32例肺结节病临床诊断分析  

Clinical analysis of 32 cases of pulmonary sarcoidosis

作　　者：王凡[1] 陈旭昕[1] 韩志海[1] 田光[1] 

机构地区：[1]海军总医院呼吸科,北京100048

出　　处：《临床肺科杂志》2016年第7期1255-1257,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的提高对结节病的认识,减少误诊和漏诊。方法回顾性分析32例结节病患者。结果肺部临床表现以咳嗽最多见22例(68.75%),其次为胸闷气短16例(50.00%)和咳痰12例(37.50%),肺外主要表现为皮肤红斑或皮下结节占13例(40.63%),浅表淋巴结肿大6例(18.75%)四肢关节肿痛5例(15.63%)。肺功能异常以小气道功能障碍为主要表现10例(47.62%),其次为混合性通气功能障碍5例(23.81%)。肺部影像学主要表现为肺浸润24例(75.00%),双侧肺门淋巴结肿大24例(75.00%),纵隔淋巴结肿大22例(68.75%)。支气管镜检查表现以支气管黏膜充血肥厚为主。本组病例中PPD试验阴性者17例(68.00%),血清血管紧张素转换酶升高14例(56.00%),血沉升高4例(16.00%),28例患者行血钙检测,均无升高,尿钙值升高者2例(22.22%)。本组所有患者均进行了活检,其中经支气管镜支气管黏膜活检者占20例(62.5%),应用最多。结论肺结节病是临床上容易误诊的一种自身免疫性疾病,临床工作者应给予足够重视,了解其临床特点,减少漏诊及误诊,以及时确立诊断。Objective To improve the recognition of sarcoidosis in order to reduce diagnostic errors and missed diagnosis. Methods The clinical data of 32 patients with pulmonary sarcoidosis was retrospectively ana- lyzed. Results The main symptoms of respiratory system were cough （68. 75% ） , shortness of breath （50. 00% ） and expectoration （ 37.50% ）. The main external manifestations of lung were skin erythema or subcutaneous nodules （40. 63% ）, enlargement of superficial lymph nodes （ 18. 75% ） and joint pain （ 15.63% ）. The main manifestations of pulmonary dysfunction were small airway dysfunction （47.62%） and mixed ventilator dysfunction （23.81%）. The main performances of pulmonary imaging were pulmonary infiltration （75.00%） , bilateral hilar lymphadenophathy （75.00%） and mediastinal lymph node enlargement （68. 75% ）. The main bronchoscopic manifestation was bronchial mucosal congestion. 17 of 25 cases were negative in PPD test in our study. 14 of 25 cases got a rise in serum angiotensin converting enzyme （sACE）. 4 of 25 cases got a rise in erythroeyte sedimentation rate （ESR）. None of the 28 cases got high level of serum calcium, while 2 of 9 cases got a rise in urinary calcium. Bronchial mucosa biopsy was the most commonly used biopsy method. Condusion Pulmonary sarcoidosis is an anto-immune disease which is clinically easy to be misdiagnosed. Enough attention should be paid to it in order to reduce misdiagnosis and missed diagnosis.

关 键 词：结节病 肺 肉芽肿 临床表现 

分 类 号：R563[医药卫生—呼吸系统]