Ungprasert Patompong, Crowson Cynthia S, Carmona Eva M, Matteson Eric L
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.
Division of Rheumatology, Department of Medicine, Faculty of medicine Siriraj hospital, Mahidol University, Bangkok, Thailand.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(2):123-128. doi: 10.36141/svdld.v35i2.6356. Epub 2018 Apr 28.
A hallmark of sarcoidosis is lung disease. However, the prognosis and long-term outcome of pulmonary sarcoidosis are not well-defined due to the limited number of studies with long duration of follow-up. This study was undertaken to characterize the course of pulmonary sarcoidosis in a population-based cohort. A population-based cohort of 311 incident cases of pulmonary sarcoidosis among Olmsted County, Minnesota residents in 1976-2013 were identified. Medical records of the confirmed cases were reviewed from diagnosis to last follow-up. Data on stage of pulmonary sarcoidosis at diagnosis, serial pulmonary function tests, requirement of oxygen therapy and treatment were abstracted. The cumulative incidence of chronic respiratory impairment (defined as forced vital capacity of <50%, diffuse capacity for carbon monoxide of <40% or requirement to use oxygen supplementation) adjusted for the competing risk of death was estimated. Cox models were used to assess the association of stage of pulmonary sarcoidosis and treatment on the development of chronic respiratory impairment. 25 patients developed chronic respiratory impairment which corresponded to a 10-year event rate of 4.4% (95% confidence interval [CI], 1.9.-6.9). Stage of pulmonary sarcoidosis at diagnosis was a strong predictor for chronic respiratory impairment with hazard ratio compared with stage I of 5.29 (95% CI, 1.65-16.96) for stage II and 8.36 (95% CI, 26.3-26.52) for stage III and IV. Use of glucocorticoids and immunosuppressive agents was associated with a significantly increased risk of chronic respiratory impairment. Patients with pulmonary sarcoidosis have a good pulmonary prognosis with a low incidence of chronic respiratory impairment. .
结节病的一个标志是肺部疾病。然而，由于长期随访研究数量有限，肺结节病的预后和长期结局尚不明确。本研究旨在描述基于人群队列的肺结节病病程。确定了1976 - 2013年明尼苏达州奥尔姆斯特德县居民中311例肺结节病发病病例的基于人群队列。回顾确诊病例从诊断到最后随访的医疗记录。提取了诊断时肺结节病的分期、系列肺功能测试、氧疗需求和治疗的数据。估计了经死亡竞争风险调整后的慢性呼吸功能损害（定义为用力肺活量<50%、一氧化碳弥散量<40%或需要使用氧补充剂）的累积发病率。使用Cox模型评估肺结节病分期和治疗与慢性呼吸功能损害发生之间的关联。25例患者出现慢性呼吸功能损害，相当于10年事件发生率为4.4%（95%置信区间[CI]，1.9 - 6.9）。诊断时肺结节病的分期是慢性呼吸功能损害的有力预测指标，与I期相比，II期的风险比为5.29（95% CI，1.65 - 16.96），III期和IV期为8.36（95% CI，2.63 - 26.52）。使用糖皮质激素和免疫抑制剂与慢性呼吸功能损害风险显著增加相关。肺结节病患者的肺部预后良好，慢性呼吸功能损害发生率较低。
