38例结节病诊断方法分析并文献复习

37 cases of sarcoidosis report on diagnosis method and literature review

目的探讨结节病不同诊断方法的临床价值,以提高诊断水平。方法回顾性分析瑞金医院呼吸内科2011年5月-2016年6月确诊的38例结节病病人资料,并进行文献复习。结果临床症状无特异性,影像学对诊断有一定辅助。38例病人中病理或细胞学证实结节病者27例(71%),病理未明确但临床治疗后回顾性诊断11例,2/11例患者经眼科会诊后发现眼底典型结节病表现。EBUS-TBNA阳性结果 3例,EBUS-TBNA联合纤支镜其他标本获取手段(BALF+EBB+TBB)阳性结果 4例,EBUS-TBNA联合EUS-FNA阳性结果 3例。结论结节病的诊断需要综合分析患者的临床资料,而EBUS-TBNA联合EUS-FNA的临床应用前景较有优势,但目前尚无足够的临床数据能对此做出有力的证明。

Objective To study the clinical value of various diagnosis Methods in order to improve diag- nosing sarcoidosis. Methods A retrospective analysis was conducted on 38 sarcoidosis patients in Respiratory De- partment of Ruijin Hospital from May 2011 to June 2016 and their relevant literature was reviewed. Results There was no special symptoms of sarcoidosis. Chest image screening was helpful at some degree. All 38 patients got suc- cessfully pathological biopsied samples, with a confirmed result in 27 cases （71% ）. Among 11 patients of negative pathological results, 2 cases were confirmed after ophthalmic consultation. In the above 27 patients, 3 positive results were obtained by EBUS-TBNA, 4 positive results obtained by EBUS-TBNA combined with bronchoscopy （ BALT ＋ EBB ＋ TBB）, and 3 positive results obtained by EBUS-TBNA combined with EUS-FNA. Conclusion All the pa- tients＇clinical data should be analyzed to diagnose sarcoidosis. By combining EBUS-TBNA with EUS-FNA, more di- agnosis can be made. However, a significant demonstration needs more clinical statistics.