198例结节病的诊断方法及其要点分析

Diagnostic procedure and gist of sarcoidosis:analysis of 198 cases

目的 了解结节病的临床特征、影像学改变和病理资料 ,以探讨其诊断方法。方法 回顾分析我院自 1980年来经病理确诊的 198例结节病患者的临床资料。结果 结节病有以下临床特征。 (1)以中青年患者为主 :平均年龄 3 5 .1岁 ;(2 )女性多于男性 :女 12 5例 (63 .1% ) ,男 73例(3 6.9% ) ;(3 )病程长 :平均病程 6.1个月 ;(4 )分期 :0期 3例 ,Ⅰ期 86例 ,Ⅱ期 91例 ,Ⅲ期 18例 ;(5 )呼吸道症状轻 ,肺外以浅表淋巴结肿大 ,皮肤结节和眼部受累 ,有 3 5 .4%体检发现 ,64 .6%因咳嗽、胸闷、发热、胸痛等 ;(6)胸部X线、CT检查显示 :肺门、纵隔淋巴结肿大伴或不伴两肺病变 ;(7)纵隔镜淋巴结活检应用价值最高 ,浅表淋巴结 ,皮下结节 ,支气管黏膜及经气管镜肺活检值得临床推广。结论 结节病易误诊 ,误诊率 3 9.9%。有上述胸部X线、CT检查特征时 ,均应警惕本病可能 ,尽可能作组织病理学检查明确诊断 ,严防漏诊和误诊。

Objective To know about the clinical feature,the changes in radiography,the pathological findings of sarcoidosis and its diagnostic procedure through cases analysis.Methods Analyse 198 confirmed sarcoidosis patients involved from 1980 and their clinical data.Results Sarcoidosis’s clinical features as follows:(1)Main are middle and young patiens:the average age is 35.1 years old.(2)There were more female patients than male:125 female patients (63.1%) and 73 male patients (36.9%).(3)Long duration of the desease:the average was 6.1 months.(4)Stage:there were 3,86,91 and 18 cases in stage 0, I, II, and III respectively.(5) Respiratory duct symptom was mild and extrapulmonary manifestations were superficial lymphoadenopathy,eyesight faintness,and skin node,35.4% of those were found by the regular physical examination while others (64.6%) complained of various symptoms such as cough, breathless, fever and chest pain. (6) The usual presentation of the chest X-ray and CT was hilar and/or mediastinal lymphoadenopathy accompanied with diffusive lesion in bilateral lungs or not. (7) Among the various biopsy methods, lymph node biopsy through mediastinoscopy is the most valuable, and the superficial lymph node, skin nodes, bronchial mucous and transbronchial lung biopsies are strongly recommended.Conclusion Sarcoidosis is easy to misdiagnosis,and the rate is 39.9%.It should be alert to this disease when the patients have the above chest X-ray,CT features.A possible tissue pathological examination should be made for the prevention of missed diagnosis and misdiagnosis.