96例结节病临床及确诊方法分析

Analysis of the clinical data and definition methods of 96 cases with sarcoidosis

目的 加深对结节病的认识。方法 总结 96例经组织病理学证实的结节病患者临床资料 ,分析其实验室检查及病理活检方法的特点。结果 结节病患者按胸片表现分为三期 (Ⅰ期42例 ,Ⅱ期 40例 ,Ⅲ期 14例 )。临床表现以咳嗽、胸闷、发热、胸痛等为主 ,肺外表现以浅表淋巴结肿大及皮肤损害为主。血清血管紧张素转换酶 (SACE)敏感性为 44 .0 5 % ,纤维支气管镜检查可见炎症表现 (4 3 .85 % )、粘膜结节 (2 2 .81% )、管腔狭窄 (7.0 2 % )等。支气管肺泡灌洗液 (BALF)中BALF ACE、淋巴细胞分类及CD4/CD8比值增高。 93 .5 9%患者 67Ga异常浓聚 ,其中 5 0 %为较典型活动期表现。各种活检方法中 ,纵隔镜淋巴结活检应用价值较高。结论 结节病临床表现多样而无特异性 ,容易造成误诊 ,明确诊断依赖病理活检 ,SACE、BALF中BALF ACE、淋巴细胞分类、CD4/CD8比值及

Objective To improve the awareness of sarcoidosis.Methods The data of 96 patients with sarcoidosis was reviewed,the characteristics of the laboratory and pathologic biopsy were analyzed.Results According to the chest X-ray,the patients were devided into three stages:42 cases of stageⅠ,40 cases of stage Ⅱ and 14 cases of stage Ⅲ.The main symptoms included cough,chest distress,fever and thoracalgia.Of extropulmonary presentation,the most common is superficial lymphadenhypertrophy and skin manifestation.In our group,the sensitivity of serum angiotensin-converting enzyme(SACE)was 44.05%.The bronchoscopy test involved inflammation,submucous tubercles,bronchiostenosis and etc.The ACE level,lymphocyte counts and CD 4/CD 8 ratio in bronchoalveolar lavage fluid(BALF)had increased.Gallium 67 scanning showed abnormal accumulation in 93.59% of the patients,and 50% of them expressed typical active stage.In all approaches of biopsy,the biopsy of lymphonodus of mediastinum through mediastinoscopy was the best method for the definition of sarcoidosis.Conclusions The clinical presentation of sarcoidosis is varied and nonspecific,so it is likely to be misdiagnosed.The definitive diagnosis depends on the pathologic biopsy.SACE,the ACE level,lymphocyte counts and CD 4/CD 8 ratio in BALF and gallium 67 scanning are of important values in assessing sarcoidosis activity.