中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2014年
11期
905-909
,共5页
蒲纯%杨翼萌%曾平%缪竞智%许小毛
蒲純%楊翼萌%曾平%繆競智%許小毛
포순%양익맹%증평%무경지%허소모
结节病%回顾性研究%随访
結節病%迴顧性研究%隨訪
결절병%회고성연구%수방
Sarcoidosis%Retrospective studies%Follow up
目的 提高对结节病的诊治水平.方法 回顾总结1988至2005年,经北京医院病理确诊的165例结节病病例的首诊科室、胸内外受侵情况、泼尼松治疗剂量及其与复发的关系.结果 资料完整并随诊观察5年以上者114例,随访时间5 ～ 32年,平均(11.7±5.7)年.累及肺部144例(87.3％)、胸外淋巴结85例(51.5％)、皮肤11例(6.7％)、眼和唾液腺各10例(各6.1％)、肝脾7例(4.2％),肾脏、周围神经等受累较少,46例(40.4％)无临床症状经体检发现.114例中口服泼尼松治疗组74例,糖皮质激素吸入治疗组2例,临床观察组38例.口服泼尼松治疗组完全缓解48例(64.9％),复发13例(17.6％);临床观察组完全缓解25例(65.8％),复发1例(2.6％).口服泼尼松治疗组复发率高于临床观察组(P＜0.05);10～15 mg/d维持时间及总疗程长有助于减少复发(均P ＜0.05).结论 结节病常侵犯多个系统,肺及淋巴结受累最多,有一定自限性.Ⅰ期或无症状,对肺功能正常的Ⅱ期需严密观察,有症状及肺功能进行性恶化的Ⅱ期及Ⅲ期需泼尼松治疗.10～15 mg/d维持治疗6个月以上,总疗程18个月以上者,复发机会减少.
目的 提高對結節病的診治水平.方法 迴顧總結1988至2005年,經北京醫院病理確診的165例結節病病例的首診科室、胸內外受侵情況、潑尼鬆治療劑量及其與複髮的關繫.結果 資料完整併隨診觀察5年以上者114例,隨訪時間5 ～ 32年,平均(11.7±5.7)年.纍及肺部144例(87.3％)、胸外淋巴結85例(51.5％)、皮膚11例(6.7％)、眼和唾液腺各10例(各6.1％)、肝脾7例(4.2％),腎髒、週圍神經等受纍較少,46例(40.4％)無臨床癥狀經體檢髮現.114例中口服潑尼鬆治療組74例,糖皮質激素吸入治療組2例,臨床觀察組38例.口服潑尼鬆治療組完全緩解48例(64.9％),複髮13例(17.6％);臨床觀察組完全緩解25例(65.8％),複髮1例(2.6％).口服潑尼鬆治療組複髮率高于臨床觀察組(P＜0.05);10～15 mg/d維持時間及總療程長有助于減少複髮(均P ＜0.05).結論 結節病常侵犯多箇繫統,肺及淋巴結受纍最多,有一定自限性.Ⅰ期或無癥狀,對肺功能正常的Ⅱ期需嚴密觀察,有癥狀及肺功能進行性噁化的Ⅱ期及Ⅲ期需潑尼鬆治療.10～15 mg/d維持治療6箇月以上,總療程18箇月以上者,複髮機會減少.
목적 제고대결절병적진치수평.방법 회고총결1988지2005년,경북경의원병리학진적165례결절병병례적수진과실、흉내외수침정황、발니송치료제량급기여복발적관계.결과 자료완정병수진관찰5년이상자114례,수방시간5 ～ 32년,평균(11.7±5.7)년.루급폐부144례(87.3％)、흉외림파결85례(51.5％)、피부11례(6.7％)、안화타액선각10례(각6.1％)、간비7례(4.2％),신장、주위신경등수루교소,46례(40.4％)무림상증상경체검발현.114례중구복발니송치료조74례,당피질격소흡입치료조2례,림상관찰조38례.구복발니송치료조완전완해48례(64.9％),복발13례(17.6％);림상관찰조완전완해25례(65.8％),복발1례(2.6％).구복발니송치료조복발솔고우림상관찰조(P＜0.05);10～15 mg/d유지시간급총료정장유조우감소복발(균P ＜0.05).결론 결절병상침범다개계통,폐급림파결수루최다,유일정자한성.Ⅰ기혹무증상,대폐공능정상적Ⅱ기수엄밀관찰,유증상급폐공능진행성악화적Ⅱ기급Ⅲ기수발니송치료.10～15 mg/d유지치료6개월이상,총료정18개월이상자,복발궤회감소.
Objective To explore the clinical characteristics,relationship between treatment and prognosis of sarcoidosis and relationship of relapse to prednisone.Methods The clinical data of 165 patients with sarcoidosis were collected.The clinical characteristics,treatment process and prognosis,relationship of relapse with prednisone maintenance dose and course of treatment were retrospective analyzed.Results Among them,the most common involved systems were lung and lymph nodes.The involvement rates of lung,extra-thorax lymph nodes,cutaneous,ocular,salivary glands,liver & spleen,kidney and nervous system was 87.3％,51.5％,6.7％,6.1％,6.1％,4.2％,1.2％ and 1.2％ respectively.Unilateral tonsil,breast,ovary and bone involvement was seen in only 1 patient respectively with an involvement rate of 0.6％.A retrospective analysis was made for 114 cases with complete follow-up data.The mean follow-up period was (11.7 ± 5.7) (5-32) years.And 46 cases had no symptom on routine medical examinations.The most common consulted departments were respiratory,dermatological and general surgery departments.Among 74 patients on prednisone,48 patients (64.9％) were cured while 13 patients (17.6％) relapsed.Whereas in the observation group,25/38 patients (65.8％) remitted spontaneously and only 1 patient (2.6％) had recurrence.Relapse occurred more often in prednisone therapy group than in observation group (P ＜ 0.05).Longer prednisone 10-15 mg daily maintenance and a longer total course of treatment were associated with fewer recurrence(P ＜ 0.05).Conclusions The clinical manifestations of sarcoidosis vary and many patients have a self-limiting course.The most common involved systems are lung and lymph nodes.Stage Ⅰ / Ⅱ disease should be observed before prednisone therapy.Prednisone 10-15 mg daily for at least 6 months and a total course of treatment over 18 months may prevent relapse.
