肺结节病60例临床分析

Clinical analysis of 60 cases of pulmonary sarcoidosis

目的探讨肺结节病的临床及病理特点、诊治方法及预后。方法选取60例确诊为肺结节病的患者，回顾性分析其临床表现、实验室检查及影像学检查等资料。结果患者平均年龄54．6岁，女性多于男性；临床表现包括呼吸系统症状和肺外表现；血管紧张素转换酶（ACE）、血生化、T-SPOT等检查有助于诊断，胸部影像学检查有助于早期诊断，确诊依赖于肺穿刺活检、淋巴结活栓、皮肤结节活检等组织病理学检查；糖皮质激素为肺结节病首选治疗药物，其次可选甲氨蝶呤等，一般呈良性过程，预后较好，少数可复发或恶化。结论肺结节病临床表现多样，为明确诊断应完善组织病理学检查；糖皮质激素为首选治疗药物，大多数患者预后良好。

Objective To investigate the clinical and pathological features, diagnose and treat- ment method and prognosis of pulmonary sarcoidosis. Methods Sixty patients diagnosed as pulmonary sareoidosis by histopathology were selected and the clinical manifestations, laboratory examinations and imaging examinations of them were analyzed retrospectively. Results The average age of all patients was 54.6 years, and there were more female patients than male; the main clinical symptoms included respira- tory symptoms and extrapulmonary manifestations; angtiotensin converting enzyme （ACE）, blood bio- chemistry, T-SPOT were helpful for the diagnosis; chest imaging was helpful for early diagnosis, and def- inite diagnosis depended on histopathological examination, such as lung biopsy, lymph node biopsy, skin biopsy ; corticosteroids was the first choice for the treatment of sarcoidosis, followed by methotrexate, with a better prognosis and a few cases of relapse or disease progression. Conclusions The clinical manifes- tation of pulmonary sarcoidosis is various, so the histopathological examination should be complete as far as possible for definite diagnosis ; glucocorticoid is the first choice for the treatment of pulmonary sarcoido- sis, and the prognosis is good in most patients.