Judson Marc A, Baughman Robert P, Thompson Bruce W, Teirstein Alvin S, Terrin Michael L, Rossman Milton D, Yeager Henry, McLennan Geoffrey, Bresnitz Eddy A, DePalo Louis, Hunninghake Gary, Iannuzzi Michael C, Johns Carol J, Moller David R, Newman Lee S, Rabin David L, Rose Cecile, Rybicki Benjamin A, Weinberger Steven E, Knatterud Genell L, Cherniak Reuben
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
Sarcoidosis Vasc Diffuse Lung Dis. 2003 Oct;20(3):204-11.
A cohort of 215 sarcoidosis patients from the ACCESS study underwent a clinical evaluation at study enrollment and two years later. Approximately 80% of subjects had an improved or stable FVC, FEV1, chest radiograph determined by Scadding stage, and dyspnea scale. African-Americans had less improvement in FVC than Caucasians (p = 0.04). Patients with erythema nodosum at presentation were more likely to have improvement in the chest radiograph at two-year follow-up (p = 0.007). Patients with a lower annual family income were more likely to worsen with respect to dyspnea (p = 0.01) and more likely to have new organ involvement at two-year follow-up (p = 0.045). The development of new organ involvement over the two year follow-up period was more common in African-Americans compared to Caucasians (p = 0.002) and more likely in those with extrapulmonary involvement at study entry (p = 0.003). There was an excellent concordance between changes in FVC and FEV1 over the two-year period. However, changes in FVC alone were inadequate to describe the change in pulmonary status of the patients, as changes in chest radiographic findings or the level of dyspnea did often but not always move in the same direction as FVC. In conclusion, data from this heterogeneous United States sarcoidosis population indicate that sarcoidosis tends to improve or remain stable over two years in the majority of patients. Several factors associated with improved or worse outcome over two years were identified.
来自ACCESS研究的215名结节病患者队列在研究入组时和两年后接受了临床评估。约80%的受试者的用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、根据斯卡丁分期确定的胸部X光片以及呼吸困难量表评分有所改善或保持稳定。非裔美国人的FVC改善程度低于白种人（p = 0.04）。出现结节性红斑的患者在两年随访时胸部X光片更有可能改善（p = 0.007）。家庭年收入较低的患者呼吸困难更有可能加重（p = 0.01），且在两年随访时更有可能出现新的器官受累（p = 0.045）。在两年随访期内，非裔美国人比白种人更常见出现新的器官受累（p = 0.002），且在研究入组时出现肺外受累的患者中更有可能出现（p = 0.003）。在两年期间，FVC和FEV1的变化具有高度一致性。然而，仅FVC的变化不足以描述患者肺部状态的变化，因为胸部X光片表现或呼吸困难程度的变化通常但并非总是与FVC的变化方向一致。总之，来自美国这个异质性结节病人群的数据表明，在大多数患者中结节病在两年内倾向于改善或保持稳定。确定了与两年内改善或不良结局相关的几个因素。
