22例胸内结节病的诊治体会

Clinical experience of 22 cases of intrathoracic sarcoidosis

目的提高对结节病的认识。方法回顾分析经病理确诊的结节病22例患者的临床资料。结果临床表现以咳嗽、咳痰、胸闷、胸痛等为主,肺外表现以发热、浅表淋巴结肿大为主。血清血管紧张素转换酶(SACE)敏感性为77.3%,支气管肺泡灌洗液(BALF)中ACE敏感性为82.4%、CD4/CD8比值敏感性为64.7%。各种活检方法中,纵隔镜淋巴结活检应用价值较高。结论结节病临床表现多样而无特异性,容易造成误诊,明确诊断依赖病理活检,SACE、BALF中ACE、CD4/CD8比值等对判定结节病活动性有重要价值。

Objective To increase the awareness of intrathoracic sarco-idosis.Methods The clinical datas of 22 cases with intrathoracic sarcoidosis confirmed by pathology were reviewed.Results The main clinical presentation included cough,expectoration, chest distress and thoracalgia.Of extropulmonary presentation,the most common was fever and superficial lymphadenhypertrophy.In our group,the sensitivity of serum angiotensin-converting enzyme （SACE） was 77.3%.The ACE level in bronchoalveolar lavage fluid （BALF） was 82.4%,CD4/CD8 ratio in bronchoalveolar lavage fluid （BALF） was 64.7%.In all approaches of biopsy , the biopsy of lymphonodus of mediastinum through mediastinoscopy was the best method for the definition of sarcoidosis.Conclusion The clinical presentation of sarcoidosis is varied and nonspecific,so it is likely to be misdiagnosed.The definitive diagnosis depends on the pathologic biopsy.SACE,the ACE level and CD4/ CD8 ratio in BALF are of important values in assessing sarcoidosis activity.