行。舌红，少苔或无苔，或舌有裂纹，脉细、沉细或细弱。	养阴增液，生津润燥。	沙参麦冬汤合六味地黄丸，或增液汤加减。	沙参、麦冬、玉竹、玄参、生地黄、熟地黄、山药、山萸肉、茯苓、泽泻、牡丹皮等。
气阴两虚证	口眼干燥，神疲乏力，动则心悸，气短懒言，干咳少痰，夜尿频，便溏。舌红，苔少而干或有裂纹，脉细弱或细数。	益气养阴，润燥通络。	生脉饮合沙参麦冬汤，或四君子汤合益胃汤加减。	沙参、玉竹、麦冬、天花粉、石斛、葛根、生地黄、太子参、南沙参、五味子、白术、茯苓、山药、赤芍、大血藤、乌梢蛇等。
阴虚内热证	口干咽痛，眼干目赤，烦渴多饮，口角干裂，鼻干鼻衄，干咳，手足心热，盗汗，午后热甚，心烦失眠，小便短赤，大便干结。舌红或红绛，有裂纹，苔干燥少津，或少苔、无苔，脉细数。	养阴清热，润燥生津。	一贯煎合青蒿鳖甲汤，或清燥救肺汤加减。	北沙参、麦冬、当归、生地黄、枸杞子、川楝子、青蒿、鳖甲、知母、牡丹皮、桑叶、石膏、甘草、胡麻仁、苦杏仁、枇杷叶等。
燥瘀互结证	口干不欲饮，眼干少泪，鼻干，咽干，肌肤甲错或有瘀斑瘀点，关节肌肉疼痛，肢端皮肤变白、变紫，颐肿不消或瘰疬。舌质暗或有瘀斑、瘀点，或舌下脉络迂曲青紫，苔少且干，脉涩或细涩。	滋阴润燥，活血通络。	活血润燥生津汤加减。	当归、白芍、天冬、麦冬、天花粉、桃仁、红花、忍冬藤、络石藤、鸡血藤等。
燥湿互结证	口渴不欲饮，目涩多眵，口中黏腻，脘痞腹胀，肢体沉重、周身倦怠，咳嗽、痰黏难出，关节肿胀疼痛，尿频，大便黏滞不爽。舌淡红，苔白腻，脉濡滑。	润燥祛湿、行气散结。	甘露饮，或乌梅丸，或知柏地黄丸加减。	生地黄、熟地黄、山药、茯苓、泽泻、桔梗、枳实、香橼、佩兰、青蒿、黄芩、黄连、黄柏、天冬、麦冬、乌梅、当归、连翘、浙贝母、路路通等。

表1

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