100例结节病患者的临床特征分析  

Analysis of clinical characteristics of 100 patients with sarcoidosis

作　　者：周振兴[1] 土旦朗杰 杨小东[1] Zhou Zhenxing;Tudan Langjie;Yang Xiaodong(Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Pulmonary Medicine,the Third People′s Hospital of Tibet Autonomous Region,Lhasa 850000,China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,成都610041 [2]西藏自治区第三人民医院肺科,拉萨850000

出　　处：《国际呼吸杂志》2023年第5期589-594,共6页International Journal of Respiration

摘　　要：目的总结分析结节病的临床特征、诊治及预后, 提高对结节病的认识, 减少误诊。方法本研究为横断面研究。收集2011年1月至2017年12月在四川大学华西院诊断为结节病(包括肺内与肺外)的100例患者临床资料, 并对临床特征、实验室及胸部CT检查、获取病理组织的部位及结果、治疗、预后等方面进行统计分析。结果共收集100例, 以女性多见, 男女比为1∶2.22;年龄(47.12±11.95)岁, 年龄范围为10~80岁;临床表现以咳嗽(58/93, 62.4%)为主, 其余可见呼吸困难(25/93, 26.9%)、胸痛(23/93, 24.7%)等。实验室检查异常主要表现为淋巴细胞的降低(47.5%, 47/99)以及炎症指标(红细胞沉降率、白细胞介素6、C反应蛋白)升高[50%(38/76)、43.7%(7/16)、43.6%(17/39)]。男性患者降钙素原、C反应蛋白水平均高于女性患者(Z值分别为2.38、2.40, 均P<0.05)。Ⅱ期结节病患者的外周血淋巴细胞绝对值、CD4+/CD8+比值、血浆IgM均较Ⅰ期结节病患者低(Z值分别为2.37、1.99、2.01, 均P<0.05)。胸部CT可见结节病典型影像表现, 影像分期以Ⅰ期(27/98, 27.6%)、Ⅱ期(65/98, 66.3%)为主。超声引导下经支气管针吸活检阳性率为61.7%(37/60)。在85例患者的随访过程中, 结节病有较高的自发好转率, Ⅰ期结节病的自发好转率为78.6%(11/14), 治疗好转率为80.0%(8/10), Ⅱ期结节病的自发好转率为52.6%(10/19), 治疗好转率88.6%(31/35), Ⅱ期结节病治疗者预后优于未治疗者(χ^(2)=6.85, P=0.009)。所有治疗患者均首选口服泼尼松, 87.0%(40/46)的患者用量为20~40 mg/d。结论结节病好发于中年女性, 临床表现多样。实验室检查以淋巴细胞降低及红细胞沉降率、白细胞介素6、C反应蛋白等炎性指标升高为主要表现。病变主要累及肺部。Ⅱ期结节病需要治疗。Objective To summarize and analyze the clinical features,diagnosis,treatment,and outcomes of sarcoidosis,aiming to reduce the rate of misdiagnosis.Methods It was a cross-sectional study involving 100 patients diagnosed as either intrapulmonary or extrapulmonary sarcoidosisinthe West China Hospital of Sichuan University from January 2011 to December 2017.Clinical features,laboratory and chest CT examinations,biopsy sites and pathological results,treatment and outcomes were analyzed.Results A total of 100 patients with sarcoidosis were included,with the male-to-female ratio of 1∶2.22.The mean age of included patients was 47.12±11.95(10-80)years.Cough(58/93,62.4%)was the dominant clinical manifestation,followed by dyspnea(25/93,26.9%)and chest pain(23/93,24.7%).Abnormal laboratory findings include decreased lymphocyte count(47/99,47.5%)and increased levels of inflammatory indexes like erythrocyte sedimentation rate(ESR,38/76,50.0%),interleukin-6(IL-6,7/16,43.7%),and C-reactive protein(CRP,17/39,43.6%).Procalcitonin(PCT)and CRPwere significantly higher in male patients than those of females(Z=2.38,and 2.40,respectively;both P<0.05).The absolute lymphocyte count,CD4+/CD8+ratio,and plasma immunoglobulin M(IgM)were significantly lower in patients with stageⅡsarcoidosis than those with stageⅠ(Z=2.37,1.99 and 2.01,respectively;all P<0.05).Typical imaging manifestations of sarcoidosis were seen on chest CT scans,which werepredominantly stageⅠ(27/98,27.6%)and stageⅡ(65/98,66.3%).The positive rate of sarcoidosis diagnosed by the endobronchial ultrasound-guided trans-bronchial needle aspiration(EBUS-TBNA)was 61.7%(37/60).During the follow-up period in 85 patients,a high spontaneous improvement rate was obtained.The spontaneous improvement rate(78.6%,11/14 vs 52.6%,10/19)and treatment improvement rate(80.0%,8/10 vs 88.6%,31/35)of stageⅠsarcoidosis were lower than those of stageⅡsarcoidosis.The prognosis of patients with stageⅡsarcoidosis with clinical management was better than that of untreated patients(χ^(2

关 键 词：结节病 临床特征 治疗 预后 

分 类 号：R563[医药卫生—呼吸系统]