CAJ | 학술논문

目的：了解伴眼部受累的结节病的临床特征。方法回顾性分析2004年3月至2014年2月北京同仁医院经组织病理学确诊的19例伴眼部受累的结节病患者的临床资料，分析其眼部表现、胸部影像学特征、实验室检查结果和病理学诊断情况，总结伴眼部受累的结节病的临床特征。结果在其间诊断的39例结节病患者中，19例伴有眼部受累。其中男6例，女13例；年龄16～76岁，平均（47±14）岁；12例以眼部症状首发，2例于病程中出现眼部症状，5例无眼部症状而经眼科会诊补充诊断为眼部结节病。眼部结节病诊断以葡萄膜炎为主（16例），其他包括脉络膜视网膜炎（3例）、视网膜血管炎（2例）、视神经炎（1例）和眶内肿物（3例）等；双侧肺门淋巴结肿大是胸部影像学的主要特征（14/16）；17例患者经眼部以外部位组织活检确定诊断；支气管镜下支气管黏膜活检诊断阳性率为8/9。结论结节病眼部受累临床并不少见；其表现多样，且部分病例可出现严重的视力障碍，临床上应重视结节病患者的眼部检查；对以眼部表现为首发症状的结节病应重视胸部影像学特征和经支气管镜黏膜活检对其诊断的临床价值。
목적：료해반안부수루적결절병적림상특정。방법회고성분석2004년3월지2014년2월북경동인의원경조직병이학학진적19례반안부수루적결절병환자적림상자료，분석기안부표현、흉부영상학특정、실험실검사결과화병이학진단정황，총결반안부수루적결절병적림상특정。결과재기간진단적39례결절병환자중，19례반유안부수루。기중남6례，녀13례；년령16～76세，평균（47±14）세；12례이안부증상수발，2례우병정중출현안부증상，5례무안부증상이경안과회진보충진단위안부결절병。안부결절병진단이포도막염위주（16례），기타포괄맥락막시망막염（3례）、시망막혈관염（2례）、시신경염（1례）화광내종물（3례）등；쌍측폐문림파결종대시흉부영상학적주요특정（14/16）；17례환자경안부이외부위조직활검학정진단；지기관경하지기관점막활검진단양성솔위8/9。결론결절병안부수루림상병불소견；기표현다양，차부분병례가출현엄중적시력장애，림상상응중시결절병환자적안부검사；대이안부표현위수발증상적결절병응중시흉부영상학특정화경지기관경점막활검대기진단적림상개치。
Objective To explore the clinical characteristics and systemic manifestations of sarcoidosis with ocular involvement.Methods The clinical data of 19 cases of sarcoidosis with ocular involvement confirmed by pathology at Beijing Tongren Hospital from March 2004 to February 2014 were analyzed retrospectively.The ocular manifestations, chest imaging findings, laboratory tests and pathological diagnosis were reviewed. And the clinical features of sarcoidosis with ocular involvement were summarized.Results Among them, there were 6 males and 13 females with an average age of (47 ±14) (16-76) years.The ocular symptoms were the initial presenting manifestations of sarcoidosis in 12 cases while 2 cases presented ocular symptoms during the course of disease.And aother 5 cases without ocular symptoms were confirmed to have ocular involvement by eye examination.The main manifestations of ocular sarcoidosis were uveitis (n=16), chorioretinitis (n=3), retinal vasculitis (n=2), optic neuritis (n=1) and orbital mass (n=3).The key feature of sarcoidosis was bilateral hilar lymphadenopathy (BHL) (14/16) on chest film.The diagnosis in 17 cases was confirmed by biopsy of extra-ocular organs.The positive diagnostic rate of bronchial biopsy was 8/9.Conclusions Ocular involvement in sarcoidosis is relatively common due to a variety of ocular manifestations and serious vision impairment in some patients. Ophthalmologic examination is essential in the clinical management of sarcoidosis. Chest imaging and bronchial biopsy are important for the diagnosis of sarcoidosis with initial ocular manifestations.