Calaras Diana, Munteanu Oxana, Scaletchi Valentina, Simionica I, Botnaru V
"Nicolae Testemitanu" State Medical and Pharmaceutical University, Department of Pneumology and Allergy, Chisinau, Republic of Moldova.
Phthisiopneumology Institute "Chiril Draganiuc", Department of Functional and Endoscopic Evaluation, Chisinau, Republic of Moldova.
Sarcoidosis Vasc Diffuse Lung Dis. 2017;34(1):58-67. doi: 10.36141/svdld.v34i1.5134. Epub 2017 Apr 28.
Although sarcoidosis is commonly considered a restrictive disorder, more recent studies demonstrated opposite results. To determine the prevalent functional pattern in patients with intrathoracic sarcoidosis and to assess the role of granulomatous inflammation in determining ventilatory disturbances. We included 144 consecutive newly diagnosed patients with sarcoidosis, who were evaluated by chest radiography, chest high resolution computer tomography, pulmonary function tests and dyspnea score. Additionally, endobronchial and transbronchial biopsies were performed to a subset of 78 patients. We obtained a wide range of ventilatory abnormalities that characterize airways impairment: FEV1/FVC<70% - in 14 (9.7%) cases, low MMEF - in 69 (47.9%) patients, increased RV/TLC - in 65 (45.1%) subjects, while the subjects with restrictive defects was observed in a minority of cases - 7 (4.9%). Decreased DLCO was found in 100 (69.4%) individuals, in the majority of cases with mild changes. Patients in whom endobronchial biopsy showed granuloma had worse ventilatory results versus those in whom they have not been detected, with significant differences in FEV1 and MMEF We found significant correlations between radiological stage and pulmonary function tests. Dyspnea score (mMRC scale) in our cohort reflected lung volumes and DLCO modifications. The dominant functional abnormality in patients with intrathoracic sarcoidosis is obstruction, which affects the entire length of the bronchial tree causing a wide range of airways impairment and altered gas diffusion. These functional disturbances are prevalent from early stages of the disease and have a tendency to coexist with restriction as the disease advances. Granulomatous inflammation seems to have an important role in determining obstructive defect, even from "infra-radiological" stages. .
尽管结节病通常被认为是一种限制性疾病，但最近的研究显示了相反的结果。为了确定胸内结节病患者中普遍存在的功能模式，并评估肉芽肿性炎症在确定通气障碍中的作用。我们纳入了144例连续的新诊断结节病患者，这些患者接受了胸部X线摄影、胸部高分辨率计算机断层扫描、肺功能测试和呼吸困难评分。此外，对78例患者的一个子集进行了支气管内和经支气管活检。我们获得了一系列表征气道损害的通气异常：FEV1/FVC<70%——14例（9.7%），低MMEF——69例（47.9%），RV/TLC增加——65例（45.1%），而少数病例（7例，4.9%）观察到限制性缺陷。100例（69.4%）个体发现DLCO降低，大多数病例变化轻微。支气管内活检显示肉芽肿的患者与未检测到肉芽肿的患者相比，通气结果更差，FEV1和MMEF有显著差异。我们发现放射学分期与肺功能测试之间存在显著相关性。我们队列中的呼吸困难评分（mMRC量表）反映了肺容量和DLCO的改变。胸内结节病患者的主要功能异常是阻塞，它影响支气管树的全长，导致广泛的气道损害和气体扩散改变。这些功能障碍在疾病早期就很普遍，并且随着疾病进展有与限制共存的趋势。肉芽肿性炎症似乎在确定阻塞性缺陷中起重要作用，甚至在“放射学下”阶段也是如此。
