皮质激素治疗结节病的疗效及对预后的影响

The effect of therapeutic intervention with corticosteroids on outcome and prognosis of sarcoidosis

目的 探讨皮质激素治疗结节病的疗效及对预后的影响。方法 总结 13 3例病理确诊并追随 4年以上结节病 ,比较皮质激素治疗与自然病程的预后。结果 眼结节病 7例 ,6例泼尼松治愈 ,1例未全身治疗失明 ;3 8例肺外结节病中的 3 3例自限 ,5例进展。肺结节病Ⅰ期 2 6例 ,2 2例自限 ,3例进展 ,1例泼尼松治愈。Ⅱ期 5 6例 ,45例泼尼松治疗接近痊愈 ,10例进展 ,1例未治、进展为Ⅳ期。Ⅲ期 3例泼尼松控制。Ⅳ期 3例泼尼松无效。结论 皮质激素治疗眼、Ⅱ及Ⅲ期肺结节病是有效的干预措施 ,能减轻症状 。

Objective To evaluate the effects of corticosteroids on the prognosis of sarcoidosis Method There were analysis and comparison on the prognosis of natural course and corticosteroids therapy of 133 patients with sarcoidosis diagnosed by biopsy pathologic histology follow up over 4 years Results Six of the 7 patients with ocular sarcoidosis were cured by oral prednisone(PRED), and 1 patient receiving intraocular dexamethasone lost his sight In patients with extra pulmonary sarcoidosis who were not treated, 33 of the 38 cases underwent spontaneous remission, but another 5 cases progressed Twenty two of the 26 patients with stage Ⅰ pulmonary disease underwent spontaneous remission, 3 progressed, with only one case cured by PRED therapy In the 55 patients with stage Ⅱ pulmonary sarcoidosis who received PRED therapy, the chest roentgenogram and lung function were back to normal in 45 cases, but 10 cases failed One patient with stage Ⅱ pulmonary disease without treatment progressed to stage Ⅳ Three patients with stage Ⅲ pulmonary sarcoidosis were cured by PRED therapy, but Ⅲ patients with stage Ⅳ sarcoidosis failed to respond to PRED therapy Conclusions Systematic therapy with oral corticosteroids for ocular and stage Ⅱ～Ⅲ pulmonary sarcoidosis is a curative intervention Corticosteroids can relieve symptoms, reduce inflammation, and improve the prognosis of ocular and pulmonary sarcoidosis