Jordan D R, Anderson R L, Nerad J A, Scrafford D B
Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City.
Can J Ophthalmol. 1988 Aug;23(5):203-7.
The diagnosis of sarcoidosis depends on the clinical and radiologic features along with histologic evidence of epithelioid-cell granulomas on biopsy. The amount of histologic support required varies inversely with the certainty with which the pattern of clinical features is recognized. It is essential to exclude other recognized causes of granulomatous disease. On the basis of our experience and that of other workers, we believe that sarcoidosis must be considered in the differential diagnosis when optic nerve thickening is encountered on CT, MRI or echography. Chest roentgenography is the easiest way to confirm the diagnosis. However, as many as 15% of patients will have a normal x-ray film, and other tests may be needed to help confirm the diagnosis. Biopsy of the involved tissues may be the only way to make the diagnosis. Once a provisional diagnosis is made, investigation for systemic sarcoidosis should include chest roentgenography, determination of the serum ACE level, 67Ga scanning, pulmonary function studies, testing for delayed skin reactions (with tuberculin, C. albicans, Trichophyton and mumps virus) and blood studies (determination of the erythrocyte sedimentation rate and levels of immunoglobulins, albumin, calcium and alkaline phosphatase). Finally, conjunctival biopsy is simple to do and is quite useful in supporting the diagnosis if no other tissue is readily available.
结节病的诊断取决于临床和放射学特征，以及活检时上皮样细胞肉芽肿的组织学证据。所需的组织学支持量与临床特征模式被识别的确定性呈反比。排除肉芽肿性疾病的其他已知病因至关重要。根据我们及其他研究者的经验，我们认为当CT、MRI或超声检查发现视神经增粗时，鉴别诊断中必须考虑结节病。胸部X线检查是确诊的最简单方法。然而，多达15%的患者X线片可能正常，可能需要其他检查来辅助确诊。受累组织的活检可能是确诊的唯一方法。一旦做出初步诊断，系统性结节病的检查应包括胸部X线检查、血清ACE水平测定、67Ga扫描、肺功能研究、迟发性皮肤反应检测（用结核菌素、白色念珠菌、毛癣菌和腮腺炎病毒）以及血液检查（红细胞沉降率和免疫球蛋白、白蛋白、钙及碱性磷酸酶水平测定）。最后，结膜活检操作简单，如果没有其他容易获取的组织，对支持诊断非常有用。
