University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA,
Clin Rev Allergy Immunol. 2015 Aug;49(1):79-92. doi: 10.1007/s12016-015-8492-9.
In general, sarcoidosis treatment should be offered to palliate symptoms and improve quality of life or to prevent end-organ disease. Symptoms include pulmonary as well as extra-pulmonary manifestations of the disease. The assessment of response to disease includes functional studies such as the forced vital capacity. Radiologic imaging such as chest x-ray has also been used to assess response, although standardized measures have rarely been tested. There are sufficient clinical trials to make specific recommendations regarding treatment of symptomatic pulmonary disease. Initial therapy is usually prednisone or a similar glucocorticoid. However, there are several features of this treatment which are unknown. This includes the initial dose, timing of reduction of dose, and when to discontinue treatment. Since many patients are intolerant of prednisone, steroid-sparing alternatives have been studied. Methotrexate is the most widely used anti-metabolite, but azathioprine, leflunomide, and mycophenolate have also been reported as helpful. The biologic agents, especially monoclonal anti-tumor necrosis factor (anti-TNF) antibodies, have proved effective in patients who have failed other treatments. Infliximab, the most widely studied anti-TNF antibody, has proved effective for a range of refractory sarcoidosis. However, there remain questions regarding dose and duration of therapy. For the clinician, the many treatment options allow for a specific treatment regimen for each patient which minimizes risk while enhancing benefit.
一般来说，应该提供治疗来缓解症状，提高生活质量或预防终末器官疾病。症状包括肺部和疾病的肺外表现。对疾病反应的评估包括用力肺活量等功能研究。胸部 X 射线等放射影像学也被用于评估反应，尽管很少有测试过标准化措施。有足够的临床试验可以针对治疗有症状的肺病提出具体建议。初始治疗通常是泼尼松或类似的糖皮质激素。然而，这种治疗有几个方面是未知的。这包括初始剂量、剂量减少的时间以及何时停止治疗。由于许多患者对泼尼松不耐受，因此已经研究了类固醇保存替代物。甲氨蝶呤是最广泛使用的抗代谢物，但已报道使用硫唑嘌呤、来氟米特和霉酚酸酯也有帮助。生物制剂，特别是单克隆抗肿瘤坏死因子（anti-TNF）抗体，已被证明对其他治疗失败的患者有效。英夫利昔单抗是研究最多的抗 TNF 抗体，已被证明对一系列难治性结节病有效。然而，在治疗剂量和持续时间方面仍存在问题。对于临床医生来说，许多治疗选择允许为每个患者制定特定的治疗方案，在降低风险的同时提高疗效。
