Taieb Dov, Pastré Jean, Juvin Karine, Bouvry Diane, Jeny Florence, Sanchez Olivier, Uzunhan Yurdagül, Valeyre Dominique, Nunes Hilario, Israël-Biet Dominique
Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France; UFR de Médecine, Université Paris Cité, Paris, France.
Service de Pneumologie et Soins Intensifs, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, 75015 Paris, France.
Respir Med Res. 2023 Nov;84:101050. doi: 10.1016/j.resmer.2023.101050. Epub 2023 Sep 23.
Sarcoidosis is an independent risk factor for venous thromboembolism (VTE). However, the characteristics and clinical evolution of sarcoidosis patients presenting a VTE (sarcoidosis/VTE group) in the course of their disease are not known. Consequently, if VTE occurrence is associated with a more severe disease is still pending. We conducted a retrospective case-control study of sarcoidosis/VTE patients compared to matched sarcoidosis controls without VTE in two French tertiary centers, analysed and compared the clinical, biological, functional, imaging and evolutive profiles of the two groups. Sixty-one patients were included with at least one episode of VTE during course of sarcoidosis. At sarcoidosis onset (before/at the time of VTE occurrence) the number of affected organs, radiological stages and pulmonary functional tests were not significantly different between the two groups. In contrast, we found that sarcoidosis/VTE patients required more frequently a systemic immunosuppressive therapy (corticosteroids and/or immunosuppressors, 79% versus 58%; p = 0.008). The functional course was also poorer in sarcoidosis/VTE patients with a more frequent decrease in functional vital capacity (33% versus 18% in sarcoidosis/VTE patients and controls, respectively, p = 0.008). Finally, sarcoidosis/VTE patients presented more frequently with pulmonary hypertension (10% versus 1% in patients and controls, respectively, p = 0.006), and their survival was significantly worse (log-rank p <0.001). The occurrence of VTE during sarcoidosis is associated with a more severe disease and a poorer prognosis. The occurrence of VTE during sarcoidosis might signal a more inflammatory and/or evolutive disease in sarcoidosis/VTE patients and should be taken in consideration when designing therapeutic strategies for them.
结节病是静脉血栓栓塞症（VTE）的独立危险因素。然而，在疾病过程中出现VTE的结节病患者（结节病/VTE组）的特征和临床演变尚不清楚。因此，VTE的发生是否与更严重的疾病相关仍未确定。我们在法国的两个三级中心进行了一项结节病/VTE患者与匹配的无VTE结节病对照的回顾性病例对照研究，分析并比较了两组的临床、生物学、功能、影像学和演变特征。纳入了61例在结节病病程中至少发生过一次VTE的患者。在结节病发病时（VTE发生之前/之时），两组之间受影响器官的数量、放射学分期和肺功能测试并无显著差异。相比之下，我们发现结节病/VTE患者更频繁地需要全身免疫抑制治疗（皮质类固醇和/或免疫抑制剂，分别为79%和58%；p = 0.008）。结节病/VTE患者的功能进程也较差，功能肺活量更频繁下降（结节病/VTE患者和对照组分别为33%和18%，p = 0.008）。最后，结节病/VTE患者更频繁地出现肺动脉高压（患者和对照组分别为10%和1%，p = 0.006），且他们的生存率明显更差（对数秩检验p <0.001）。结节病期间VTE 的发生与更严重的疾病和更差的预后相关。结节病期间VTE 的发生可能表明结节病/VTE患者的疾病更具炎症性和/或处于演变中，在为他们设计治疗策略时应予以考虑。
