Schulte W, Costabel U, Kirsten D
Abteilung Pneumologie/Allergologie, Ruhrlandklinik Essen.
Pneumologie. 2003 Dec;57(12):752-60. doi: 10.1055/s-2003-812420.
Sarcoidosis is a systemic disease, in which early inflammatory organic changes, which are often reversible under treatment, may take a subclinical course. In scarred residual tissue improvement id rare. Continuing functional loss or even organ failure is possible. The involvement of the heart is of essential prognostic value. Early onset of treatment with corticosteroids before irreversible functional loss of the heart occurs leads to an excellent prognosis. Technical progress in the imaging techniques have led to great improvement of the graphical presentation of cardiac structure and function, but not one of these techniques has yet been approved of for early diagnosis. Still, a combination of different diagnostical measures in addition to the evaluation of clinical symptoms often allows early diagnosis. A decisive factor is "to consider it" and a timely start of further diagnostics if certain symptoms are presented. Alternatives to the specific treatment with cortisone are still lacking. Symptomatic cardiac treatment is mainly oriented on the therapy of dilatory cardiomyopathies, since there are no reliable systematic studies available on questions concerning, for example, antiarrhythmic treatment or indications for the implantations of pacemakers in connection with cardiac sarcoidosis.
结节病是一种全身性疾病,其早期炎症性器质性改变在治疗下通常是可逆的,但可能呈亚临床病程。在瘢痕残留组织中很少有改善。持续的功能丧失甚至器官衰竭是可能的。心脏受累具有重要的预后价值。在心脏发生不可逆功能丧失之前尽早开始使用皮质类固醇治疗可导致极佳的预后。成像技术的技术进步极大地改善了心脏结构和功能的图形显示,但这些技术中尚未有一项被批准用于早期诊断。尽管如此,除了评估临床症状外,结合不同的诊断措施通常可以实现早期诊断。一个决定性因素是“考虑到它”,如果出现某些症状,及时开始进一步诊断。目前仍缺乏可的松特异性治疗的替代方法。有症状的心脏治疗主要针对扩张型心肌病的治疗,因为对于例如抗心律失常治疗或与心脏结节病相关的起搏器植入指征等问题,尚无可靠的系统研究。