肺结节病并胸腔积液诊治分析

Cfinical analysis of pulmonary sarcoidosis with pleural effusion

目的对肺结节病合并胸腔积液的诊治进行分析。方法对我院2000年1月至2012年7月期间收治的13例肺结节病合并胸腔积液患者的病历资料进行回顾性分析。结果13例中3例为I期，9例为Ⅱ期，1例为Ⅲ期；8例曾误诊为结核性胸膜炎，2例曾误诊为肺癌。13例口服醋酸泼尼松片0．5～1．0mg／（kg·d）并逐渐减量治疗。治疗1个月后，5例胸腔积液消失，4例明显减少；3个月后13例患者胸腔积液均消失，3例留有胸膜肥厚。结论肺结节病出现胸腔积液的机制不明，有症状的伴有胸腔积液的结节病患者需要行激素治疗。结节病并胸腔积液确诊依赖胸膜、肺、支气管活检，结合临床、影像及实验室检查，可降低误诊率。

Objective To analyze the diagnosis and treatment of pulmonary sarcoidosis with pleural effu- sion. Methods All 13 cases with pulmonary sareoidosis with pleural effusion of in our hospital during the period of Jan. 2000 to July 2012 were analyzed. Results There were 3 cases in stage I , 9 cases in stage II and 1 case in stage Ⅲ. Among them 8 cases were misdiagnosed as tuberculous pleurisy and 2 patients were misdiagnosed as lung cancer. All 13 cases were taken orally by prednisone acetate tablets 0.5 - 1.0 mg/（ kg· d） , and the dose was gradually reduced. After treatment for one month, pleural effusion of 5 cases disappeared, pleural effusion of 4 cases was significantly reduced; pleural effusion of 13 patients disappeared after 3 months; 3 cases had thickening pleura. Conclusions The mechanism of pulmonary sarcoidosis with pleural effusion is unknown. Patients of sarcoidosis with pleural effusion need hormone therapy when they have symptoms. Sareoidosis with pleural effusion is easily misdiagnosed. Image and laboratory examination combined with clinical can improve the diagnostic and reduce the misdiagnosis rate.