Baumann M H, Strange C, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425.
AJR Am J Roentgenol. 1990 Mar;154(3):481-5. doi: 10.2214/ajr.154.3.2106208.
The use of serial chest radiographs to assess disease activity in patients with sarcoidosis is controversial. However, reliance on the symptomatic clinical course to assess disease activity may be misleading. As many patients being treated with corticosteroids have an abrupt clinical deterioration when doses of those medications are decreased, we questioned whether the chest radiograph could depict alterations in disease activity as measured by spirometry in this subset of patients. We retrospectively reviewed the clinical course of all patients with pulmonary sarcoidosis in whom the corticosteroid dose was reduced during a 6-month period. The 15 patients without fever, chills, or purulent sputum during that time were then examined to determine the presence (n = 10) or absence (n = 5) of a symptomatic relapse. All patients who had a symptomatic relapse also had a fall in forced vital capacity of at least 10%, suggesting an increase in disease activity. Serial chest radiographs were evaluated during and after corticosteroid dose reductions and after clinical recovery on higher steroid doses in the patients who had had a relapse. In eight patients, the disease was in radiographic stage 2 (hilar adenopathy and parenchymal lung disease); in seven patients it was in radiographic stage 3 (parenchymal lung disease alone). The disease did not change stage in any patient during the study. Chest radiographs worsened more frequently in patients who had a clinical relapse (seven of 10) than in those who did not have a relapse (zero of five, p less than .05). An alveolar chest radiographic pattern (n = 4) or reticulonodular pattern (n = 3) was noted in the seven patients who had a relapse, with worsening on radiographs often occurring before detection of relapse by symptomatology (four of seven) or spirometry (three of seven). Spirometry and radiographs improved or stabilized after an increase in corticosteroid dose in all 10 patients who had a relapse. We conclude that serial chest radiographs can reflect clinical relapse in patients with sarcoidosis during corticosteroid dose reduction. Furthermore, worsening seen on chest radiographs may be the first evidence of relapse.
使用系列胸部X光片评估结节病患者的疾病活动存在争议。然而，依靠有症状的临床病程来评估疾病活动可能会产生误导。由于许多接受皮质类固醇治疗的患者在药物剂量减少时会出现临床症状突然恶化，我们质疑胸部X光片是否能够描绘出这部分患者中通过肺活量测定法所衡量的疾病活动变化。我们回顾性分析了在6个月内皮质类固醇剂量减少的所有肺结节病患者的临床病程。然后对在此期间无发热、寒战或脓性痰的15名患者进行检查，以确定是否存在有症状的复发（n = 10）或无复发（n = 5）。所有有症状复发的患者其用力肺活量至少下降了10%，提示疾病活动增加。在复发患者中，于皮质类固醇剂量减少期间及之后以及在临床恢复且使用更高剂量类固醇后，对系列胸部X光片进行了评估。8名患者的疾病处于放射学2期（肺门淋巴结肿大和实质性肺部疾病）；7名患者处于放射学3期（仅实质性肺部疾病）。在研究期间，没有患者的疾病分期发生变化。有临床复发的患者（10例中的7例）胸部X光片恶化的频率高于无复发的患者（5例中的0例，p < 0.05）。7例复发患者中出现了肺泡型胸部X光片表现（n = 4）或网状结节型表现（n = 3），X光片恶化通常在通过症状学（7例中的4例）或肺活量测定法（7例中的3例）检测到复发之前就已出现。在所有10例复发患者中，增加皮质类固醇剂量后，肺活量测定和X光片表现均有所改善或稳定。我们得出结论，系列胸部X光片可反映结节病患者在皮质类固醇剂量减少期间的临床复发。此外，胸部X光片上出现的恶化可能是复发的首个证据。
