肺门影像增大的辨认——兼论结节病的鉴别诊断  

Identification of Pulmonary Hilar Lymphaden Hypertrophy and Differential Diagnosis of Sarcoidosis

作　　者：罗慰慈[1] 

机构地区：[1]北京协和医院内科,北京100730

出　　处：《临床误诊误治》2011年第7期1-3,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：肺门部X线影像增大的原因有多种,宜慎加辨识。若疑诊肺门部淋巴结增大,需仔细鉴别淋巴结结核、恶性肿瘤和结节病。结节病是一种多系统、多器官受累的肉芽肿性疾病,双侧肺门淋巴结增大为最常见的早期体征,CD4/CD8细胞比例升高提示病情活跃期。对疑似结节病由简而繁的鉴别手段为结核菌素试验、X线胸片、皮肤结节病理诊断、纤维支气管镜活检或支气管肺泡灌洗、血钙及尿钙测定等,有条件可行血管紧张素Ⅰ转换酶测定、Kve im-S iltzbach皮肤试验及放射性核素67镓测定等,纵隔镜行纵隔淋巴结活检可用于难以诊断的病例。结节病治疗以泼尼松为主,疗效显著且价格适中。肺门影像增大贵在及时准确诊断,结节病明确后,应掌握其施治原则,正确用药,防止病情反复。Many factors may contribute to pulmonary hilar lymphaden hypertrophy and should be indentified with caution. If someone is suspected of having hilar lymphaden hypertrophy, it is vitally important to differentiate whether it is tuberculosis of lymph node, cancer or sarcoidosis. Sarcoidosis is a kind of disease involving multiple systems and or- gans, bilateral hilar lymphaden hypertrophy is the most common sign in early stage, and the increasing of CD4/CD8 value indicates that the disease is in active stage. Sarcoidosis can be differentially diagnosed with the methods of tuberculin test, chest x-ray film, pathology diagnosis of skin nodule, bronchofiberscope biopsy or bronchoalveolar lavage, and deter- mination of blood and urine calcium. The determination of angiotensin I converting enzyme, Kveim-Sihzbach dermal test and detection of radioactive nuclide gallium should be tried in difficult cases in diagnosis. The treatment of sarcoidosis mainly depends on prednisone for its effectiveness and suitable price. Accurate diagnosis is the key point in the treatment of hilar lymphaden hypertrophy, and correct therapeutic principles should be followed in order to prevent relapses.

关 键 词：肺 放射摄影术 结节病 诊断 鉴别 

分 类 号：R563.9[医药卫生—呼吸系统]