印度327例结节病患者的临床概况：结核病（TB）流行人群中的一项双向队列研究
Clinical Profile of 327 patients with Sarcoidosis in India: An Ambispective Cohort Study in a Tuberculosis (TB) Endemic Population.
作者信息
Madan Karan, Sryma P B, Pattnaik Bijay, Mittal Saurabh, Tiwari Pawan, Hadda Vijay, Mohan Anant, Guleria Randeep
机构信息
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Lung India. 2022 Jan-Feb;39(1):51-57. doi: 10.4103/lungindia.lungindia_960_20.
INTRODUCTION
Sarcoidosis is a multisystem granulomatous disease with a varied clinical presentation. We describe the clinical characteristics of patients with sarcoidosis from a tuberculosis (TB) endemic setting.
METHODS
We performed an analysis of the sarcoidosis database at a tertiary care facility in North India.
RESULTS
Of the 327 patients, 50.8% were male, with a mean age of 42.8 years (range: 16-70 years). Females were significantly older. 42.6% had comorbidities, of which diabetes (17.1%) was most common. More than half (57.1%) were obese. Serum angiotensin-converting enzyme levels were elevated in 186 (57.9%). Eleven (3.8%) had hypercalcemia, while hypercalciuria was present in 54 (31.7%). The majority (89.9%) were tuberculin skin test negative (<10 mm induration), while 71.9% were tuberculin anergic. 47.7% had normal spirometry, while a restrictive impairment was the most common abnormality (44.6%). Obstruction on spirometry was present in 8.3%. Nearly half (160, 49%) had involvement of an extrapulmonary site. Most patients were (96%) symptomatic. Cough, shortness of breath, fatigue, weight loss, and fever were the predominant symptoms. A majority had Stage 1 (47.7%) sarcoidosis. Two hundred and eighty-seven (87.8%) patients underwent bronchoscopy or endosonographic (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration [EUS-B-FNA]) sampling. A histopathological diagnosis with the demonstration of granulomas was achieved in 90.8%. The diagnostic yield of EBUS-TBNA/EUS-B-FNA was 77.4%. In 13.5% of patients, necrotizing granulomas were present in tissue samples.
CONCLUSION
The clinical profile of patients with sarcoidosis in TB endemic settings has certain differences from nonendemic populations. Bronchoscopy and endosonography allow a confident diagnosis in the majority of patients.
引言
结节病是一种多系统肉芽肿性疾病，临床表现多样。我们描述了来自结核病流行地区的结节病患者的临床特征。
方法
我们对印度北部一家三级医疗机构的结节病数据库进行了分析。
结果
327例患者中，50.8%为男性，平均年龄42.8岁（范围：16 - 70岁）。女性年龄显著更大。42.6%有合并症，其中糖尿病（17.1%）最为常见。超过一半（57.1%）患者肥胖。186例（57.9%）患者血清血管紧张素转换酶水平升高。11例（3.8%）有高钙血症，54例（31.7%）有高钙尿症。大多数（89.9%）患者结核菌素皮肤试验阴性（硬结<10 mm），71.9%患者结核菌素无反应。47.7%患者肺功能正常，最常见的异常是限制性损害（44.6%）。肺功能检查显示阻塞性改变的占8.3%。近一半（160例，49%）患者有肺外部位受累。大多数患者（96%）有症状。咳嗽、气短、疲劳、体重减轻和发热是主要症状。大多数患者为1期结节病（47.7%）。287例（87.8%）患者接受了支气管镜检查或内镜超声检查（支气管内超声引导下经支气管针吸活检[EBUS - TBNA]或经食管支气管镜超声引导下细针穿刺活检[EUS - B - FNA]）取样。90.8%的患者通过组织病理学检查证实有肉芽肿。EBUS - TBNA/EUS - B - FNA的诊断阳性率为77.4%。13.5%的患者组织样本中有坏死性肉芽肿。
结论
结核病流行地区结节病患者的临床特征与非流行地区人群存在一定差异。支气管镜检查和内镜超声检查能使大多数患者得到明确诊断。
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