Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York.
Semin Respir Crit Care Med. 2020 Oct;41(5):741-757. doi: 10.1055/s-0040-1709496. Epub 2020 Aug 10.
As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.
由于结节病可能累及任何器官，因此结节病患者应评估是否存在隐匿性疾病。如果某些器官受累不太可能引起症状、器官功能障碍或影响临床结局，则不一定需要进行筛查。即使器官受累影响临床结局，如果早期检测不能改变患者的生活质量或预后，也不一定需要进行筛查。另一方面，早期发现某些形式的结节病可能会改善结局和生存率。本文描述了对以前未被发现的疾病进行结节病患者筛查的方法。结节病的筛查应从详细的病史和体格检查开始。许多结节病患者表现出尚未被认为是疾病表现的结节病的体征或症状。在这些情况下，检测结节病取决于临床医生对结节病各种临床表现的熟悉程度。此外，结节病患者可能出现与特定器官受累无关的症状或体征，这些症状或体征被描述为副结节病综合征。据推测，副结节病综合征是由于结节病肉芽肿中炎症介质的系统性释放引起的。某些形式的结节病可能导致永久性和严重的问题，如果在疾病早期发现，可以预防这些问题。这些问题包括：(1) 可能导致永久性视力损害的眼部受累；(2) 维生素 D 失调，可能导致高钙血症、肾结石和永久性肾损伤；(3) 心脏结节病，可能导致心肌病、室性心律失常、心脏传导阻滞和猝死。这些形式的器官受累的筛查需要详细的筛查方法。
