Sakuta Manabu, Kumamoto Toshihide, Iizuka Takahiro, Nishiyama Kazutoshi, Oritsu Masaru
Dpt Neurology, Kyorin University.
Rinsho Shinkeigaku. 2005 Nov;45(11):837-40.
We have collaborated with Japanese Sarcoidosis Society and Japanese Society of Respiratory diseases to make a new diagnostic criteria of neurosarcoidosis. (definite) Having positive clinical findings which suggest a neurosarcoidosis. Pathology proven case. (probable) Having positive clinical findings which suggest a neurosarcoidosis. Pathology proven in other organ. Elevated serum ACE or BHL demonstrated by chest XP or CT scan. (possible) Having positive clinical findings which suggest a neurosarcoidosis. Elevated serum ACE or BHL demonstrated by chest XP or CT scan. CNS sarcoidosis, sarcoid neuropathy and sarcoid myopathy are separately diagnosed. To evaluate our criteria, about 100 papers on neurosarcoidosis published worldwide in these 6 years were retrospectively examined. Our criteria showed a better results than 1988 criteria (former Japanese criteria) and Zajicek's criteria which was published in 1999 (QJ Med 92: 103). Point is there is no more need to depend upon Kveim reaction which is time consuming, not so specific and difficult to obtain its antigen. Our new criteria is calculated to be sensitivity of 78-98% (BHL or ACE), and specificity of 83-99% (ACE). Because of their low specificity, Gallium scintigraphy and broncho alveolar lavage fluid examination are excluded from our diagnostic criteria, however, their high sensitivity are still useful to begin with.
我们与日本结节病协会及日本呼吸疾病学会合作制定了神经结节病的新诊断标准。(确诊)具有提示神经结节病的阳性临床发现。病理证实病例。(疑似)具有提示神经结节病的阳性临床发现。其他器官病理证实。胸部X线或CT扫描显示血清ACE或BHL升高。(可能)具有提示神经结节病的阳性临床发现。胸部X线或CT扫描显示血清ACE或BHL升高。中枢神经系统结节病、结节性神经病变和结节性肌病需分别诊断。为评估我们的标准,我们回顾性研究了这6年全球发表的约100篇关于神经结节病的论文。我们的标准比1988年标准(原日本标准)和1999年发表的扎伊采克标准(《英国医学杂志》92:103)效果更好。关键在于不再需要依赖耗时、特异性不强且难以获取抗原的克维姆反应。我们的新标准计算得出敏感度为78 - 98%(BHL或ACE),特异性为83 - 99%(ACE)。由于镓闪烁显像和支气管肺泡灌洗液体检查特异性较低,我们的诊断标准中未纳入,但它们的高敏感度在起始阶段仍很有用。