Ploysongsang Y, Roberts R D
Respiration. 1986;49(3):204-15. doi: 10.1159/000194880.
Fourteen patients with early sarcoidosis were prospectively studied over a period of 12-24 months. After baseline physiologic measurements they were treated with 40 mg of prednisone daily for 8 weeks and the measurements were repeated. Thereafter, the steroid dosage was reduced to 0-10 mg every other day and the measurements were repeated between the 12th and 24th month. Relatively normal lung volumes (VC, FRC, RV, TLC) and low DLCO increased with 8-week intensive steroid treatment and fell to below the pretreatment levels when the steroid was either tapered or stopped. The Vmax50-air, Vmax50-He, FEF25-75, upstream conductance (Gus) increased during intensive treatment whereas the RL fell and the FEV1/FVC ratio did not change. The CC/TLC, CV/VC, delta N2, CLdyn/CLst, delta Vmax50 were abnormal in many patients and did not change after 8 weeks of steroid treatment. We concluded that the obstructive defect is common in early sarcoidosis, predominantly in small airways and patchy in nature; the functional derangement is always improved by intensive and adequate steroid therapy and worsened when the drug is tapered or stopped.
对14例早期结节病患者进行了为期12至24个月的前瞻性研究。在进行基线生理测量后，他们每天接受40毫克泼尼松治疗，持续8周，然后重复测量。此后，类固醇剂量减至每隔一天0至10毫克，并在第12个月至24个月期间重复测量。相对正常的肺容积（肺活量、功能残气量、残气量、肺总量）和低一氧化碳弥散量在8周的强化类固醇治疗后增加，而当类固醇减量或停药时则降至治疗前水平以下。在强化治疗期间，最大呼气中期流速-空气、最大呼气中期流速-氦气、用力呼气流量25%-75%、上游传导率增加，而比气道阻力下降，第一秒用力呼气容积/用力肺活量比值未改变。许多患者的闭合气量/肺总量、闭合容量/肺活量、氮浓度差、动态顺应性/静态顺应性、最大呼气中期流速变化异常，在类固醇治疗8周后没有改变。我们得出结论，阻塞性缺陷在早期结节病中很常见，主要发生在小气道，且呈斑片状；强化且适当的类固醇治疗总能改善功能紊乱，而当药物减量或停药时则会恶化。
