Rohatgi P K, Goldstein R A
Ann Allergy. 1984 May;52(5):316-28.
To this point we have attempted to summarize what we believe to be the most exciting new findings relative to sarcoidosis, along with providing data in support of those comments. We wish to conclude this brief review by sharing some anecdotal thoughts (no benefit of controlled clinical trials) concerning how the individual practitioner may apply this "research" information in caring for patients. In newly diagnosed patients with sarcoidosis, especially with widespread use of transbronchial lung biopsy, we would recommend BAL at that time because it can provide very valuable information with minimal increased morbidity or cost. BAL, in combination with SACE and possibly gallium scan (not required in all), along with the usual measures such as pulmonary function studies, chest roentgenograms (all of which are already commonly done) permit the clinician to make an accurate conclusion about disease activity in the lungs. Because there are no published therapeutic trials of corticosteroids in which the ultimate prognosis of pulmonary sarcoidosis has been improved, the decision to initiate therapy in these patients remains a clinical one and is commonly based upon practitioner experience rather than a particular laboratory test per se. Once that decision has been made, a decision to repeat any "research" studies would have to be individualized. Clearly serial SACE measures are relatively inexpensive and without morbidity. Moreover, despite their lack of "diagnostic value" serial measurements in known sarcoidosis have been shown to be very valuable in assessing disease activity and may therefore provide the clinician with a valuable aid to monitoring steroid treatment. A less common and much more perplexing circumstance occurs when evaluating patients with sarcoidosis established for several years present with evidence of progressive or chronic pulmonary involvement and dyspnea. In such individuals a measure of activity would be very helpful because the clinician would like to avoid steroids in persons with end stage and irreversible fibrosis and consider their use in those individuals in whom there is evidence of continued disease activity. In this instance, gallium scan, SACE and even BAL may all prove valuable. When we have found SACE elevated and gallium scan positive, we have assumed the disease to be active (even if the chest X-rays show stability).(ABSTRACT TRUNCATED AT 400 WORDS)
至此，我们已尝试总结我们认为与结节病相关的最令人兴奋的新发现，并提供支持这些观点的数据。我们希望通过分享一些个人观点（无对照临床试验的益处）来结束这篇简短综述，内容涉及个体从业者如何在照顾患者时应用这些“研究”信息。在新诊断的结节病患者中，尤其是在经支气管肺活检广泛应用的情况下，我们建议此时进行支气管肺泡灌洗（BAL），因为它能以最低的发病率增加或成本提供非常有价值的信息。BAL与血清血管紧张素转换酶（SACE）以及可能的镓扫描（并非所有患者都需要）相结合，再加上诸如肺功能研究、胸部X线片等常规检查（所有这些检查通常都已进行），可使临床医生对肺部疾病活动情况做出准确判断。由于尚无已发表的关于皮质类固醇的治疗试验能改善肺结节病的最终预后，因此在这些患者中启动治疗的决定仍是临床决策，通常基于从业者的经验而非某一项特定的实验室检查本身。一旦做出该决定，是否重复任何“研究”检查则需个体化。显然，连续测定SACE相对便宜且无不良影响。此外，尽管其缺乏“诊断价值”，但在已知结节病患者中进行连续测量已被证明在评估疾病活动方面非常有价值，因此可为临床医生监测类固醇治疗提供有价值的帮助。在评估患有结节病数年且出现进行性或慢性肺部受累及呼吸困难证据的患者时，会出现一种不太常见且更令人困惑的情况。在此类患者中，评估疾病活动度会非常有帮助，因为临床医生希望避免在患有终末期和不可逆纤维化的患者中使用类固醇，并考虑在有持续疾病活动证据的患者中使用。在这种情况下，镓扫描、SACE甚至BAL可能都很有价值。当我们发现SACE升高且镓扫描呈阳性时，我们认为疾病处于活动期（即使胸部X线片显示稳定）。（摘要截取自400字）
