结节病胸膜病变分析并文献复习  

Pleural sarcoidosis:report of cases and review of the literature

作　　者：孙永昌[1] 姚婉贞[1] 沈宁[1] 石雪迎[2] 赵鸣武[1] 

机构地区：[1]北京大学第三医院呼吸科,100083 [2]北京大学第三医院病理科,100083

出　　处：《中华结核和呼吸杂志》2006年第4期243-246,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的分析结节病胸膜病变的临床特征,探讨鉴别诊断方法。方法回顾性分析确诊的有病理证据的结节病32例,报告以胸膜病变为主要表现的典型病例,对临床特点和鉴别诊断进行分析。检索国内文献中结节病胸膜病变的病例报告和病例总结,分析其发生率和临床特征。结果1989年至2004年共确诊胸内结节病32例,以胸腔积液为主要表现者2例(2/32,6.3%),其中1例双侧胸腔积液经内科胸腔镜检查确诊;自发性气胸1例(1/32,3.1%),经开胸肺活检确诊。胸腔积液分析为渗出液,细胞分类以淋巴细胞为主,腺苷脱氨酶(ADA)均未超过30 U/L,其中1例胸腔积液血管紧张素转换酶(ACE)升高。3例在确诊前均被误诊为肺结核,接受抗结核治疗1～12个月不等。国内发表的病例总结中,结节病胸膜病变发生率为3.4%～16.7%;个案报道显示结节病胸腔积液最常被误诊为结核性胸膜炎。结论结节病胸膜病变并非罕见,临床上常被误诊。这一认识无论对于结节病的及时诊断,还是对于胸膜病变的鉴别诊断都有重要临床意义。Objective To analyze the clinical features and differential diagnosis of pleural disease caused by sarcoidosis. Methods The clinical data of cases of sarcoidosis diagnosed with pathological evidence in this hospital were retrospectively analyzed. The clinical features and the diagnostic procedures of the cases with pleural disease as the main manifestations were reported. A review of case reports and series published in Chinese literature were carried out to study the incidence and the features of pleural effusion and pneumothorax in sarcoidosis. Results Thirty-two cases of pulmonary sarcoidosis were diagnosed with pathological evidence, of which 2 cases （2/32, 6. 3% ） presented as pleural effusion with one confirmed by medical thoracoscopy; one case （1/32, 3.1% ） presented as recurrent pneumothorax and interstitial lung disease, and the diagnosis was confirmed by open lung biopsy. Pleural fluid analysis showed exudates with lymphocyte predominance. The fluid level of adenosine deaminase （ ADA ） was all less than 30 U/L and increased angiotensin converting enzyme level was demonstrated in one case. All 3 cases had been misdiagnosed as tuberculosis and received anti-tuberculous therapy for a period of 1 - 12 months. A review of the case reports and series in Chinese literature showed that the incidence of pleural disease in sarcoidosis was 3.4% -16. 7% in different series, and that pleural effusion in sarcoidosis was misdiagnosed as tuberculous in most cases. Conclusions Pleuml sarcoidosis is not rare in Chinese patients, but often misdiagnosed as tuberculous pleural disease. Recognition of this fact is of clinical importance both in the diagnosis of sarcoidosis and in the differential diagnosis of pleural diseases.

关 键 词：结节病 胸膜疾病 胸腔积液 气胸 

分 类 号：R593.9[医药卫生—内科学] R561.04[医药卫生—临床医学]