Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA; St. George's University School of Medicine, Grenada, West Indies.
Respir Med. 2019 Jun;152:14-19. doi: 10.1016/j.rmed.2019.03.012. Epub 2019 Mar 23.
Although it is the general consensus that sarcoidosis patients who present with sarcoidosis-related symptoms have a worse outcome than patients whose disease is detected incidentally without symptoms, this premise has not been rigorously examined.
Consecutive patients followed longitudinally at one US university sarcoidosis clinic were questioned concerning the onset and description of sarcoidosis-related symptoms at disease presentation. The patients were classified into those with no sarcoidosis-related symptoms at presentation (NSP group) and those with symptoms at presentation (SP group). The following outcomes were examined in the NSP and SP groups: most recent spirometry, organ involvement, need for sarcoidosis therapy, most recent health related quality of life (HRQOL) as measured by the Sarcoidosis Assessment Tool (SAT), most recent chest imaging Scadding stage results.
660 sarcoidosis patients were analyzed, with 175 in the NSP group and 485 in the SP group. Compared to the NSP group, the SP group had a more frequent requirement for any sarcoidosis treatment, corticosteroid treatment, and non-corticosteroid treatment at some time and within the most recent year of follow up (at least 50% more than the NP group with strong statistical differences with p values all 0.01 or less). In addition, the SP group had significantly more organ involvement (p < 0.001) and several worse SAT domains (p < 0.022) than the NP group. There were no differences between the groups in terms of final spirometry or development of Scadding stage 4 chest radiographs. These findings held even after adjusting for age, sex, race, and time between presentation and the most recent follow-up visit using a multivariable logistic regression framework.
In our sarcoidosis cohort, compared to the absence of symptoms at presentation, the presence of symptoms was associated with a greater need for treatment, more organ involvement, and worse HRQOL.
尽管普遍认为出现结节病相关症状的结节病患者比无症状偶然发现疾病的患者预后更差，但这一前提尚未经过严格检验。
在一家美国大学的结节病诊所进行纵向随访的连续患者被询问了疾病发作时结节病相关症状的发作和描述。患者分为无疾病相关症状（NSP 组）和有症状（SP 组）。在 NSP 和 SP 组中检查了以下结果：最近的肺活量测定、器官受累、结节病治疗需求、最近的健康相关生活质量（HRQOL），用结节病评估工具（SAT）测量、最近的胸部影像学 Scadding 分期结果。
分析了 660 例结节病患者，其中 NSP 组 175 例，SP 组 485 例。与 NSP 组相比，SP 组在任何时候和最近的随访期内（至少比 NP 组多 50%，统计学差异显著，p 值均<0.01），更需要进行任何结节病治疗、皮质激素治疗和非皮质激素治疗。此外，SP 组的器官受累明显多于 NSP 组（p<0.001），且 SAT 多个领域的评分也较差（p<0.022）。两组在最终肺活量或 Scadding 4 期胸片的发展方面没有差异。即使在使用多变量逻辑回归框架调整年龄、性别、种族和从发病到最近随访时间后，这些发现仍然成立。
在我们的结节病队列中，与无疾病相关症状相比，出现症状与治疗需求更大、更多器官受累和更差的 HRQOL 相关。
