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目的探讨结节病的治疗、影响预后的因素及判断病情和预后的指标。方法回顾性分析1984年1月-2003年1月北京协和医院住院治疗且随访≥2年的59例结节病临床资料。结果随访时间(61.9±49.4)个月。(1)0期患者7例,均在确诊后即口服糖皮质激素(以下简称激素)治疗,其中4例完全缓解。Ⅰ期患者22例,确诊后未予治疗的5例患者中1例进展,3例自愈,1例部分缓解;确诊后即予激素治疗的17例患者中,9例完全缓解,1例进展至Ⅱ期。Ⅱ期患者23例,1例在未予治疗3个月加重后及22例在确诊后开始激素治疗,13例完全缓解,2例进展至Ⅲ期。Ⅲ期5例患者均在确诊后即予激素治疗,1例治愈,2例进展Ⅳ期。Ⅳ期患者2例,尽管长期激素治疗,病情仍在缓慢进展。(2)Ⅰ期、Ⅱ期患者发病时的支气管肺泡灌洗液(BALF)中细胞总数和分类、CD_4/CD_8比值及血清血管紧张素转换酶(sACE)水平差异无统计学意义。(3)共有24例患者复发,其中胸内结节病20例,14例有肺外受累;未复发者中10例有肺外受累;有肺外受累与无肺外受累比较,P=0.006。(4)完全缓解者发病时 BALF 中中性粒细胞数低于尚未缓解者(P<0.001)。结论结节病病程有一定的自愈性。对Ⅰ期患者可先观察。有肺外病变的胸内结节病患者更易复发。发病时BALF 中中性粒细胞数可能作为一个预测预后的指标。
Objective To investigate the treatment of sarcoidosis, factors that affect the prognosis and indicators to judge the disease and prognosis. Methods The clinical data of 59 patients with sarcoidosis from January 1984 to January 2003 in Beijing Union Medical College Hospital who were followed up for more than 2 years were retrospectively analyzed. Results The follow-up time was 61.9 ± 49.4 months. (1) 0 patients in 7 cases, were diagnosed with oral glucocorticoid (hereinafter referred to as hormone) treatment, of which 4 patients completely remission. Among the 22 patients with stage Ⅰ disease, 1 patient progressed in 5 patients who were diagnosed as untreated, 3 patients were self-healing, and 1 patient was partly relieved. Of the 17 patients who received hormone therapy after diagnosis, 9 patients achieved complete remission and 1 patient progressed To Ⅱ period. Twenty-three patients were in stage II, one was treated with no treatment for 3 months, and 22 received steroid treatment after diagnosis. Thirteen patients were completely relieved and two patients progressed to stage III. Five patients in stage Ⅲ were treated with hormonal therapy after diagnosis, one was cured and two were stage Ⅳ. Two patients in stage IV, despite long-term hormone therapy, the condition is still slowly progressing. (2) There was no significant difference in the total number and classification of cells, the ratio of CD 4 / CD 8 and the level of serum angiotensin converting enzyme (sACE) in bronchoalveolar lavage fluid (BALF) in stage I and II patients. (3) A total of 24 patients relapsed, including 20 cases of intrathoracic sarcoidosis and 14 cases of extrapulmonary involvement; 10 cases of non-recurrent extra-pulmonary involvement; with extra-pulmonary involvement and no extra-pulmonary involvement, P = 0.006 . (4) The number of neutrophils in BALF at the time of complete remission was lower than that of non-remission (P <0.001). Conclusion The course of sarcoidosis has a certain degree of self-healing. The first phase of patients can be observed. Patients with intrathoracic sarcoidosis who have extrapulmonary lesions are more likely to relapse. The number of neutrophils in BALF at onset may be used as a predictor of prognosis.