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[肺结节病和肺外结节病的临床诊断算法]

[The diagnostic algorithm of practice in pulmonary and extrapulmonary sarcoidosis].

作者信息

Dubaniewicz Anna

机构信息

Department of Pulmonology, Medical University of Gdansk, Poland.

出版信息

Pol Merkur Lekarski. 2018 Mar 27;44(261):101-109.

Abstract

Sarcoidosis (SA) is a granulomatous multisystem disease of unknown ethiology. Pulmonary, lymphadenopathy, liver, spleen, skin, and bone sarcoidosis are more frequent but also SA of the heart, central nervous system, eye, and hypercalcemia with following kidney failure also occur. Sarcoidosis may co-exist with extrapulmonary forms, which may overtake or precede each other. SA may occur as acute or chronic with the possibility of complete remission in the early stages of disease. Due to frequent occurrence of asymptomatic SA in threatening vital organs a diagnostic algorithm of practice in pulmonary and extrapulmonary sarcoidosis has been proposed by the author of the article. Diagnosis of SA is based on a correlation of clinical, radiological and histopathological pictures with the presence of non-caseating granuloma in material from the biopsy from at least one organ and having excluded tuberculosis. In all forms of SA, USG abdomen, ECG, ECHO heart, blood tests (blood count, calcium, creatinine, transaminases), level of calcium in a 24-hour urine samples, ophtalmoscopic examinations and lung function tests in pulmonary sarcoidosis should be undertaken to avoid overlooking any form of SA, especially in threatened vital organs. For this purpose, the multidisciplinary team providing an adequate care to the patient with SA has been created by the author of the article has been created by the author of the article in the University Clinical Center in Gdansk providing comprehensive care to patients with sarcoidosis.

摘要

结节病(SA)是一种病因不明的肉芽肿性多系统疾病。肺部、淋巴结、肝脏、脾脏、皮肤和骨骼结节病较为常见,但心脏、中枢神经系统、眼睛的结节病以及继发肾衰竭的高钙血症也会发生。结节病可能与肺外形式共存,它们可能相互重叠或先后出现。SA可呈急性或慢性,在疾病早期有可能完全缓解。由于无症状SA在威胁重要器官时频繁出现,本文作者提出了一种针对肺结节病和肺外结节病的诊断算法。SA的诊断基于临床、影像学和组织病理学表现,以及至少一个器官活检材料中存在非干酪样肉芽肿且已排除结核病。在所有形式的SA中,都应进行腹部超声、心电图、心脏超声、血液检查(血常规、钙、肌酐、转氨酶)、24小时尿钙水平检测、眼科检查以及肺结节病的肺功能测试,以避免漏诊任何形式的SA,尤其是在重要器官受到威胁时。为此,本文作者在格但斯克大学临床中心组建了一个多学科团队,为结节病患者提供充分的护理,为结节病患者提供全面护理。

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