45例结节病不同影像分期与临床特征分析

Clinical and imaging features of 45 patients with sarcoidosis

目的 分析结节病的不同影像分期与临床特征,提高结节病临床诊断准确率。方法选择 2010 年 2 月至 2015 年 12 月在我院经病理证实的结节病患者 45 例,回顾性分析这些患者不同影像分期与临床特征。结果 结节病呼吸系统主要症状为咳嗽、咳痰,其次是胸闷,分别占 55.6% 、48.9% 和 44.4% 。全身症状无特异性,肺外表现常见为外周淋巴结肿大和皮下结节,分别占 31.1% 和24.4% 。实验室检查常见血沉增快而 C 反应蛋白多正常, 84.2% 患者 BALF 中 CD4 / CD8 升高 （ 〉3.5 ）。肺 CT 表现最常见为双肺门对称性淋巴结肿大 （ 55.6% ）,确诊依赖组织病理学检查。结论 提高对肺结节病多系统受累表现的认识,完善并提高辅助检查手段能协助临床诊断,尽可能行组织病理学检查明确诊断,口服激素治疗对多数患者有效。

Objective To explore the clinical and imaging features, improve the clinical diagnostic accuracy of sarcoidosis. Methods Clinical data of 45 patients with biopsy-proven sarcoidosis were retrospectively analyzed. Results Sarcoidosis had several clinical features including pulmonary and extropulmonary presentation. The mainly symptoms of respiratory system were cough, expectoration, followed by chest tightness, which accounted for 55.6%, 48.9% and 44.4% respectively. Systemic symptoms were nonspecific. The peripheral lymph node enlargement and subcutaneous nodules were common, which accounted for 31.1% and 24.4%. Laboratory examination showed higher erythrocyte sedimentation rate and normal C-reactive protein. CD4/CD8 in bronchoalveolar lavage fluid of 84.20/00 patients was increased （more than 3.5）. The symmetrical lymph node enlargement was common in pulmonary CT scan （55.6%）. The diagnosis was depended on histopathology. Conclusions It is important to be aware of sarcoidosis features including pulmonary and extropulmonary presentation. Auxiliary examination is helpful for diagnosis, as far as possible to perform biopsy to confirm the diagnosis. Oral glucocorticoid is the effective drug for therapy.