Baughman R P, Judson M A, Teirstein A, Yeager H, Rossman M, Knatterud G L, Thompson B
University of Cincinnati Medical Center, 1001 Holmes, Eden Avenue, Cincinnati, OH 45267-0565, USA.
QJM. 2006 May;99(5):307-15. doi: 10.1093/qjmed/hcl038. Epub 2006 Apr 4.
Some sarcoidosis patients never need therapy, but many still require therapy more than 2 years after initial diagnosis.
To determine what features at initial presentation are associated with treatment 2 years later.
Patients with biopsy-confirmed sarcoidosis enrolled in the ACCESS (A Case Control Etiologic Study of Sarcoidosis) study were initially evaluated within 6 months of diagnosis. Pulmonary function, chest X-ray and dyspnoea score were measured, and systemic therapy for the sarcoidosis recorded. Organ involvement was assessed using a standardized instrument. A subset (n = 215) were seen 18-24 months later for follow-up, and these patients constitute our study group.
Ten patients had only received therapy before the first visit, with no further therapy, and were excluded from analysis. Of the remaining 205, 95 were not on therapy at the initial visit and 75 (79%) of these were never treated during follow-up. Of the 110 initially on therapy, 52 (47%) remained on therapy at follow-up. Other initial features associated with continued therapy were the level of dyspnoea and predicted vital capacity. On logistic regression, only dyspnoea and therapy at initial visit remained significant. Patients on systemic therapy at initial evaluation were more likely to be on therapy at follow-up (OR 3.6, p = 0.003). Neither ethnicity nor gender independently predicted therapy at follow-up.
This study group represents a sample of newly diagnosed sarcoidosis patients. However, this is a referral population, and there was no set protocol for treatment. Use of systemic therapy within the first 6 months after diagnosis appears to be strongly associated with continued use of therapy 2 years later.
一些结节病患者从未需要治疗，但许多患者在初次诊断后2年以上仍需要治疗。
确定初次就诊时的哪些特征与2年后的治疗相关。
纳入ACCESS（结节病病例对照病因研究）研究的经活检确诊的结节病患者在诊断后6个月内进行了初次评估。测量了肺功能、胸部X线和呼吸困难评分，并记录了结节病的全身治疗情况。使用标准化工具评估器官受累情况。18 - 24个月后对一个亚组（n = 215）进行随访，这些患者构成了我们的研究组。
10名患者在首次就诊前仅接受过治疗，未再接受进一步治疗，被排除在分析之外。在其余205名患者中，95名在初次就诊时未接受治疗，其中75名（79%）在随访期间从未接受过治疗。在最初接受治疗的110名患者中，52名（47%）在随访时仍在接受治疗。与继续治疗相关的其他初始特征是呼吸困难程度和预计肺活量。经逻辑回归分析，只有呼吸困难和初次就诊时的治疗情况仍具有显著性。初次评估时接受全身治疗的患者在随访时更有可能仍在接受治疗（比值比3.6，p = 0.003）。种族和性别均不能独立预测随访时的治疗情况。
该研究组代表了新诊断的结节病患者样本。然而，这是一个转诊人群，且没有固定的治疗方案。诊断后前6个月内使用全身治疗似乎与2年后继续使用治疗密切相关。
